A UK doctor says a drug used to treat COPD can help with drooling in pleural mesothelioma patients on palliative care.
Dr. Claire Plunkett recently published the case report of a mesothelioma patient receiving palliative care. The patient developed a problem with drooling and swallowing. The medical term for drooling is sialorrhoea. It can happen in people with certain conditions or on certain drugs.
Doctors at Farleigh Hospice in Chelmsford, UK treated the man with a glycopyrronium bromide inhaler. Glycopyrronium is normally used for patients with chronic obstructive pulmonary disorder (COPD).
The treatment cured the problem in just a few days. Plunkett says this is evidence that glycopyrronium is a good option to treat drooling in pleural mesothelioma patients.
What Causes Drooling in Pleural Mesothelioma Patients?
Pleural mesothelioma starts on one side of the chest in the lining around the lungs. It can quickly spread around the body. It can spread into the lungs, kidneys, liver, diaphragm and other organs.
Sometimes, mesothelioma spreads to the thyroid gland in the neck. People with mesothelioma in their thyroid may have trouble swallowing their saliva. This can cause drooling in pleural mesothelioma patients.
As mesothelioma progresses, patients may have pain and other symptoms. They may need palliative care to help them manage those symptoms. Some drugs used for palliation in mesothelioma can also trigger excess saliva.
Glycopyrronium for Sialorrhoea
Glycopyrronium bromide is an anticholinergic medication. It is available in oral, intravenous, topical, and inhaled forms. Among other things, glycopyrronium can help with excess sweating, peptic ulcers, and coughing, wheezing and breathlessness in people with COPD.
Sometimes, it is injected as a way to help treat drooling in mesothelioma patients.
The patient in the UK report was a 73-year-old man with pleural mesothelioma. He had the sarcomatoid subtype of mesothelioma, which is the most aggressive form.
As his mesothelioma spread, the man developed problems with drooling and swallowing. Doctors gave him a glycopyrronium inhaler. The inhaler delivered 55 μg of glycopyrronium bromide per puff. The patient started with one puff a day and increased to two.
“He reported a significant decrease in his symptoms 2 days after initiation using a numerical rating scale,” reports author Claire Plunkett. “A regular dose of one puff two times per day completely resolved the patient’s symptoms within 5 days.”
Dr. Plunkett says the case shows that inhaled glycopyrronium could help with drooling in pleural mesothelioma patients on palliative care.
Another plus for the inhaled form of the medicine: Doctors were able to give the patient a much lower dose than he would have gotten if he had received an injection.
Plunkett, Claire, “Sialorrhoea treated with inhaled glycopyrronium”, August 21, 2020, BUM Supportive and Palliative Care, Online ahead of print, https://spcare.bmj.com/content/early/2020/08/20/bmjspcare-2020-002527