Atorvastatin is an oral medicine that belongs to the statins group. Statins are used to prevent heart attacks and strokes by working to lower “bad” cholesterol levels (low-density lipoprotein or LDL). They also lower the level of inflammation in the body, which is good for diseases other than those of the cardiovascular system.
Research has found that statins reduce lung inflammation in response to bacteria, making them of interest in the treatment of chest infections, such as recurrent infections experienced by people with bronchiectasis.
How atorvastatin works
Atorvastatin (commonly known by a brand name, Lipitor), as with other statins, works primarily by slowing the production of fatty substances like triglycerides and LDL cholesterol in the body, especially in the blood, so that less cholesterol adheres to artery walls and blocks blood flow.
The mechanism giving atorvastatin and other statins an anti-inflammatory effect is not well-known, but it is thought to come through one of three ways: 1. statins prevent lymphocytes from bonding to intercellular adhesion molecule-1, thereby impairing stimulation of T-cells; 2. statins inhibit an enzyme, HMG-CoA reductase, which converts HMG-CoA into a cholesterol precursor known as mevalonic acid; or, 3. statins reduce the amount of C-reactive protein (CRP), in the liver, a protein whose production is linked to inflammation.
Common side effects of atorvastatin use can include diarrhea, heartburn, gas, joint pain, memory loss, and confusion.2
Studies on atorvastatin in bronchiectasis as a stable treatment
A proof-of-concept study in 60 bronchiectasis patients who had at least two recurrent chest infections in the previous year found that atorvastatin (80 mg, once daily) helped to reduce exacerbations compared to placebo at six months. The study’s primary outcome, a significant reduction in cough as measured by the Leicester Cough Questionnaire (LCQ) score, was reported by investigators in treated patients, as was a significant reduction in exacerbations. Study results were published in the European Respiratory Journal in 2015.
A Phase 4 study (NCT01299194) evaluating the role of atorvastatin in treating severe bronchiectasis as an anti-inflammatory agent — the lungs of its 27 final participants were colonized with Pseudomonas aeruginos — is listed as ongoing, although its results have been published. This clinical trial is a crossover study, meaning that one group was given atorvastatin (80 mg, once daily) for three months, followed by a six-month “washout” period with no medication, and then switched to placebo for another three months. People in the original placebo group switched to atorvastatin treatment for the study’s final three months.
The trial, unlike the other, did not reach its primary outcome — reduced couch as measured by LCQ after three months of treatment — according to a study of trial data published in the European Respiratory Journal in 2016. But some secondary endpoints were met, including reduced signs of inflammation (in serum interleukin 8, tumor necrosis factor alpha, and ICAM-1) and reported improvements in quality of life after treatment compared to placebo.
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