What is the role of Benzonatate (Tesalon) in asthma management?

From the Guidelines

Benzonatate is not recommended for the treatment of asthma. This medication is primarily used as an antitussive (cough suppressant) and works by numbing stretch receptors in the lungs, which helps reduce the cough reflex. While benzonatate (typically dosed at 100-200 mg three times daily) is effective for managing coughs associated with various conditions, it has no bronchodilatory, anti-inflammatory, or other therapeutic effects that would benefit asthma pathophysiology.

Key Points to Consider

• For asthma management, appropriate medications include:
  • Inhaled corticosteroids (like fluticasone, budesonide)
  • Bronchodilators (such as albuterol, salmeterol)
  • Leukotriene modifiers (montelukast), which directly address the underlying airway inflammation and bronchoconstriction characteristic of asthma 1.
• Using benzonatate in asthma patients might actually be counterproductive, as suppressing cough could potentially mask worsening symptoms that would otherwise alert patients to seek appropriate asthma treatment.
• If a patient with asthma has a problematic cough despite optimal asthma management, the focus should be on improving asthma control rather than adding a cough suppressant like benzonatate.

Evidence-Based Recommendations

The most recent and highest quality studies support the use of inhaled corticosteroids, bronchodilators, and leukotriene modifiers for asthma management, with no evidence to support the use of benzonatate for this condition 1.

Clinical Implications

In clinical practice, the use of benzonatate for asthma would not be recommended due to its lack of therapeutic effects on asthma pathophysiology and the potential for masking worsening symptoms 1. Instead, healthcare providers should focus on optimizing asthma control with evidence-based medications.

From the FDA Drug Label

BENZONATATE acts peripherally by anesthetizing the stretch receptors located in the respiratory passages, lungs, and pleura by dampening their activity and thereby reducing the cough reflex at its source. BENZONATATE has no inhibitory effect on the respiratory center in recommended dosage. BENZONATATE is indicated for the symptomatic relief of cough.

The use of benzonatate in asthma is not directly addressed in the provided drug labels. However, based on the information that benzonatate is indicated for the symptomatic relief of cough 2 and it acts by reducing the cough reflex at its source 2, it may be considered for use in asthma patients with cough symptoms.

• Key points:
  • Benzonatate reduces the cough reflex.
  • Benzonatate is indicated for symptomatic relief of cough. However, benzonatate's effect on asthma itself, beyond cough relief, is not explicitly stated in the labels 2 2.

From the Research

Asthma Treatment Overview

• Asthma is a heterogeneous clinical syndrome primarily affecting the lower respiratory tract, characterized by episodic or persistent symptoms of wheezing, dyspnea, and cough 3
• The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry
• Identifying clinically important allergen sensitivities is useful in managing asthma

Benzonatate in Asthma

• There is no direct mention of Benzonatate in the provided studies as a treatment for asthma
• However, the studies discuss various treatments for asthma, including inhaled corticosteroids, long-acting β2-agonists, and combination therapies 3, 4, 5, 6, 7

Alternative Treatments for Asthma

• Inhaled corticosteroids and long-acting β2-agonists are recommended treatment options for asthma 4
• Combination therapies, such as fluticasone/salmeterol and budesonide/formoterol, are effective in improving lung function and symptom control in patients with asthma 4, 5, 6, 7
• Other controller approaches include long-acting muscarinic antagonists and biological agents directed against proteins involved in the pathogenesis of asthma 3

Comparison of Asthma Treatments

• Studies have compared the effectiveness of different combination therapies, such as budesonide/formoterol and fluticasone/salmeterol, in reducing asthma exacerbations and improving symptom control 5, 6, 7
• The results suggest that budesonide/formoterol may be more effective in reducing asthma exacerbations and improving symptom control compared to fluticasone/salmeterol 5, 7