Inhaled fluticasone in bronchiectasis: A 12 month study

Department of Respiratory and Critical Care Medicine, University Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Thorax (Impact Factor: 8.29). 04/2005; 60(3):239-43. DOI: 10.1136/thx.2002.003236
Source: PubMed


The clinical efficacy of inhaled corticosteroid (ICS) treatment has not been evaluated in bronchiectasis, despite the presence of chronic airway inflammation.
After three consecutive weekly visits, 86 patients were randomised to receive either fluticasone 500 mug twice daily (n = 43, 23F, mean (SD) age 57.7 (14.4) years) or matched placebo (n = 43, 34F, 59.2 (14.2) years) and reviewed regularly for 52 weeks in a double blind fashion.
35 and 38 patients in the fluticasone and placebo groups completed the study. Significantly more patients on ICS than on placebo showed improvement in 24 hour sputum volume (OR 2.5, 95% CI 1.1 to 6.0, p = 0.03) but not in exacerbation frequency, forced expiratory volume in 1 second, forced vital capacity, or sputum purulence score. Significantly more patients with Pseudomonas aeruginosa infection receiving fluticasone showed improvement in 24 hour sputum volume (OR 13.5, 95% CI 1.8 to 100.2, p = 0.03) and exacerbation frequency (OR 13.3, 95% CI 1.8 to 100.2, p = 0.01) than those given placebo. Logistic regression models revealed a significantly better response in sputum volume with fluticasone treatment than with placebo among subgroups of patients with 24 hour sputum volume <30 ml (p = 0.04), exacerbation frequency </=2/year (p = 0.04), and sputum purulence score >5 (p = 0.03).
ICS treatment is beneficial to patients with bronchiectasis, particularly those with P. aerurginosa infection.

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    • "Inhaled corticosteroids have proved undeniable benefits in patients with asthma or chronic obstructive pulmonary disease, but very little is known of its anti-inflammatory effects in bronchiectasis. Several small scale studies have observed that in patients with non-cystic fibrosis bronchiectasis, high doses of inhaled corticosteroids can positively influence several bronchial inflammatory parameters and certain key symptoms, such as dyspnea or sputum volume, while improving patients' health-related quality of life, without affecting either the number of exacerbations or lung function35-37. However, a Cochrane review concluded that there was insufficient evidence to recommend the routine use of inhaled corticosteroids in adults with stable-state bronchiectasis, and that a therapeutic trial may be justified in adults with difficult to control symptoms and in a certain subgroups38. "
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    ABSTRACT: The frequency of diagnosing bronchiectasis is increasing around the world. Cystic fibrosis is the most common inherited cause of bronchiectasis, but there is increasing recognition of significant numbers of patients with bronchiectasis from various causes. With increasing awareness of bronchiectasis, a significant number of research, concerning the causes and treatments, were published over the past few years. Investigation of the underlying cause of bronchiectasis is the most important key to effective management. The purpose of this report is to review the immunological abnormalities that cause bronchiectasis in those that the cystic fibrosis has been excluded, identify the available evidences of current management, and discuss several controversies in the treatment of this disorder.
    Tuberculosis and Respiratory Diseases 11/2012; 73(5):249-57. DOI:10.4046/trd.2012.73.5.249
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    • "Inhaled corticosteroids have been shown in randomized trials to reduce the number of exacerbations, reduce sputum volume, and improve quality of life in bronchiectasis [22, 42, 43]. One randomized trial of eighty-six adults showed that subjects colonized with Pseudomonas aeruginosa derived the most benefit from the use of inhaled corticosteroids [22]. "
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    ABSTRACT: Non-cystic fibrosis-related bronchiectasis is a chronic inflammatory lung disease, which is regarded as an "orphan" lung disease, with little research devoted to the study of this condition. Bronchiectasis results in impaired quality of life and mortality if left untreated. The tools available in the armamentarium for the management of bronchiectasis entail antibiotic therapy traditionally used to treat exacerbations, stratagems to improve mucociliary clearance, and avoidance of toxins. Macrolides have been known for the last two decades to have not only anti-bacterial effects but immunomodulatory properties as well. In cystic fibrosis, the use of macrolides is well documented in subjects colonized with Pseudomonas aeruginosa, to improve quality of life and lung function. There is currently emerging evidence to suggest the benefit of macrolides in subjects not colonized with Pseudomonas aeruginosa. This beneficial effect has been less explored in the context of bronchiectasis from other causes. The purpose of this paper is to review the current literature on the use of macrolides in non-cystic fibrosis related bronchiectasis in paediatrics.
    Mediators of Inflammation 04/2012; 2012(3):134605. DOI:10.1155/2012/134605 · 3.24 Impact Factor
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    ABSTRACT: Aminoglycosides are a mainstay of therapy for patients with cystic fibrosis (CF) or non-CF bronchiectasis who are infected with Pseudomonas aeruginosa (Psa). Traditionally, aerosolized antibiotics are delivered by liquid nebulization. The objective of this study was to determine whether a gentamicin dry powder inhaler (DPI) is as microbiologically active and potentially safe as gentamicin inhaled via a small-volume nebulizer (SVN) or given intravenously. The study was done according to a randomized, single-dose, and triple crossover protocol. Ten patients with CF or non-CF bronchiectasis and chronically infected with Psa were recruited. Patients received a single dose of either gentamicin 160 mg via DPI or SVN, or gentamicin at 5 mg/kg by intravenous infusion. In seven of the 10 patients, the minimum inhibitory concentration (MIC) was achieved in sputum after DPI and SVN, with mean (95% confidence interval) gentamicin concentrations at 2 h after administration of 13.1 microgram/g sputum (range: 2.2 to 23.9 microgram/g) and 97.2 microgram/g sputum (range: 0.3 to 194.2 microgram/g), respectively, whereas gentamicin levels in the sputum after intravenous administration failed to reach the MIC. Gentamicin given by DPI and SVN significantly decreased the sputum Psa density (p < 0.05), by almost one order of magnitude. No significant decline in bacterial counts was observed after intravenous gentamicin. When gentamicin was inhaled, blood concentrations were minimal, and were below concentrations known to cause systemic toxicity. For treatment of Psa infections susceptible to gentamicin, gentamicin administration by DPI appeared to be as efficient as by SVN, despite the delivery of a 7-fold lower dose to the airways.
    American Journal of Respiratory and Critical Care Medicine 11/1999; 160(5 Pt 1):1711-6. DOI:10.1164/ajrccm.160.5.9810080 · 13.00 Impact Factor
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