High Adherence, Microbiological Control and Reduced Exacerbations in Patients With Non-Cystic Fibrosis Bronchiectasis Treated With Nebulised Colistin. A Prospective Observational Study

Bueno, Belén Navas; Maldonado, Francisco Casas; Galo, Alicia Padilla; Mondelo, Enrique Gonzalez-Moya; Gordillo, Manuel Arenas; Rivera, Juan Carlos Bioque; Galván, Rocío Jimeno; Gómez, Maria Soledad Cano; Lόpez-Campos, José Luís; Navarro, Silvia Merlos; Morales, Agustin Valido; Barrios, José Manuel Vaquero

doi:10.1016/j.arbres.2022.03.023

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…This negative impact was seen, however, in those patients with a reduced number of peripheral eosinophils. Since eosinophilic inflammation and bronchial infection are potential treatable traits [43,44] related to a higher number of exacerbations which impact the prognosis in both bronchiectasis and COPD [45,46], it seems important to monitor the number of peripheral eosinophils in patients with BCOS. New studies on the effect of ICs [23,47] and antieosinophils biologics are needed [48][49][50], as well as the relationship between BEC and the microbiological profile using techniques to analyze the lung microbiome.…”

Section: Discussionmentioning

confidence: 99%

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Oscullo,

Gómez-Olivas,

Ingles

et al. 2023

JCM

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Both chronic obstructive pulmonary disease and bronchiectasis are highly prevalent diseases. In both cases, inhaled corticosteroids (ICs) are associated with a decrease in exacerbations in patients with a high peripheral blood eosinophil count (BEC), but it is still not known what occurs in bronchiectasis-COPD overlap syndrome (BCOS). The present study aimed to assess the effect of ICs on various outcomes in patients with BCOS, according to BEC values. We undertook a post-hoc analysis of a cohort of 201 GOLD II-IV COPD patients with a long-term follow-up (median 74 [IQR: 40–106] months). All participants underwent computerized tomography and 115 (57.2%) had confirmed BCOS. A standardized clinical protocol was followed and two sputum samples were collected at each medical visit (every 3–6 months), whenever possible. During follow-up, there were 68 deaths (59.1%), and the mean rate of exacerbations and hospitalizations per year was 1.42 (1.2) and 0.57 (0.83), respectively. A total of 44.3% of the patients presented at least one pneumonic episode per year. The mean value of eosinophils was 402 (112) eosinophils/µL, with 27 (23.5%), 63 (54.8%), and 25 patients (21.7%) presenting, respectively, less than 100, 101–300, and more than 300 eosinophils/µL. A total of 84 patients (73.1%) took ICs. The higher the BEC, the higher the annual rate of exacerbations and hospitalizations. Patients with less than 100 eosinophils/µL presented more infectious events (incident exacerbations, pneumonic episodes, and chronic bronchial infection via pathogenic bacteria). Only those patients with eosinophilia (>300 eosinophils/µL) treated with ICs decreased the number (1.77 (1.2) vs. 1.08 (0.6), p < 0.001) and the severity (0.67 (0.8) vs. 0.35 (0.5), p = 0.011) of exacerbations, without any changes in the other infectious outcomes or mortality. In conclusion, ICs treatment in patients with BCOS with increased BEC decreased the number and severity of incident exacerbations without any negative influence on other infectious outcomes (incidence of pneumonia or chronic bronchial infection).

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Section: Discussionmentioning

confidence: 99%

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Oscullo,

Gómez-Olivas,

Ingles

et al. 2023

JCM

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“…Finally, we have only analyzed inhaled long-acting bronchodilators and ICS. Other inhaled drugs such as antibiotics [ 25 ] and, in the near future, other potential drugs that will be administered in inhaled form [ 26 ] have not been considered in this article, nor has nebulized therapy [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Different Doses in Inhaled Therapy: A Comprehensive Analysis

Lopez-Campos,

Reinoso-Arija,

Ferrer Galván

et al. 2023

Pharmaceutics

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Background. Currently, there is a considerable degree of confusion over the dosage of inhaled medications. Here, we carried out a review of all the doses used for the devices used in inhalation therapy. Methods. We first performed a systematic search of the different inhalation devices included on the July 2023 Spanish Ministry of Health Billing List. We then consulted the Spanish Agency for Medicines and Health Products to find the updated official label and to obtain the information on the exact composition. Results. We identified 90 unique products, of which 22 were long-acting bronchodilators (and combinations thereof) and 68 were products containing inhaled corticosteroids (ICS). Overall, 10 products with bronchodilators and 40 with ICS were marketed with the metered dose, while 11 with bronchodilators and 28 with ICS were marketed with the delivered dose. In addition, in some bronchodilators, the drug was referred to as a type of salt, whereas in others the information referred to the drug itself. Conclusions. Our data show that for each inhaled drug there may be up to four different doses and that the marketed name may refer to any of these. Clinicians must be aware of these different dosages when prescribing inhaled medications.

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“…This efficacy, together with the advantages of DPIs over nebulizers, have led to their increasing use in other airway diseases that cause CBI, especially in patients with bronchiectasis of other aetiologies. Although there have been some prospective observational and RCT studies on the efficacy and safety of colistin or tobramycin in bronchiectasis [68][69][70], to date there has been only one randomized clinical trial with the DPI formulation of these drugs: the iBest Study. This phase II, double-blind study aimed to determine the efficacy and safety of different dosages of TIP in patients with non-CF bronchiectasis.…”

Section: Studies With Antibiotic Dry Powder Inhalers In Bronchiectasismentioning

confidence: 99%

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

Rosa

Suárez-Cuartín

Sibila

et al. 2023

JCM

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The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics.

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High Adherence, Microbiological Control and Reduced Exacerbations in Patients With Non-Cystic Fibrosis Bronchiectasis Treated With Nebulised Colistin. A Prospective Observational Study

Cited by 6 publications

References 17 publications

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Evaluation of Different Doses in Inhaled Therapy: A Comprehensive Analysis

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

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