Background: No prospective study has assessed eradication treatment of early Pseudomonas aeruginosa colonisation in bronchiectasis not due to cystic fibrosis (CF). Objectives: To evaluate the efficacy of 3 months of nebulised tobramycin after a short course of intravenous antibiotics in the eradication of P. aeruginosa and its clinical consequences in non- CF bronchiectasis following initial P. aeruginosa infection. Methods: A 15-month, single-masked, randomised study including 35 patients was conducted in a tertiary university hospital. Following the isolation of P. aeruginosa and a 14-day intravenous treatment with ceftazidime and tobramycin, patients received 300 mg nebulised tobramycin twice daily or placebo during 3 months, and were followed up for 12 months thereafter. Results: The median time to recurrence of P. aeruginosa infection was higher in the tobramycin than in the placebo group (p = 0.048, log-rank test). At the end of the study 54.5% of the patients were free of P. aeruginosa in the tobramycin group and 29.4% in the placebo group. The numbers of exacerbations (p = 0.044), hospital admissions (p = 0.037) and days of hospitalisation (p = 0.034) were lower in the tobramycin than in the placebo group. A global, non-significant trend to improvement in the tobramycin group was observed in most of the other studied parameters on comparing the two groups. Bronchospasm in the tobramycin group was remarkable. Conclusions: Our study shows that 3 months of nebulised tobramycin following a short course of intravenous antibiotics may prevent bronchial infection with P. aeruginosa and has a favourable clinical impact on non-CF bronchiectasis.

Although further studies are required, inhaled corticoid treatment may be efficacious and safe in bronchiectasis not due to cystic fibrosis.

In this article we will review the role of long acting 2-adrenoreceptor agonists and long-acting muscarinic agents in the management of airflow obstruction. We will then focus our attention on indacaterol, one of the new once daily inhaled 2-adrenoreceptor agonists. Pharmacologically this drug is a nearly full 2-agonist without loss of efficacy after prolonged administration. We will also discuss its dosing, safety and tolerability.

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