Effectiveness of treatment with nebulized colistin in patients with COPD

Abstract

ObjectivesTo analyze whether the introduction of nebulized colistin in patients with chronic obstructive pulmonary disease (COPD) and infection with Pseudomonas aeruginosa (PA) is associated with a decrease of the number and duration of severe exacerbations.Materials and methodsThirty six patients with COPD and infection with PA treated with nebulized colistin attending a day hospital during a 5-year (January 2010–December 2014) period were prospectively included. Repeated-measures t-tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalizations, comparing for each patient the year prior to the introduction of colistin with the year after.ResultsAfter the introduction of colistin, the number of admissions decreased from 2.0 to 0.9 per individual year (P=0.0007), and hospitalizations were shorter (23.3 vs 10.9 days, P=0.00005). These results persisted when patients with and without bronchiectasis or with and without persistence of Pseudomonas were separately analyzed. No pre–post differences were detected in the number of exacerbations not requiring admission.ConclusionNebulized colistin seems associated with a strong decrease in the number and duration of hospitalizations due to exacerbation in patients with COPD and infection with PA. Clinical trials with a larger number of patients are needed in order to confirm these results.

Microbiological Progress in Patients with Bronchial Infection with <b><i>Pseudomonas aeruginosa</i></b> Treated with Nebulised Colistin

“…Several nebulised antibiotics have been studied in patients with chronic P. aeruginosa infections: tobramycin, aztreonam, colistin or fluoroquinolones. These antibiotics have shown to decrease the number of exacerbations, reduce bacterial load or improve pulmonary function in several chronic respiratory conditions [7, 8, 21-23]. …”

“…The management of these patients requires strategies to deal with difficult-to-treat infections with P. aeruginosa . Nebulised antibiotics, such as colistin, have been used in patients with chronic bronchial infection [5-8]. …”

Inhaled Treatments and the Future of Respiratory Diseases: Holding Our Breath

“…While in asthma, inhaled antibiotics have not been tested due to the risk of bronchospasm, few studies performed in COPD patients with chronic PA infection provided some encouraging results [5]. …”

“…The topic is not new to Bruguera-Avila and colleagues, who in 2017 described the efficacy of nebulised colistin in a small group of COPD patients with chronic PA infection, with or without BE [5]. Both studies demonstrate that using inhaled antibiotics in COPD is possible and shows benefits, although their tolerance has to be individually assessed.…”

“…Another interesting open issue is the use of inhaled antimicrobial therapy for patients with chronic respiratory diseases other than CF and BE. In particular, it is essential to further study their use in COPD, in order to confirm what has been published so far [5]. High-quality randomized clinical trials are needed to support or contraindicate the use of inhaled antibiotics in COPD.…”