Inhaled Dry Powder Antibiotics in Patients with Non-Cystic Fibrosis Bronchiectasis: Efficacy and Safety in a Real-Life Study

Abstract

Background: Nebulised antibiotics are habitually used in patients with bronchiectasis, but the use of dry powder inhaled antibiotics (DPIA) in these patients is extremely limited. This study seeks to analyse the efficacy and safety of DPIA in bronchiectasis patients. Material and methods: Multi-centre study of historic cohorts. All the hospital centres in Spain were contacted in order to collect data on patients with a diagnosis of bronchiectasis who had taken at least one dose of DPIA. Its efficacy was analysed in clinical, functional and microbiological terms by comparing the year before and the year after the prescription of DPIA. Adverse effects and variables associated with these effects, or any need to withdraw the drug, were also analysed. Results: 164 patients from 33 Spanish centres were included; 86% and 14% of these were treated with dry powder colistin and tobramycin, respectively. Chronic bronchial infection by Pseudomonas aeruginosa was present in 86% of these patients, and DPIA significantly reduced the number of exacerbations, the quantity and purulence of sputum and the isolation of pathogenic microorganisms. The most common adverse effect was cough (40%), particularly in cases of Chronic Obstructive Pulmonary Disease (COPD) and a previous cough and in those patients who had difficulties in handling the device. These factors were associated with a higher level of withdrawal of the treatment. There were no serious adverse effects. Conclusions: Our study suggests that DPIA are clinically efficacious and safe for treating bronchiectasis patients. Cough was shown to be the most common side-effect and reason for withdrawal of the treatment.

Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis

“…Study-related cough was reported as an adverse event in 25% of subjects with DPI versus 4% of the subjects on SVN [ 33 ], although in most cases this did not require medication withdrawal. In a real-world study performed in 164 NCFB patients, who were treated with colistin or tobramycin via DPI [ 7 ], 24.4% of them were withdrawn from treatment, mainly due to cough. Main risk factors were previous coughing, COPD and insufficient patient instruction regarding how to use the device.…”

“…Devices used to deliver therapeutic agents as aerosols are based on nebulizers (SVN), pressurized metered-dose inhalers, or dry powder inhalers (DPI) [ 7 ], mostly for beta-agonists, anti-cholinergic agents, and steroids [ 8 ]. Clinical insight suggests that not only different types of devices, but even different models of the same device, can make a difference on efficiency [ 9 ].…”

Inhaled Antibiotics in Non-cystic Fibrosis Bronchiectasis (NCFB): A Systematic Review of Efficacy and Limitations in Adult Patients

“…The Martínez-García et al study concluded there was no difference in endpoints between colistin and tobramycin [14]. In their analysis, they found that the use of any inhaled antibiotic was beneficial for the patients as it resulted in a marked decline in long-standing bronchial infection.…”

“…It is worth mentioning that the efficacy and safety profile of a drug can vary depending on the form of atomizer being used. In order to make a better understanding of the available treatment options, we made a comparison of the drugs in accordance to the type of inhalation form used [14][15][16][17][18][19][20][21].…”

“…Recently, there has been a focus on the DPI variety of antibiotics as a form of delivery. A multicenter retrospective cohort in Spain of 164 patients in a Martínez-García et al study included 86% of adult patients on dry powder colistin and 14% on dry powder tobramycin category [14]. In 24.4% of the total patients, treatment had to be stopped due to unwanted side effects, among which cough was the most common concern in the majority.…”