Chest
Volume 127, Issue 2, February 2005, Pages 522-529
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Clinical Investigations: Asthma
Bronchial Constriction and Inhaled Colistin in Cystic Fibrosis

https://doi.org/10.1378/chest.127.2.522Get rights and content

Study objective

Inhaled colistin is used for the treatment of Pseudomonas aeruginosa infection in cystic fibrosis (CF) patients despite reports of chest tightness and bronchospasm. The main objective of the study was to assess whether bronchospasm occurred in pediatric CF patients with or without clinical evidence of airway hyperreactivity.

Design and methods

A prospective placebo-controlled clinical trial with crossover design was devised using challenge tests with 75 mg colistin in 4 mL saline solution and a placebo solution of the same osmolarity using a breath-enhanced nebulizer for administration. Subjects were recruited as follows: high risk (HR) for bronchospasm due to a personal history of recurrent wheezing, a family history of asthma and/or atopy, or bronchial lability, as demonstrated in pulmonary function tests; or low risk (LR) without these characteristics.

Results

The mean FEV1 (expressed as the mean [± SD] fall from baseline) of the HR group (n = 12) fell 12 ± 9% after placebo was administered, and fell 17 ± 10% after colistin was administered. For the LR group (n = 8), the mean FEV1 fell 9 ± 4% following placebo administration and 13 ± 8% following colistin administration. There was a greater number of subjects in the HR group compared to the LR group, which had a mean fall in FEV1 of ≥ 15% (p < 0.01) after inhaling colistin. The differences between placebo and colistin therapy in the LR group were not significant.

Conclusion

The results demonstrated that colistin can cause bronchospasm, particularly in those patients with coexisting CF and asthma.

Section snippets

Materials and Methods

This study was a prospective, placebo-controlled clinical trial with a crossover design. The aim of the study was to recruit 24 subjects from the Cystic Fibrosis Clinic at the Hospital for Sick Children (HSC). The medical records of CF patients between 5 and 18 years of age who were able to perform technically acceptable spirometry21 and could use a nebulizer with a mouthpiece were reviewed. The selection criteria were based on a previously published study22 in which the subjects were separated

Results

Twenty-three patients were enrolled into the study, and 20 patients completed it (HR group, 12 patients 8 to 18 years of age; LR group, 8 patients 8 to 17 years of age). The LR group lost three patients due to incomplete visits. One patient did not return for scheduled visit 2, and there was difficulty in rebooking during the appropriate time period. Two patients had exacerbations between visits with a baseline FEV1 > 15% lower on visit 2, which excluded them from continuing. None of the three

Discussion

The results indicate that a certain degree of bronchoconstriction following the inhalation of an aerosol is common, irrespective of the agent inhaled. However, for those patients with demonstrated airway lability (ie, the HR group), the fall in FEV1 was greater if the agent being inhaled was colistin. These differences were not apparent in the LR group. The degree of fall in FEV1 was higher than that found in the study by Cunningham et al,17 where 95% of the subjects were regularly receiving

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    The nebulizers were generously provided by Pari Respiratory Equipment, and the colistin was provided by Parke Davis Canada. The study was supported in part by the Canadian Cystic Fibrosis Foundation, and no author had any financial relationship with either Pari Respiratory Equipment Inc. or Parke Davis Canada.

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