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Paediatric Pulmonology and Allergology
2008 April, Vol. XI, No. 1 (3867-3883)
INHALE THERAPY IN CYSTIC FIBROSIS TREATMENT ALGORYTHMS
Ieva Laimute Indrejaityte, Egle Garbuziene, Sigitas Dumcius, Vanda Kriukiene, Arunas Valiulis
Vilnius University Medical Faculty, Dept of Paediatrics, Center of General and Ambulatory Paediatrics, Vilnius City University Hospital, Antakalnio Str. 57, LT-10207 Vilnius, Lithuania
Inhalation therapy for cystic fibrosis treatment was applied for many years, however it was limited only with viscous sputum liquefaction with physiological or sodium bicarbonate solutions, trypsin and others, but the effect was poor. Yet in 1940–1950 there were trying to administer aerosols of antibiotics (penicillin, polymyxin), later gentamicin, carbenicillin aerosols. The first who compared the efficacy of aerosol antibiotics was M. E. Hodson (1981). There were compared aerosol of gentamicin and carbenicillin with placebo. Pulmonary function improvement was observed, exacerbations of respiratory tract infections and rate of hospitalisation were less frequent. However inhalation therapy was not administered for CF treatment for a long time. During last 20 years technology of inhalative respiratory devices improved significantly, new inhalative antibiotics, mucolytics and other medicines were developed. Therefore inhalation therapy today becomes one of the most important part of CF treatment. Large scale clinical tials with rhDNase (Pulmozim) showed good effect for most patients, though some of the patients did not respond to the therapy, and for some of them condition worsened. It seems today the most offen prescribed inhale antibiotic is colistin. Both colistin and tobramycin are most effective in combination with cyprofloxacine, when sputum P. aeruginosa culture is possitive for the firs time in CF patient. The indications of inhal antibiotics, mucolytics, including rhDNase, bronchodilatators, steroids and other medicines are presented in this review article. The authors are discussed current algorythms of the treatment of CF patients using inhale medicines as well as different techniques for aerosol inhalations.