Nebulized colistin causes chest tightness in adults with cystic fibrosis

Abstract

Nebulized antipseudomonal antibiotics may be useful therapeutic agents in patients with cystic fibrosis (CF) (l-3). Short term studies of nebulized colistin have demonstrated its efficacy in eradicating recently acquired Pseudomonas aeruginosa in children (4) and in the management of chronic infection in adults (5). There is no uniform policy regarding the use of nebulized colistin in different CF centres. In our unit patients infected with P. aeruginosa are candidates for regular therapy with the drug if their requirements for oral or i.v. antibiotics are increasing and their pulmonary function is deteriorating. Each potential candidate is challenged to a standard dose of nebulized colistin and, if immediate side effects are not prohibitive, commences regular therapy with the drug. In stable state we recommend that patients inhale nebulized colistin twicedaily, butduringexacerbationsrequiringi.v. antibiotics that the drug be omitted. We do not use the drug as first line therapy during infective exacerbations. Nebulized colistin causes chest tightness in some patients and may lead to discontinuation of regular therapy (4). In this study we have focused specifically on chest tightness as a reason for discontinuing therapy. Patients able to maintain regular therapy (tolerant) have been compared to those who discontinued or could not begin regular therapy because of chest tightness (intolerant) using three measurements; the degree of bronchoconstriction at colistin challenge, severity of airways disease (% predicted FEV,) and reversibility to bronchodilators in stable state.