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Inhaled non-steroid anti-inflammatories for children and adults with bronchiectasis (Review)

Pizzutto, Susan J., Upham, John W., Yerkovich, Stephanie T. and Chang, Anne B. (2010). Inhaled non-steroid anti-inflammatories for children and adults with bronchiectasis (Review). Cochrane Database of Systematic Reviews,2010(4):1-19.

Document type: Journal Article
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IRMA ID 81704288xPUB21
Title Inhaled non-steroid anti-inflammatories for children and adults with bronchiectasis (Review)
Author Pizzutto, Susan J.
Upham, John W.
Yerkovich, Stephanie T.
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2010
Volume Number 2010
Issue Number 4
ISSN 1469-493X   (check CDU catalogue open catalogue search in new window)
Start Page 1
End Page 19
Total Pages 19
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
HERDC Category C1 - Journal Article (DEST)
Abstract Background
Chronic neutrophilic inflammation, both in the presence and absence of infection, is a feature of bronchiectasis in adults and children. The anti-inflammatory properties of non-steroid anti-inflammatory drugs (NSAIDs)may be beneficial in reducing airway inflammation and thus potentially improve lung function and quality of life in patients with bronchiectasis.

Objectives
To evaluate the efficacy of inhaled NSAIDs in the management of non-cystic fibrosis bronchiectasis in children and adults.

Search methods
We searched the Cochrane Airways Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 3),MEDLINE,OLDMEDLINE and EMBASE databases. The latest searcheswere carried out inOctober 2009

Selection criteria
All randomised controlled trials comparing inhaled NSAIDs to a control group (placebo or usual treatment) in children or adults with bronchiectasis not related to cystic fibrosis.

Data collection and analysis
We reviewed the results of the searches against pre-determined criteria for inclusion.

Main results
One small, short-term trial was eligible for inclusion. We included this study of 25 adults with chronic lung disease (including bronchiectasis) as the other conditions were linked to development of bronchiectasis and all had chronic sputum production. The single trial in adults reported a significant reduction in sputum production over 14 days in the treatment group (inhaled indomethacin) compared to placebo (difference -75.00 g/day; 95% CI -134.61 to -15.39) and a significant improvement in a dyspnoea score (difference -1.90; 95% CI -3.15 to -0.65). There was no significant difference between groups in lung function or blood indices. No adverse events were reported.

Authors’ conclusions
There is currently insufficient evidence to support or refute the use of inhaled NSAIDs in the management of bronchiectasis in adults or children. One small trial reported a reduction in sputum production and improved dyspnoea in adults with chronic lung disease who were treated with inhaled indomethacin, indicating that further studies on the efficacy of NSAIDs in treating patients with bronchiectasis are warranted.

PLAIN LANGUAGE SUMMARY
Inhaled non-steroid anti-inflammatories (NSAIDs) for children and adults with bronchiectasis The airways of patients with bronchiectasis are characterised by chronic inflammation. The anti-inflammatory effects of inhaled nonsteroid anti-inflammatory drugs (NSAIDs) may be beneficial in patients with bronchiectasis. However, the short and long-termbenefits in both adults and children require investigation, in addition to the potential side effects of the long-term use of NSAIDs. For this review we found one small study that reported an improvement in sputum production and dyspnoea (shortness of breath) in adults with chronic lung disease (chronic bronchitis, bronchiectasis or diffuse panbronchiolitis) who received inhaled indomethacin compared to the placebo group. There was no significant improvement in lung function (forced expiratory volume in one second (FEV1) and vital capacity (VC)). However, the small scale of this study and the collective analysis of data from the three disease states made it difficult to draw any solid conclusions on the benefit of using NSAIDs to treat adults with bronchiectasis. There were no studies identified on the use of NSAIDs in children with bronchiectasi
DOI http://dx.doi.org/10.1002/14651858.CD007525.pub2   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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