NEW YORK (Reuters Health) - Inhalation of colistin, used to treat Pseudomonas aeruginosa infection in patients with cystic fibrosis, can cause bronchospasm and a fall in FEV1 -- especially those with coexisting asthma -- according to findings published in the February issue of Chest.
Dr. Allan L. Coates and colleagues from the University of Toronto, Ontario, Canada, examined whether inhaled colistin triggered bronchospasm in pediatric CF patients with or without coexistent asthma.
The researchers conducted a prospective placebo-controlled, crossover trial using challenge tests with 75 mg colistin in 4 mL saline solution and a placebo solution of the same osmolarity. A breath-enhanced nebulizer was used for administration.
Subjects enrolled in the study were classified as high risk (HR) for bronchospasm or low risk (LR). High-risk patients had a personal history of recurrent wheezing, a family history of asthma, and/or atopy, or bronchial lability.
A total of 23 patients were enrolled and 20 completed the study, including 12 in the HR groups and 8 in the LR group. Baseline FEV1 was slightly lower in the HR group than the LR group (67% versus 74% predicted, respectively).
A small but significant fall in FEV1 (expressed as a percent fall from baseline) was observed after placebo inhalation in both the HR group (12%) and the LR group (9%). Four of 12 patients in the HR group and 1 of 8 in the LR group had a fall in FEV1 of at least 15%.
After colistin inhalation, the mean fall in FEV1 was 17% and 13% for the HR and LR groups, respectively. Seven of 12 HR group patients and 4 of 8 LR group patients had a fall of at least 15%.
“The changes in FEV1 postinhalation of placebo versus colistin were significant for the HR group (p < 0.002), but not for the LR group,” Dr. Coates and colleagues report.
None of the patients experienced serious adverse events. None withdrew before completion of the study. No desaturations following either colistin or placebo inhalation were observed.
“Colistin-induced bronchospasm, while it does exist, appears to be manageable and does not constitute a reason not to administer colistin by inhalation when medically indicated,” the researchers conclude.
Source: Chest 2005;127:522-529. [ Google search on this article ]
MeSH Headings:Respiratory Mechanics: BronchoconstrictionCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
