Inhaled bronchodilators for cystic fibrosis.

Area of Science:

• Pulmonary Medicine
• Pharmacology

Background:

• Recurrent wheezing and breathlessness are common symptoms in cystic fibrosis (CF).
• Inhaled bronchodilators are frequently prescribed for CF patients, despite limited objective evidence of their efficacy.
• This study addresses the need for evidence regarding bronchodilator effectiveness in CF.

Purpose of the Study:

• To evaluate the effectiveness of inhaled bronchodilators in children and adults with cystic fibrosis.
• To synthesize evidence from randomized and quasi-randomized trials on bronchodilator use in CF.

Main Methods:

• Searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register and other databases.
• Included randomized or quasi-randomized trials comparing inhaled bronchodilators to placebo or other bronchodilators in CF patients.
• Independently extracted data, assessed trial quality, and subgrouped by bronchodilator class and duration of effect.

Main Results:

• Fourteen trials with 257 participants were included; meta-analysis was not possible due to heterogeneity.
• Short-acting beta-2 agonists improved lung function (FEV1) short-term and peak expiratory flow long-term in responsive individuals.
• Long-acting beta-2 agonists improved lung function (FEV1, FEF 25-75%) short-term in responsive individuals, with inconsistent long-term results.
• Short-acting anticholinergics showed no consistent effect; no trials supported fenoterol, formoterol, or tiotropium use.

Conclusions:

• Full effectiveness of inhaled bronchodilators in CF could not be determined due to lack of meta-analysis.
• Short- and long-acting beta-2 agonists can benefit CF patients with demonstrable bronchodilator or bronchial hyperresponsiveness.
• Further research is needed to fully establish the role of various inhaled bronchodilators in cystic fibrosis management.