Anti-inflammatory approaches to cystic fibrosis airways disease

Therapy aimed at combating excessive lung inflammation should benefit patients with cystic fibrosis. This article reviews anti-inflammatory strategies, focusing on new evidence published since 2006.

Use of oral corticosteroids was associated with benefit in an epidemiological study but they are still not recommended; high dose inhaled corticosteroids may cause harm (effect on growth), but they can safely be withdrawn in many patients. Some small beneficial effect of ibuprofen was seen in a multicentre study, but it is unlikely that this will change practice. Altering the imbalance seen in fatty acid metabolism with omega3 polyunsaturated fatty acid supplementation may be helpful but therapeutic benefit is not yet proven. Combating cysteinyl leukotrienes has potential but benefit remains to be proved. The beneficial effect of macrolides has been confirmed in patients with milder disease, but caution is needed because of emerging resistance patterns. Renewed research interest in antiproteases has not demonstrated any significant benefit.

The ideal therapeutic drug, with the optimal balance of benefit and harm, is not yet available.