Bronchodilators in cystic fibrosis: a critical analysis

Cystic fibrosis airways disease is characterized by chronic inflammation and infection resulting in bronchiectasis. Published guidelines recommend medications for use by CF patients to maintain lung health. There are conflicting recommendations regarding inhaled bronchodilators. This is primarily because of the interpretation of the available evidence, which suffers from studies using small numbers of subjects, varying doses and durations of treatment, and modest effects on clinically relevant endpoints. Areas covered: Herein we review the available evidence demonstrating the challenge in determining whether bronchodilators have benefit for patients. We examine the potential indications and the current guidance from clinical studies. We highlight the outstanding questions examining bronchodilator use in CF. Expert commentary: The use of bronchodilators in CF remains commonplace despite the lack of solid evidence. Further studies should define key endpoints to determine a role for bronchodilators in light of a substantial treatment burden endured by people with CF.