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Role of inhaled antibiotics in the era of highly effective CFTR modulators

J Stuart Elborn1, Francesco Blasi2,3, Pierre-Régis Burgel4,5

  • 1Faculty of Medicine Health and Life Sciences, Queen's University, Belfast, UK s.elborn@qub.ac.uk.

European Respiratory Review : an Official Journal of the European Respiratory Society
|January 11, 2023
PubMed

Insights

Inhaled antibiotics remain crucial for managing chronic lung infections in cystic fibrosis (CF), even with new CFTR modulator therapies. These advanced treatments improve lung function but do not eliminate the need for inhaled antibiotics in CF care.

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Genetics

Background:

  • Recurrent bacterial infections and lung function decline are hallmarks of cystic fibrosis (CF).
  • Inhaled antibiotics are vital for treating chronic respiratory infections and eradicating *Pseudomonas aeruginosa* in CF patients.
  • Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators offer targeted therapy for specific CFTR mutations, improving mucus hydration and mucociliary clearance.

Purpose of the Study:

  • To review the evolving role of inhaled antibiotics in managing chronic pulmonary infections in cystic fibrosis patients.
  • To examine how emerging CFTR modulator therapies impact the use and importance of inhaled antibiotics.
  • To discuss the future of CF treatment strategies integrating CFTR modulators and inhaled antibiotics.

Main Methods:

  • Literature review of studies on inhaled antibiotics and CFTR modulators in cystic fibrosis.
  • Analysis of clinical trial data and treatment guidelines.
  • Synthesis of current research on the interplay between CFTR modulators and pulmonary infection management.

Main Results:

  • CFTR modulators significantly reduce pulmonary exacerbations and improve lung function, shifting treatment paradigms.
  • Despite CFTR modulator efficacy, they do not fully restore lung physiology or resolve chronic lung damage.
  • Inhaled antibiotics continue to play a key role in managing persistent infections and preventing further lung damage in CF.

Conclusions:

  • CFTR modulators represent a significant advancement in personalized medicine for CF, targeting specific genetic defects.
  • The effectiveness of CFTR modulators necessitates a re-evaluation of inhaled antibiotic strategies in CF management.
  • A combined approach utilizing both CFTR modulators and inhaled antibiotics is likely essential for optimal long-term outcomes in cystic fibrosis patients.

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