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Inhaled gentamicin reduces airway neutrophil activity and mucus secretion in bronchiectasis
1Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Abstract:
To investigate whether aerosolized gentamicin (GM) prevents myeloperoxidase (MPO)-mediated airway injury and mucus hypersecretion, a short course of aerosol therapy (3 d) with GM 40 mg or 0.45% saline (saline) twice per day was conducted. Twenty-eight patients with bronchiectasis and mucus hypersecretion after adequate chest care and hydration were enrolled in a randomized, double-blind fashion. MPO levels in sputum collected on arising were determined by fluorometric assay at 655 nm before and after treatment. The sputum MPO level significantly decreased in patients receiving aerosolized GM, from 0.22 +/- 0.04 to 0.14 +/- 0.04 U/g (n = 15), but not in patients with saline inhalation (0.23 +/- 0.03 to 0.17 +/- 0.02 U/g; n = 11). The daily sputum amount significantly decreased from 94.6 +/- 21.6 to 58.1 +/- 17.8 ml (n = 13, p < 0.01) in the GM group, whereas it increased from 78.6 +/- 25.4 ml to 120.5 +/- 33.9 ml (n = 11, p < 0.05) in the saline group. The change in the amount of daily sputum was related to that in the sputum MPO level in the GM group (r = 0.61; p < 0.01). Inhalation of GM, but not saline, significantly (p < 0.05) increased the value of peak expiratory flow (PEF) from 186.4 +/- 25.1 to 216.4 +/- 26.4 L/min and decreased the variability of PEF from 24.6 +/- 5.1 to 6.1 +/- 2.3 %. The nocturnal desaturation and the 6-min walking distances were also significantly improved in the GM group (11.2 +/- 3.8 to 0.6 +/- 0.5 min/h; 324.9 +/- 43.1 to 408.1 +/- 25.9 m; p < 0.05; respectively), but not in the saline group. Subjective improvements in the Borg scale and self-sputum assessment were found in the GM group only. In conclusion, aerosolized GM is effective in improving airway hypersecretion and inflammation in patients with bronchiectasis.
Insights
Aerosolized gentamicin (GM) effectively reduced airway inflammation and mucus in bronchiectasis patients. This treatment improved sputum levels, lung function, and exercise tolerance, offering a promising therapy for airway hypersecretion.
Area of Science:
- Pulmonary Medicine
- Pharmacology
Background:
- Bronchiectasis is characterized by chronic airway inflammation and mucus hypersecretion.
- Myeloperoxidase (MPO) is a key enzyme implicated in airway injury and inflammation.
- Current treatments for mucus hypersecretion in bronchiectasis have limitations.
Purpose of the Study:
- To evaluate the efficacy of aerosolized gentamicin (GM) in reducing MPO-mediated airway injury and mucus hypersecretion in patients with bronchiectasis.
- To assess the impact of GM inhalation on lung function and exercise capacity.
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 28 patients with bronchiectasis.
- Patients received either aerosolized GM (40 mg) or saline twice daily for 3 days.
- Sputum MPO levels, daily sputum amount, peak expiratory flow (PEF), nocturnal desaturation, and 6-minute walking distance were measured before and after treatment.
Main Results:
- Aerosolized GM significantly decreased sputum MPO levels and daily sputum amount compared to saline.
- GM inhalation led to significant improvements in PEF, reduced PEF variability, and improved nocturnal desaturation and 6-minute walking distance.
- Patients receiving GM reported subjective improvements in symptoms, unlike the saline group.
Conclusions:
- Aerosolized gentamicin is an effective therapeutic option for managing airway hypersecretion and inflammation in patients with bronchiectasis.
- GM treatment demonstrates potential to improve lung function and exercise capacity in this patient population.
- Further research may explore long-term efficacy and optimal dosing of aerosolized GM for bronchiectasis.