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Inhaled therapy in cystic fibrosis: agents, devices and regimens

Penny Agent, Helen Parrott
Breathe 2015 11: 110-118; DOI: 10.1183/20734735.021014
Penny Agent
Royal Brompton and Harefield NHS Foundation Trust, London, UK
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  • For correspondence: p.agent@rbht.nhs.uk
Helen Parrott
Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Abstract

Key points

  • There have been significant advances in both inhalation medicines and delivery devices with “intelligent nebulisers” and “dry-powder inhalers” becoming commonplace in CF care.

  • Inhaled medicines generate high levels of a drug within the airways with limited systemic effects, offering safe and convenient antibiotic and mucolytic therapy for individuals with CF.

  • Variations in adherence are not unique to CF; however, treatment burden is high and therefore fast inhaled drug delivery devices may assist individuals in completing the prescribed treatment regimes.

  • Prescribers of inhaled medicines have a responsibility to consider, in addition to efficacy, the appropriated drug/device combination for each individual in order to promote adherence and achieve the desired clinical benefit.

Summary The recognised mainstay daily treatments for cystic fibrosis (CF) focus on inhaled and oral medications, airway clearance and optimised nutrition. This review discusses recent advances in inhaled therapies for the management of CF, including devices such as intelligent nebulisers, drug formulations and supporting evidence for inhaled antibiotics (for the management of chronic Pseudomonas aeruginosa) and muco-active drugs. We include practical advice for clinicians regarding the optimisation of inhalation technique and education. The influence of adherence on the use of inhaled therapies in CF is also reviewed.

Educational aims

  • To inform readers about the history and progression of inhaled therapies for people with CF with reference to the literature supporting current practice.

  • To highlight the factors that may impact the success of inhaled therapies, including those which are device specific such as drug deposition and those which influence adherence.

Footnotes

  • Conflict of interest None declared.

  • ©ERS 2015

Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Inhaled therapy in cystic fibrosis: agents, devices and regimens
Penny Agent, Helen Parrott
Breathe Jun 2015, 11 (2) 110-118; DOI: 10.1183/20734735.021014

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Inhaled therapy in cystic fibrosis: agents, devices and regimens
Penny Agent, Helen Parrott
Breathe Jun 2015, 11 (2) 110-118; DOI: 10.1183/20734735.021014
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  • Article
    • Abstract
    • Nebuliser devices
    • Inhaled antibiotics
    • Other inhaled therapies
    • Delivery optimisation
    • Treatment regimens and adherence
    • Conclusion
    • Footnotes
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  • Figures & Data
  • Info & Metrics
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Subjects

  • CF and non-CF bronchiectasis
  • Pulmonary pharmacology and therapeutics
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