New treatment options for bronchiectasis

Therapies shown to be effective in cystic fibrosis are often provided to patients with bronchiectasis, without definitive evidence of benefit. In recent years, there has been increased interest in validating and developing new therapies for patients with noncystic fibrosis bronchiectasis. While inhaled tobramycin improves microbiologic parameters, improvements in outcomes have been more difficult to demonstrate, in part due to the occurrence of bronchospasm in a significant minority of treated patients. Outcome data from studies of inhaled aztreonam and ciprofloxacin have not yet been reported, although the microbiologic data appear to be promising. Preliminary data regarding inhaled hyperosmolar agents such as hypertonic saline and mannitol are also promising, but these therapies cannot yet be recommended for routine therapy of patients with bronchiectasis. Macrolide antibiotics have anti-inflammatory properties in patients with chronic suppurative lung disease, through a variety of mechanisms. They have been proven to be beneficial in diffuse panbronchiolitis and are commonly being used in patients with bronchiectasis. Many small studies support their use in this population, although several had methodologic flaws. Thus, although chronic low-dose macrolide therapy is often used in these patients, more conclusive evidence is awaited.