Investigational inhaled therapies for non-CF bronchiectasis

ABSTRACT

Introduction: Bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis) are associated with a high unmet therapeutic need due to the lack of specifically authorized medications, especially via the inhalation route. In non-CF bronchiectasis chronic infection with Pseudomonas aeruginosa is common and favored by the persistent local inflammation and viscid sputum production. Therefore inhaled antibiotics, mucolytics or anti-inflammatory agents could represent appropriate therapeutic interventions in this setting

Areas covered: This review herein discusses the inhaled therapies currently under investigation for non-CF bronchiectasis and their potential therapeutic positioning in exacerbation versus stable state.

Expert opinion: Inhaled antipseudomonal antibiotics are of promising efficacy, but further efforts should also be made to detect bactericidal approaches against Burkholderia cepacia complex, and to interfere chronic inflammation topically.

KEYWORDS:

• Antibiotics
• anti-inflammatory
• bronchiectasis
• Burkholderia cepacian
• cystic fibrosis
• Pseudomonas aeruginosa

Article Highlights

• Non-CF bronchiectases have in common with CF chronic airways inflammation and infections with Pseudomonas aeruginosa

• Inhaled therapies currently used in non-CF are currently either ‘borrowed’ from the underlying disease (eg bronchodilator therapy used in COPD) or from CF and this approach is commonly found in hospital setting

• Several therapeutic classes are currently investigated in non-CF bronchiectasis and are represented by inhaled antibiotics, inhaled mucoactive drugs and inhaled anti-inflammatory drugs

• Some of these therapies such as inhaled antibiotics (ie tobramycin, aztreonam) are established therapies in CF, others (inhaled ciprofloxacin, inhaled antitrypsin) are developed in parallel with CF

• In non-CF bronchiectasis there is a high unmet therapeutic need and therefore further efforts should be streamed towards rapid development of effective therapies

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.