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.