Bronchial constriction and inhaled colistin in cystic fibrosis.
OBJECTIVE
Inhaled colistin is used for the treatment of Pseudomonas aeruginosa infection in cystic fibrosis (CF) patients despite reports of chest tightness and bronchospasm. The main objective of the study was to assess whether bronchospasm occurred in pediatric CF patients with or without clinical evidence of airway hyperreactivity.


METHODS
A prospective placebo-controlled clinical trial with crossover design was devised using challenge tests with 75 mg colistin in 4 mL saline solution and a placebo solution of the same osmolarity using a breath-enhanced nebulizer for administration. Subjects were recruited as follows: high risk (HR) for bronchospasm due to a personal history of recurrent wheezing, a family history of asthma and/or atopy, or bronchial lability, as demonstrated in pulmonary function tests; or low risk (LR) without these characteristics.


RESULTS
The mean FEV(1) (expressed as the mean [+/- SD] fall from baseline) of the HR group (n = 12) fell 12 +/- 9% after placebo was administered, and fell 17 +/- 10% after colistin was administered. For the LR group (n = 8), the mean FEV(1) fell 9 +/- 4% following placebo administration and 13 +/- 8% following colistin administration. There was a greater number of subjects in the HR group compared to the LR group, which had a mean fall in FEV(1) of >/= 15% (p < 0.01) after inhaling colistin. The differences between placebo and colistin therapy in the LR group were not significant.


CONCLUSIONS
The results demonstrated that colistin can cause bronchospasm, particularly in those patients with coexisting CF and asthma.
Alothman
Ghassan A
GA
Division of Respiratory Medicine, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada.
Ho
Bernard
B
Alsaadi
Muslim M
MM
Ho
Sharon L
SL
O'Drowsky
Lisa
L
Louca
Emily
E
Coates
Allan L
AL
D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000150:complications / Q000235:genetics; D001986:Bronchial Spasm / Q000139:chemically induced*; D001991:Bronchitis / Q000188:drug therapy*; D016084:Bronchoconstriction / Q000187:drug effects*; D002648:Child; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects*; D015897:Comorbidity; D018592:Cross-Over Studies; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy*; D012307:Risk Factors; D013147:Spirometry
D003091:Colistin