title: Tobramycin Nebulizer Solution in severe COPD patients colonized with Pseudomonas aeruginosa: effects on bronchial inflammation.
abstract: BACKGROUND
  Airway colonization with Pseudomonas aeruginosa is frequent in severe chronic obstructive pulmonary disease (COPD) and may lead to progressive inflammatory damage. Inhaled Tobramycin Nebulizer Solution (TNS; a preservative-free formulation) is an effective therapy in chronic P aeruginosa infection in cystic fibrosis and bronchiectasis. In this study we aimed to investigate the effects of a TNS short course on inflammatory markers in bronchial secretions from multiresistant P aeruginosa-colonized patients with severe COPD. To the authors' knowledge, this is the first study to examine this in cases of severe COPD.
  
  
  METHODS
  Thirteen COPD patients (GOLD criteria 3-4; mean age 72.7+/- 8 years; mean basal forced expiratory volume in 1 second (FEV(1)) 34.8%+/-8.1%; mean FEV(1)/forced vital capacity 0.6+/-0.1) were enrolled. All patients were colonized with P aeruginosa and resistant to oral/intravenous specific antibiotics. Eosinophilic cationic protein (ECP), interleukin-1 beta (IL-1beta), interleukin-8 (IL-8), tumor necrosis factor alfa (TNF-alpha), and cell counts were measured in spontaneous secretions before and after a 2-week TNS course (300 mg twice daily).
  
  
  RESULTS
  The TNS course induced a significant reduction in IL-1beta (P<0.03), IL-8 (P<0.02), ECP (P<0.01) concentrations, and in eosinophil count (P<0.01). TNF-alpha levels, and neutrophil and lymphocyte counts were not significantly affected. The second week of treatment proved crucial in terms of efficacy. P aeruginosa density was lowered after 6 months; severe acute exacerbations were reduced by 42%.
  
  
  CONCLUSIONS
  TNS reduced the inflammatory impact of P aeruginosa in multiresistant, P aeruginosa-colonized patients with severe COPD. A therapeutic role for TNS can be strongly suggested in these particular conditions.
authors.affiliation: UOC di Pneumologia, Ospedale Orlandi, Bussolengo, Verona, Italy. rdalnegro@ulss22.ven.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Dal Negro
authors.forename: Claudio
authors.initials: C
authors.lastname: Micheletto
authors.forename: Silvia
authors.initials: S
authors.lastname: Tognella
authors.forename: Marilia
authors.initials: M
authors.lastname: Visconti
authors.forename: Claudio
authors.initials: C
authors.lastname: Turati
mesh_terms: D000368:Aged; D001991:Bronchitis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D011550:Pseudomonas aeruginosa; D029424:Pulmonary Disease, Chronic Obstructive / Q000382:microbiology*; D013183:Sputum / Q000737:chemistry / Q000382:microbiology; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014031:Tobramycin