Inhaled non-steroid anti-inflammatories for children and adults with bronchiectasis.
BACKGROUND
Chronic neutrophilic inflammation, both in the presence and absence of infection, is a feature of bronchiectasis in adults and children. The anti-inflammatory properties of non-steroid anti-inflammatory drugs (NSAIDs) may be beneficial in reducing airway inflammation and thus potentially improve lung function and quality of life in patients with bronchiectasis.


OBJECTIVE
To evaluate the efficacy of inhaled NSAIDs in the management of non-cystic fibrosis bronchiectasis in children and adults.


METHODS
We searched the Cochrane Airways Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 3), MEDLINE, OLDMEDLINE and EMBASE databases. The latest searches were carried out in October 2009


METHODS
All randomised controlled trials comparing inhaled NSAIDs to a control group (placebo or usual treatment) in children or adults with bronchiectasis not related to cystic fibrosis.


METHODS
We reviewed the results of the searches against pre-determined criteria for inclusion.


RESULTS
One small, short-term trial was eligible for inclusion. We included this study of 25 adults with chronic lung disease (including bronchiectasis) as the other conditions were linked to development of bronchiectasis and all had chronic sputum production.The single trial in adults reported a significant reduction in sputum production over 14 days in the treatment group (inhaled indomethacin) compared to placebo (difference -75.00 g/day; 95% CI -134.61 to -15.39) and a significant improvement in a dyspnoea score (difference -1.90; 95% CI -3.15 to -0.65). There was no significant difference between groups in lung function or blood indices. No adverse events were reported.


CONCLUSIONS
There is currently insufficient evidence to support or refute the use of inhaled NSAIDs in the management of bronchiectasis in adults or children. One small trial reported a reduction in sputum production and improved dyspnoea in adults with chronic lung disease who were treated with inhaled indomethacin, indicating that further studies on the efficacy of NSAIDs in treating patients with bronchiectasis are warranted.
Pizzutto
Susan J
SJ
Child Health Division, Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia, 0811.
Upham
John W
JW
Yerkovich
Stephanie T
ST
Chang
Anne B
AB
D000280:Administration, Inhalation; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001987:Bronchiectasis / Q000188:drug therapy*; D002648:Child; D004417:Dyspnea / Q000188:drug therapy; D006801:Humans; D013183:Sputum / Q000378:metabolism
D000894:Anti-Inflammatory Agents, Non-Steroidal