Tay George T P, Reid David W, Bell Scott C
Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.
Semin Respir Crit Care Med. 2015 Apr;36(2):267-86. doi: 10.1055/s-0035-1547346. Epub 2015 Mar 31.
Bronchiectasis is a pathological diagnosis describing dilatation of the airways and is characterized by chronic lung sepsis. Bronchiectasis has multiple etiologies, but is usually considered in terms of whether it is due to the genetic disorder cystic fibrosis (CF) or secondary to other causes (non-CF bronchiectasis, NCFB). Inhaled antibiotics are used in bronchiectasis to suppress bacterial pathogens and reduce long-term lung function decline. The majority of the literature on inhaled antibiotics comes from studies on CF where the dominant bacterial pathogen in the airway is usually Pseudomonas aeruginosa. Thus, most aerosolized antibiotic regimens target this bacterium, but the emergence of molecular diagnostic methods has questioned this approach and more tailored strategies may need to be considered in CF based on the community composition of the lung microbiome. Similarly, the lung microbiome in NCFB has been found to be a complex polymicrobial one and the current practice of employing the same inhaled antibiotic regimes as are used in CF may no longer be appropriate in many patients. In this article, the use of inhaled antibiotics in CF and NCFB is considered in the light of improved understanding of the lung microbiome and why more tailored therapy may be needed based on molecular identification of the microbial pathogens present. The evidence for the use of currently available inhaled antibiotics and advances in inhaled drug packaging and delivery devices are discussed. Finally, the urgent need for prospective randomized clinical trials in CF and NCFB is highlighted and areas for future research identified.
支气管扩张是一种描述气道扩张的病理学诊断，其特征为慢性肺脓毒症。支气管扩张有多种病因，但通常根据其是否由遗传性疾病囊性纤维化（CF）引起或继发于其他原因（非CF支气管扩张，NCFB）来考虑。吸入性抗生素用于支气管扩张以抑制细菌病原体并减少长期肺功能下降。关于吸入性抗生素的大多数文献来自对CF的研究，其中气道中的主要细菌病原体通常是铜绿假单胞菌。因此，大多数雾化抗生素方案都针对这种细菌，但分子诊断方法的出现对这种方法提出了质疑，在CF中可能需要根据肺部微生物群的群落组成考虑更具针对性的策略。同样，已发现NCFB中的肺部微生物群是一个复杂的多微生物群落，在许多患者中，目前采用与CF相同的吸入性抗生素方案的做法可能不再合适。在本文中，鉴于对肺部微生物群的认识有所提高，以及基于对存在的微生物病原体的分子鉴定为何可能需要更具针对性的治疗，对CF和NCFB中吸入性抗生素的使用进行了探讨。讨论了使用现有吸入性抗生素的证据以及吸入药物包装和递送装置的进展。最后，强调了在CF和NCFB中进行前瞻性随机临床试验的迫切需求，并确定了未来的研究领域。
