group of the cystic fibrosis patients studied. These patients were known to have bronchial hyper-responsiveness -- increased response of the airway to certain stimuli. Bronchial hyper-responsiveness and responsiveness to bronchodilator drugs are markers for asthma and can be also tested for in people with cystic fibrosis.

The reviewers found the following:

• Albuterol and terbutaline -- drugs classified as short-acting beta2-agonists -- increased FEV1 and peak expiratory flow rate for patients known to have bronchial hyper-responsiveness.

• Serevent (salmeterol) -- classified as a long-acting beta2-agonist -- also improved lung function for participants known to have bronchial hyper-responsiveness.

• Atrovent (ipratropium bromide) showed no consistent effects on lung function in the trials under review.

The reviewers found no published trials that included inhaler-delivered fenoterol, formoterol or tiotropium and wrote that use of those agents could not be supported.

The reviewers noted that the trials were too varied in design to allow for a pooling of data for a strict meta-analysis.

"[B]efore embarking on what might become lifelong bronchodilator therapy, bronchodilator responsiveness should be assessed by measuring lung function both before and after a test dose of salbutamol in a standardized way, looking for an increase in baseline FEV1 of at least 10 percent," the reviewers concluded.

John Colombo, M.D., professor and chief of the pediatric pulmonology section at the University of Nebraska Medical Center, said, "My bias is that all CF [cystic fibrosis] patients deserve a trial of beta-agonist bronchodilator. This should be done in the PFT [pulmonary function test] laboratory, and, unless they develop significant adverse effects, short-acting beta-agonists should be considered as a trial for symptom relief, and possibly as an adjunct to airway clearance. A long-acting beta-agon
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Contact: Clare Halfhide
chalfhide@hotmail.com
Center for the Advancement of Health
25-Oct-2005

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