Inhaled non-steroid anti-inflammatories for children and adults with bronchiectasis

Background: Chronic neutrophilic inflammation, in both the presenceand absence of infection, is a feature of bronchiectasis in adults andchildren. The anti-inflammatory properties of non-steroid anti-inflammatorydrugs (NSAIDs) may be beneficial in reducing airway inflammation, thuspotentially improving lung function and quality of life in patients withbronchiectasis.

Objectives: To evaluate the efficacy of inhaled NSAIDs in themanagement of non-cystic fibrosis bronchiectasis in children and adults:

• during stable bronchiectasis; and

• for reduction of:

○ severity and frequency of acuterespiratory exacerbations; and

○ long-term pulmonary decline.

Search methods: We searched the Cochrane Airways Group Trials Register,which includes reports identified from the Cochrane Central Register ofControlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index toNursing and Allied Health Literature (CINAHL). We also searched the trialregistry ClinicalTrials.gov and the World Health Organization (WHO) trialportal. We carried out the latest searches on 22 September 2015.

Selection criteria: All randomised controlled trials comparing inhaledNSAIDs versus a control (placebo or usual treatment) in children or adults withbronchiectasis not related to cystic fibrosis.

Data collection and analysis: We reviewed the results of searches againstpredetermined criteria for inclusion.

Main results: One small, short-term trial was eligible for inclusion. Weincluded this study of 25 adults with chronic lung disease (only 32% of peopleincluded in the trial had bronchiectasis), as the other conditions were linkedto development of bronchiectasis, and all were characterised by chronic sputumproduction. We were not able to obtain separate data for people with adiagnosis of bronchiectasis. We judged that the study was at a high risk ofselection bias. The primary outcome (mean difference in control ofbronchiectasis severity, quality of life (Qol), cough scores) was not reportedin the included study. The single trial in adults reported a significantreduction in sputum production over 14 days for the treatment group (inhaledindomethacin) compared with the placebo group (mean difference (MD) -75.00g/day; 95% confidence interval (CI) -134.61 to -15.39) and a significantimprovement in the Borg Dyspnoea Scale score (MD -1.90, 95% CI -3.15 to -0.65).We noted no significant differences between groups in lung function or bloodindices and no reported adverse events.

Authors' conclusions: No new studies of adults or children have beenconducted since the last version of this review was published. Therefore, finalconclusions have not changed. Current evidence is insufficient to support orrefute the use of inhaled NSAIDs for the management of bronchiectasis in adultsor children. One small trial reported a reduction in sputum production andimproved dyspnoea among adults with chronic lung disease who were treated withinhaled indomethacin, indicating that additional studies on the efficacy ofNSAIDs for treatment of patients with bronchiectasis are warranted.