Study Finds Combination Therapy Reduces Number of COPD Exacerbations

Patients with severe chronic obstructive pulmonary disorder (COPD) and chronic bronchial infection due to Pseudomonas aeruginosa may benefit from combination therapy with nebulized colistin and continuous cyclic azithromycin for reducing the number of COPD exacerbations (ECOPD), according to recent research published by International Journal of Chronic Obstructive Pulmonary Disease.

The study utilized a retrospective cohort to assess patients with COPD and chronic bronchial infection due to P. aeruginosa, who were treated with nebulized colistin at the Respiratory Day Care Unit between 2005 and 2015. The researchers recorded the number of characteristics of ECOPD before and up to two years after the introduction of nebulized colistin treatment.

“In patients with severe chronic obstructive pulmonary disease (COPD), infectious exacerbations (ECOPD) are associated with poor prognosis. Some interventions in this disease aim to prevent exacerbations, in order to improve the course of COPD. Pseudomonas aeruginosa is responsible for 5—10% of COPD exacerbations,” the authors said. “Patients with severe and very severe COPD have a higher risk of suffering exacerbations due to this potentially pathogenic microorganism (PPM) than patients with mild or moderate COPD.”

In total, 32 patients who received nebulized colistin for at least 3 months were analyzed and every patient except one received combination therapy with continuous cyclic azithromycin, according to the results.

Overall, the researchers observed significant reduction in the number of ECOPD from baseline of 38.3% at two years of follow-up. There was also a clear decrease in P. aeruginosa ECOPD (from 59.5% to 24.6%) and P. aeruginosa eradiation rate of 28% over the two-year follow-up, according to the study.

“These studies should also help to establish the most appropriate treatments for severe COPD patients with chronic bronchial infection by P. aeruginosa, and the timings of their introduction — a particularly important issue, given that this situation is often difficult to handle in clinical practice,” explained the authors.

The researchers suggested that additional studies with prospective designs and larger cohorts are necessary to determine the role of each chronic antibiotic treatment.

Reference

Monton C, Prina E, Pomares X, et al. Nebulized colistin and continuous cyclic azithromycin In severe COPD patients with chronic bronchial infection due to pseudomonas aeruginosa: A Retrospective Cohort Study [published online October 17, 2019]. Int J Chron Obstruct Pulmon Dis. doi.org/10.2147/COPD.S209513