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Cystic Fibrosis Pulmonary Guidelines

Chronic Medications for Maintenance of Lung Health

¹ Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, South Carolina; ² Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; ³ Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; ⁴ Department of Medicine, University of Washington, Seattle, Washington; ⁵ Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland; ⁶ Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; ⁷ Department of Nursing, Texas Children's Hospital, Houston, Texas; ⁸ Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ⁹ Department of Respiratory Therapy, Medical University of South Carolina, Charleston, South Carolina; ¹⁰ Department of Pediatrics, Columbia University, New York, New York; ¹¹ Department of Medicine, University of Texas Southwestern, Dallas, Texas; ¹² Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; ¹³ Cystic Fibrosis Foundation, Bethesda, Maryland; and ¹⁴ Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Correspondence and requests for reprints should be addressed to Patrick A. Flume, M.D., Medical University of South Carolina, 96 Jonathan Lucas Street, 812-CSB, Charleston, SC 29425. E-mail: flumepa{at}musc.edu

Rationale: Cystic fibrosis is a recessive genetic disease characterized by dehydration of the airway surface liquid and impaired mucociliary clearance. As a result, individuals with the disease have difficulty clearing pathogens from the lung and experience chronic pulmonary infections and inflammation. Death is usually a result of respiratory failure. Newly introduced therapies and aggressive management of the lung disease have resulted in great improvements in length and quality of life, with the result that the median expected survival age has reached 36 years. However, as the number of treatments expands, the medical regimen becomes increasingly burdensome in time, money, and health resources. Hence, it is important that treatments should be recommended on the basis of available evidence of efficacy and safety.

Objectives: The Cystic Fibrosis Foundation therefore established a committee to examine the clinical evidence for each therapy and to provide guidance for the prescription of these therapies.

Methods: The committee members developed and refined a series of questions related to drug therapies used in the maintenance of pulmonary function. We addressed the questions in one of three ways, based on available evidence: (1) commissioned systematic review, (2) modified systematic review, or (3) summary of existing Cochrane reviews.

Conclusions: It is hoped that the guidelines provided in this article will facilitate the appropriate application of these treatments to improve and extend the lives of all individuals with cystic fibrosis.

Key Words: antibiotics • antiinflammatory agents • bronchodilators • mucolytics • saline solution, hypertonic

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