The Leeds Method of Management. April, 2008. Bronchodilators [online]. Leeds Regional Adult and Paediatric Cystic Fibrosis Units, St James's University Hospital, Leeds, UK. Available from http://www.cysticfibrosismedicine.com
improve respiratory function in patients with CF (Conway & Watson,
1997; Ziebach et al, 2001). Approximately 50% of patients have
some degree of bronchial lability (asthma) which will improve with a bronchodilator
(Eggleston et al, 1988). Improving airway patency before physiotherapy
may help in the clearance of secretions from the chest. Bronchodilators
may be given before physiotherapy for this reason. Bronchodilators are
free from serious side effects although mild tremor may develop in some
patients and some medications may lead to paroxysmal bronchoconstriction.
In a study carried
out at the Leeds Adult CF Unit in 2006, 15 out of 83 patients (18.1%)
showed a significant response to reversibility testing with nebulised
salbutamol during their annual assessment (Hughes et al, 2006).
The main predictive factor for a positive response was lower pre-existing
lung function. There are no trials looking at the effect of terbutaline
or fenoterol compared with placebo within the CF population (Halfhide
et al, 2005).
Bronchodilators and nebulised antibiotics
Patients should be
assessed before and after a test dose of a nebulised antibiotic. In children
chest auscultation and, where possible, respiratory function tests are
performed. In adults pre and post respiratory function tests are performed.
Some patients will develop bronchospasm and may benefit from bronchodilator
inhalation given before the antibiotic (Dodd et al, 1997; Cunningham
et al, 2001; Alothman et al, 2002).
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