Looking for a further spasmolytic I do not know by now

Question

Dear expert team,

Before each colistin inhalation (I am resistant to other antibiotics by now), I am using currently the following drugs in a 4-day alternation: Atrovent® (ipratropium bromide) alternating with Berotec N® (formoterol) aerosol and Sultanol® (salbutamol) aerosol. In the mornings Spiriva Respimat® (tiotropiumbromide) two puffs and Oxis® (formoterol) two puffs.

My problem is that I can only inhale colistin when the bronchia are extremely wide, since I get massive pulmonary bleeding otherwise (extended aortopulmonary collaterals/MAPCA with many coil embolizations that have been maxed out by now).

My question: Is there another short-term effective spasmolytic drug that I could inhale for instance the first two days alternately with Atrovent® (for the third and fourth day) and respectively, on the fifth and sixth day with Berotec N® and Sultanol®?

Of course, the new spasmolytic will have to show an effect despite inhalation with Spiriva® and Oxis® in the mornings as well as with the previously used short-term effective spasmolytics (Atrovent®, Berotec N® etc.).

The receptors in my lungs get used to the respective spasmolytic agent already on the first day of alternation, so that I have to take more each day. With Atrovent® I am often at 2.2ml (500 µg/2 ml) already after 4 days. After alternating with Berotec® and Sultanol®, I am already at 3 puffs of Berotec® and 2-3 puffs of Sultanol® by the fourth day, with unpleasant side effects, though this is better than getting pulmonary bleeding or inhaling less colistin with shortness of breath and pneumonia as a result.

I hope you can help me. I am not looking for a brand name but an active ingredient; my doctor will then tell me about the dosage.

Kind regards.

Answer

Hello,

Actually, you are already taking every drug available on the market for widening the bronchia and your are taking quite a high dosage. After all, there are only the ß2-sympatomimetics and anticholinergic drugs, long- and short-term effective, and you are already taking all of that. There is a further long-term effective sympathomimetic, indacaterol, that has to be administered only once a day. However, it is not yet approved for CF and there is no study on it, either.

More of these long-term effective drugs will soon be released, but there will not be any experience with those for CF either for the time being. Based on available data, however, one can assume that they can also help with CF.

Kind regards
Prof. Joachim Bargon

02.08.2012