inhalative cortisone therapy

Question

Dear expert-team,
In the course of a change of the care-center 6 months ago and an actual quite prologned infection I have a question about a demand-oriented inhalative cortisone therapy: For about 5 years I have been attuned to 2 puffs/day budesonid 400 at my "old" care center. At the new care center the sense of this inhalative therapy could not be seen (I do not have asthmatical symptoms or allergies, FEV1 at 65%) and we decided to quit the budenosid, which worked out well (no worsening of the lung function, no subjective worsening either). Since the beginning of december I suffer however from a bacterial infection (Staph. A), which leads in combination with the acutal very cold weather in my eyes to an extremely sensitive bronchial system. I am interested in the question now if there is any experience in giving budesonid for example for some weeks "around an infection", in order to "calm down" the attacked bronchial system a bit. Or would one rather recommend bronchial-dilating drugs, probably also fast-acting ones, which I do not have in my drug repertoire (I inhale formoterol as a long-acting dilating drung)?
Many thanks

Answer

Dear questioner,
many thanks for this interesting question. Indeed there are not good studies, which show the benefit of inhaled cortisone concerning infections in CF. A bigger english study could even show, that it is "safe" to quit the cortisone in CF patients who have inhaled it before and that it does not come to increased infections of other lung problems. Therefore the actual state of the error is, that CF patients should inhale cortisone only in case they have an asthma. Therefore we also recommmend to our patients, in case they do not have an asthma component, to quit the topical steroide and only to go on inhaling a long-acting bronchial-dilating drung (beta2-mimetic). Concerning the formoterol it is like that, that the effect does last for a long time but starts as fast as for example with the salbutamol. Therefore there is no reason to inhale another beta-2-mimetics additionally. In analogy to other chronic lung diseases (chronic obstructive pulmonary disease COPD = smokers' lung), we use in our patients beside formoterol the relatively new tiotropium. It acts with another mechanism also dilating the muscles of the bronchi (anitcholinergic). However there is no data here in CF, but in COPD patients it could have been shown that the rate of infection is clearly reduced. Therefore I can only recommend to you, probably to contact your CF-center about tiotropium and to treat an infection, like you do for sure, as fast as possible with an antibiotic against Staph. aureus.

Yours sincerely,
Dr. med. Markus Hofer
adult CF clinic
university hospital Zürich

18.01.2010