Dry Powder Inhalers in Cystic Fibrosis

Same Old Drugs But Different Benefits?

Lesley Uttley; Paul Tappenden


Curr Opin Pulm Med. 2014;20(6):607-612. 

In This Article

Abstract and Introduction


Purpose of review Newer 'innovative' formulations of antibiotics for Pseudomonas aeruginosa lung infection in patients with cystic fibrosis include colistimethate sodium and tobramycin in the form of dry powders for inhalation (DPIs). Whilst these DPIs are anticipated to improve patient adherence because of increased convenience and ease of administration, questions remain concerning whether they are as clinically effective, safe and cost-effective as nebulized antibiotics.

Recent findings This review describes the recent findings of a health technology assessment of the clinical effectiveness and cost-effectiveness of colistimethate sodium and tobramycin DPIs with regard to how innovative treatments may be judged to be incrementally better than existing treatments. The original assessment was undertaken to inform the National Institute for Health and Care Excellence's Technology Appraisal Programme to inform national clinical guidance on the use of these new treatments in the National Health Service.

Summary Three trials were included in the systematic review. Issues surrounding the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI are discussed in light of the considerable uncertainties associated with the available evidence.


Cystic fibrosis (CF) is an inherited condition which is characterized by the abnormal transport of Cl across transporting epithelia, leading to the production of thick sticky mucus in the lungs, pancreas, liver, intestine, and reproductive tract, as well as an increase in the salt content in sweat. People with CF experience many problems, including recurrent respiratory infections and difficulties digesting food. People with CF are susceptible to lung infections; this is because the thick mucus makes it difficult for the body to clear inhaled bacteria, and because people with CF have an increased airway inflammatory response to pathogens. CF significantly impairs health-related quality-of-life (HRQoL) and limits life expectancy. Amongst the most common infections in CF, including Staphylococcus aureus, Haemophilus influenzae, and Burkholderia cepacia complex, Pseudomonas aeruginosa is the most prevalent, with between 55 and 65% of CF patients between age 20 and 49 years in the United Kingdom infected with chronic P. aeruginosa in 2010.[1]