Chronic obstructive pulmonary disease (COPD) has exacerbations as common events, being morbidity and mortality significant. About 25% of cases prove colonised with Pseudomonas aeruginosa (Ps.ae.) (1), being this condition an important stimulus to persistent airway inflammation. Inhaled antibiotics represent an alternative to oral/i.v. administration due to their high concentrations at the site of infection and the low systemic toxicity (2). Tobramycin Nebulizer Solution (TNS), a preservative-free formulation for nebulization, has recently been licensed for chronic Ps. ae. infection in cystic fibrosis only (3). Aim: to investigate the effects of a TNS sort-course on inflammatory markers of bronchial secretions from Ps.ae.-colonised COPD patients. Subjects: 13 moderate-to-severe COPD patients (GOLD 2b; 10 m., mean age 72.7 yr±8sd; mean basal FEV1 = 34.8% pred.±8.1sd; mean FEV1/FVC=0.6.±0.1sd) Ps.ae. colonised (persisting CFU>106) and resistant to oral/i.v. specific antibiotics, were studied after their informed consent. Methods: IL1b, IL8, IL6 and TNFa (pg/ml; Immulite, Diagnostic Product Corp, LA, Ca, USA); ECP (mcg/l), and cell count (% total count) were measured in spontaneous bronchial secretions before and after a 2-wk TNS course (300 mg bid, TOBI Pathogenesis Limited, Dompé Farm.), and some clinical outcomes (n. fatal events; bacterial density and/or eradication; n. severe exacerbations; time to the next exacerbation) monitored for a 6-month period. Statistics: t test and p<0.05 accepted.Results in Tab 1TAB1BSLN14 DAYST TESTIL1b pg/ml1751.5±1582.7391.4±347.9P<0.006IL8 pg/ml6173.2±4278.64616.8±3394.6P<0.017TNFa pg/ml546.1±1078.6186.3±297.1NSECP mcg/l2776.6±2074.9867.4±648.5P<0.01Neutrophils %72.5±9.779.5±4.5NSEosinophils %13.7±9.94.0±5.3P<0.01Lymphocytes %13.1±4.716.8±5.1NS
1) a 2-wk TNS course decreased sub stantially the level of neutrophilic and eosinophilic chemiotactic factors, and the number of eosinophils in bron chial secretions; 2), 1 fatal event occur red in the period due to acute RSV infection;3)Ps.ae.was eradicated in 2/13 pts, and the density reduced in other 4; 4) severe exacerbations were reduced by 42% and their onset delayed. Ref.: 1) Thorax 2002; 57(9): 759-64. 2) Am J Resp Crit Care 2000; 162: 481-5; 3) ERJ 2002;20:658-64.
R.W. Dal Negro, None.