Trockenpulverinhalation bei Mukoviszidose

Zusammenfassung

Die inhalative Anwendung von Medikamenten hat für die Dauertherapie bei Mukoviszidose von jeher einen großen Stellenwert. Dabei war die Feuchtinhalation die klassische Applikationsform. Das zähe Bronchialsekret soll durch gelöste lungengängige Partikel gelockert werden, sodass die Atemwege mit Husten oder mit Physiotherapie leichter gereinigt werden können. Die erforderlichen hohen Dosierungen der pseudomonaswirksamen inhalativen Antibiotika konnten früher nur mittels Feuchtverneblung von Lösungen erreicht werden. Seit wenigen Jahren sind inhalative Präparate in Pulverform speziell für Mukoviszidose verfügbar. Die neu entwickelten Arzneimittel und Inhalatoren unterscheiden sich deutlich von den herkömmlichen Pulverpräparaten zur Therapie chronisch obstruktiver Atemwegserkrankungen. Zwei inhalative Antibiotika in Pulverform, Tobramycin und Colistin, sowie das osmotisch wirksame und schleimlösende Mannitol werden in diesem Artikel vorgestellt. Präsentiert werden technologische Aspekte, Studiendaten zu Wirksamkeit und Verträglichkeit sowie die praktische Anwendung dieser neuen Arzneimittel.

Abstract

Inhaled medications play an important role in the daily treatment of patients with cystic fibrosis (CF). The classic route of administration was nebulisation via jet nebulisers. Respiratory delivery of fluid particles should loosen the viscid respiratory secretions, making airway clearance via cough or physiotherapy more efficient. Until recently, only jet nebulisers allowed to administer high doses of aerosolised antipseudomonal antibiotics. Powder inhalers for the treatment of cystic fibrosis have recently been made available. The newly developed powders and inhalers differ considerably from conventional dry powder inhalers used for the treatment of chronic obstructive airway disease. The present article will review two inhaled antibiotics, i. e. tobramycin and colistin, and the hyperosmotic agent mannitol, which increases the hydration of the airways. Topics are particle engineering, efficacy and tolerability results from clinical trials, as well as functional and practical aspects related to these new drugs.

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