<font style=" color: rgb(0, 0, 255);" id="KonaBody">"Recurrent
wheeze and breathlessness are common in people with cystic
fibrosis, and bronchodilators are commonly prescribed,"
according to lead author Clare Halfhide, M.D., of the Royal
Liverpool Children's Hospital in England. "Despite their
wide-scale and often long-term use, there is limited objective
evidence about their efficacy in cystic fibrosis."</font>
<font style=" color: rgb(0, 0, 255);"><br style=
" color: rgb(0, 0, 255);">
</font><br>
Source: Center for Advancement in Health. Article <a href=
"http://www.sciencedaily.com/releases/2005/10/051026085739.htm">"Little
Evidence Behind Bronchodilator Therapy For Cystic
Fibrosis"</a><br>
<br>
The findings of that study were published in October, 2006. It is
the most current information I can find on the topic. Dozens of
health-related news media ran the article, so I'm confident that
it's not just a hack study published by some entity with a hidden
agenda.<br>
<br>
I often do CPT without a bronchodilator unless my asthma is acting
up or I'm fighting infection. I also am asked why I do Xopenex.
Usually RTs in the hospital ask me that because they are more
familiar with albuterol. I choose Xopenex over albuterol because of
the extreme jittery/anxious feelings I exhibit with albuterol that
don't occur with Xopenex. For me, that's a quality of life
decision, not necessarily a scientific one.<br>
<br>
I do use bronchodilators both as a "rescue med" and as
part of my preventive maintenance even if I don't do them at the
same time as CPT. Bronchodilators are most effective when they are
done first in the lineup of "usuals." Below is the proper
order of med-neb treatments, as reported by another CF patient's
clinic's recommendation:<br>
<br>
<b style=" font-family: arial;"><font size="2">1. Bronchodilator
(albuterol or xopenex)<br style=" font-family: arial;">
<br style=" font-family: arial;">
2. Mucolytics (pulmozyme THEN hypertonic saline)<br style=
" font-family: arial;">
<br style=" font-family: arial;">
3. Inhaled antibiotic (TOBI or colistin)<br style=
" font-family: arial;">
<br style=" font-family: arial;">
4. Long acting bronchodilator (serevent or foradil)<br style=
" font-family: arial;">
<br style=" font-family: arial;">
5. Inhaled steroid (flovent, advair, or pulmicort)</font></b><font
face="arial" size="2"><br>
<br>
</font>Here's why the order of operations is so important when
managing CF.<br>
<br>
The bronchodilator helps open up the airways. The more open the
airways, the better the chances of inhaling the other medications
deeply enough into the lungs where they can be most effective.
Mucolytics are "mucus cutting" medications. They help
break up the secretions so that they can be coughed up more easily.
In CF patients, the mucus and the lungs are typically dry, which is
why hypertonic saline is so useful. Hypertonic saline works by
adding moisture to the lining of the lungs, resulting in a slippery
surface conducive coughing out sputum. Following sputum clearance
of the airways, the lungs are further able to take in the nebulized
mist of the antibiotics. At this point there is a greater
likelihood of the antibiotics taking hold in both small and large
airways. The treatment concludes with inhaled steroids which help
keep the airways open for an extended period of time (i.e. 8-12
hours when it is time for another treatment.)<br>
<br>
The length of time to complete all these steps varies somewhat
depending on the type of nebulizer/compressor system being used.
For me this process takes approximately half an hour when I am not
in a TOBI month and not producing much sputum. When I am not
feeling well, am more congested or taking TOBI, it can take me as
long as 1-1/2 hours to complete the process.<br>
<br>
Although the article I cited at the beginning of this post says
that bronchodilators are shown to be ineffective treatment,
bronchodilators used in tandem with the other treatments CF
patients need are effective indeed. My opinion is that they are an
important piece of the overall treatment. While they may be
ineffective on their own, they should not be discounted altogether.