Inhaled antibiotics (IA) reduce exacerbations in COPD patients with Pseudomonas chronic bronchial infection (PCBI). The objective of this study was to evaluate the effectiveness of IA according to duration of treatment.
Prospective observational study of patients who started IA for COPD and PCBI during 2012-2020. Clinical information, spirometric data, exacerbations and Pseudomonas isolation (PI) were compared one year before and after treatment in 3 groups of patients according to the duration of IA: Group 1 <1 month, Group 2: 1-6 months, Group 3: 6-12 months.
69 patients were included: 40(58%) in Group 3, 18(26%) in Group 2, and 11(16%) in Group 1, mean treatment days of 334, 94 and 17 respectively. Changes between the year before and after IA are shown in the Table. In Group 3, exacerbations, PI and expectoration decreased. In Group 2, PI decreased, but without a statistically significant impact on the rest of outcomes. Group 1 showed no changes.
| Group 1 pre | Group 1 post | p value | Group 2 pre | Group 2 post | p value | Group 3 pre | Group 3 post | p value | |
| Daily sputum, % patiens Dyspnea mMRC* AmbulatoryExacerbations* HospitalAdmission* number PI* *mean(SD) |
91 2.6(0.7) 3.4(2.5) 2.0(1.7) 3.6(1.7) |
91 2.6(0.8) 3.1(1.7) 1.7(1.7) 3.5(3.9) |
1 0.766 0.717 0.588 0.291 |
83 2.3(1.0) 3.4(2.2) 1.7(1.9) 3.2(1.3) |
61 2.6(1.0) 2.5(1.7) 1.2(1.7) 1.3(1.1) |
0.371 0.124 0.128 0.302 0.002 |
85 2.1(0.9) 3.2(1.7) 1.4(1.6) 3.1(1.2) |
47 2.0(0.9) 1.6(1.4) 0.8(1.4) 1.1(1.4) |
0.001 0.164 0.001 0.094 0.001 |
Conclusions: Clinical impact of IA in patients with COPD and PCBI depends on the treatment duration. Only treatments longer than 6 months were associated to a decrease in exacerbations, hospital admissions and expectoration.