Inhaled Therapy for Other Respiratory Diseases: Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis

Bronchiectasis includes disease states that share common features of cough, sputum production, and episodic exacerbations associated with airway mucus obstruction, bronchiole dilatation, chronic inflammation, and bacterial infections. The clinical classification of bronchiectasis has been simplified to include cystic fibrosis associated with a monogenic defect in the cystic fibrosis transmembrane conductance regulator (CFTR) region and conditions not associated with CFTR mutations referred to as non-cystic fibrosis bronchiectasis (NCFB). Contemporary management of bronchiectasis is directed at the pathophysiology that involves bronchoconstriction, airway inflammation, excess secretions, and recurrent respiratory infections. Therapies to relieve symptoms, modify the natural history, and prevent exacerbations are prescribed in the form of bronchodilators, corticosteroids, mucolytics, and antibiotics. Notably, inhaled therapies are ideally suited to provide symptomatic relief through local deposition while reducing systemic side effects. However, inhalation therapy that is beneficial in patients with CF may not provide the same favorable effect in patients with NCFB. This chapter provides an evidence-based overview of inhaled therapies and delivery systems in the management of CF and non-CF bronchiectasis.