The use of anti-inflammatory medications in cystic fibrosis - Trends and physician attitudes

Study objectives: In recent years, there has been considerable interest in the use of antiinflammatory medications to decrease airway inflammation and preserve pulmonary function in patients with cystic fibrosis (CF) lung dis ease; Long-term use of oral corticosteroids (OCS) and ibuprofen (IBU) has b een proven efficacious in slowing the progression of CF. Inhaled corticoste roids (ICS) have not been adequately studied. Little is known regarding use trends and physician attitudes toward these drugs. Design: Cross-sectional sun ey mailed to 111 directors of Cystic Fibrosis C enters in the United States accredited by the Cystic Fibrosis Foundation. T he two-page written questionnaire included items regarding physicians' atti tudes toward anti-inflammatories, center demographics, patients receiving t herapy, and number of physicians prescribing therapy. Results: Sixty-seven surveys were returned (60%). The responding centers re presented 239 physicians and served 9,363 patients, 2,234 (24%) of whom wer e receiving routine antiinflammatory drugs. Complete data sets were availab le for 8,803 patients with 2,169 (25%) receiving anti-inflammatory therapy. Ninety-eight (41%) physicians prescribed long-term use of oral steroids fo r 413 (5%) patients, 103 (42%) prescribed inhaled steroids for 1,032 (12%) patients, and 108 (45%) prescribed high-dose IBU for 723 (8%) patients to c ontrol CF. The practitioners reported familiarity and efficacy as the prima ry reasons for prescribing OCS; concerns over side effects were the major r eason for not prescribing. Regarding ICS, the primary reasons for prescribi ng were familiarity and safety, with lack of efficacy being cited as the ma jor reason for not prescribing. For IBU, efficacy was ranked highest among reasons for prescribing, with concern over safety being the highest ranked reason for not prescribing. Conclusions: Anti-inflammatory medications appear to be an underutilized th erapeutic modality in CF care. This is true for numbers of patients receivi ng these drugs as well as numbers of care providers prescribing them. Addit ional studies will be required to address physicians' concerns regarding th e long-term efficacy and safety of anti-inflammatory drugs in treating CF.