INHALED GENTAMICIN REDUCES AIRWAY NEUTROPHIL ACTIVITY AND MUCUS SECRETION IN BRONCHIECTASIS

To investigate whether aerosolized gentamicin (CM) prevents myeloperox idase (MPO)-mediated airway injury and mucus hypersecretion, a short c ourse of aerosol therapy (3 d) with CM 40 mg or 0.45% saline (saline) twice per day was conducted. Twenty-eight patients with bronchiectasis and mucus hypersecretion after adequate chest care and hydration were enrolled in a randomized, double-blind fashion. MPO levels in sputum collected on arising were determined by fluorometric assay at 655 nm b efore and after treatment. The sputum MPO level significantly decrease d in patients receiving aerosolized GM, from 0.22 +/- 0.04 to 0.14 +/- 0.04 U/g (n = 15), but not in patients with saline inhalation (0.23 /- 0.03 to 0.17 +/- 0.02 U/g; n = 11). The daily sputum amount signifi cantly decreased from 94.6 +/- 21.6 to 58.1 +/- 17.8 ml (n = 13, p < 0 .01) in the CM group, whereas it increased from 78.6 +/- 25.4 ml to 12 0.5 +/- 33.9 ml (n = 11, p < 0.05) in the saline group. The change in the amount of daily sputum was related to that in the sputum MPO level in the GM group (r = 0.61; p < 0.01). Inhalation of CM, but not salin e, significantly (p < 0.05) increased the value of peak expiratory flo w (PEF) from 186.4 +/- 25.1 to 216.4 +/- 26.4 L/min and decreased the variability of PEF from 24.6 +/- 5.1 to 6.1 +/- 2.3 %. The nocturnal d esaturation and the 6-min walking distances were also significantly im proved in the CM group (11.2 +/- 3.8 to 0.6 +/- 0.5 min/h; 324.9 +/- 4 3.1 to 408.1 +/- 25.9 m; p < 0.05; respectively), but not in the salin e group. Subjective improvements in the Borg scale and self-sputum ass essment were found in the CM group only. In conclusion, aerosolized GM is effective in improving airway hypersecretion and inflammation in p atients with bronchiectasis.