April, 2003. Non-steroidal anti-inflammatory drugs [online]. Seacroft and St James's University Hospitals, Leeds, UK. Available from http://www.cysticfibrosismedicine.com

High doses, non steroidal anti-inflammatory agents such as Ibuprofen can inhibit neutrophil migration and adherence, and inhibit the release of lysosomal enzymes. In rat studies Ibuprofen has been demonstrated to significantly reduce lung inflammation. Getting the dose right is likely to be important as there is some evidence to suggest that the use of low drug concentrations could increase the influx of neutrophils into the lungs.

In a four year double blind placebo controlled study, Konstan et al demonstrated that high dose oral Ibuprofen reduced the decline of lung function, weight and chest radiographic scores in patients with cystic fibrosis (Konstan et al, 1995). Patients in this study had mild lung disease and a drug effect was only evident in patients who were initially less than 13 years old. Follow up data from this study suggests that the improvement in lung function has persisted and that the greatest benefit remains in the 5 - 12 year age group.

The major disadvantage of the NSAID relates to their narrow treatment window and high side effect profile. Close monitoring of plasma levels is mandatory to ensure both a potential therapeutic effect and to prevent toxicity. Results from an ongoing Canadian study are awaited.

References

Konstan MW, Byard PJ, Hoppel CL, Davis PB. Effect of high-dose ibuprofen in patients with cystic fibrosis. N Engl J Med 1995; 331: 848-854

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