Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis

Introduction: Non-cystic fibrosis bronchiectasis (NCFB) is an increasingly prevalent chronic respiratory disease, characterized by a cycle of infection and inflammation. It is progressive and associated with poor quality of life, increasing healthcare costs and mortality. Inhaled antibiotics offer the potential to decrease long-term bacterial burden and reduce or delay exacerbations which are a key driver of disease progression and healthcare costs. Currently however, no inhaled treatments are approved for the prevention of exacerbations in patients with NCFB. Areas covered: We consider current evidence for inhaled treatment in NCFB and discuss ciprofloxacin dry powder for inhalation (DPI), a novel treatment using PulmoSphere™ technology, delivered via a pocket-sized, breath-actuated inhaler. We also detail the unique features of the ongoing Phase 3 RESPIRE trials for ciprofloxacin DPI. Expert opinion: The simplicity of use and short administration time could make ciprofloxacin DPI an attractive treatment option with potential to reduce the number of exacerbations in patients with NCFB. The RESPIRE studies are the largest carried out in NCFB to date and will provide a benchmark for future trial design. If approved, following successful Phase 3 data, ciprofloxacin DPI has potential for significant use in NCFB due to its good tolerability and low treatment burden.