Written by Marcia J. Egles, MD. Six months of supplementation with the probiotic Lactobacillus reuteri significantly improved the number of pulmonary exacerbations and number of upper respiratory and gastrointestinal infections in the participating subjects with cystic fibrosis.
Cystic fibrosis is a severe genetic disease which especially affects the lungs and the gastrointestinal tract. In 1959, the median age of survival of those born with this disorder in the United States was 6 months. In 2010, the survival was estimated to be about 37 years for women and 40 years for men 1,2. Though the outlook has much improved, those with cystic fibrosis are prone to recurrent and destructive pulmonary inflammation and infection, requiring frequent rounds of antibiotics and other supportive treatments.
Prior studies have suggested that probiotics such as Lactobacillus can reduce intestinal inflammation in cystic fibrosis 3. A 2014 study from Italy further reports that the probiotic Lactobacillus reuteri, in a six-month trial in boys with cystic fibrosis, reduced the occurrences of upper respiratory infections and pulmonary exacerbations. Upper respiratory tract infections include nose, throat, sinus and ear infections. A pulmonary exacerbation is a clinical worsening of pulmonary symptoms such as increased sputum 4.
In the 2014 Italian study, 61 young men (median age 17.5 years, range 6-29) with cystic fibrosis with mild to moderate lung disease participated in a six-month, randomized, double-blind placebo-controlled trial. Half of them received 5 drops daily (10 to the 10th colony forming units) of Lactobacillus reuteri ATCC55730 (LR) by mouth. The control group, received placebo drops. During the six-month testing, the participants were not allowed to consume additional probiotics or foods containing probiotics.
The primary outcome measures are summarized in the table below. Both groups had 30 participants.
| Primary Outcome Measures | |||
|---|---|---|---|
| Variables | LR Group | Placebo Group | p-value |
| Number of pulmonary exacerbations | 1 | 11 | <0.01 |
| Number of hospitalizations for pulmonary exacerbations | 1 (14 days duration) | 1 (13.7 days duration) | not significant |
| Number of upper respiratory tract infections | 1 | 6 | <0.05 |
| Number of gastrointestinal infections | 0 | 3 | not significant |
Additional secondary outcomes included measures of bacteria present in sputum, pulmonary function tests, and measurements of inflammation such as fecal calprotectin, and IL-8 and TNF-alpha in plasma and in sputum. None of the secondary outcomes, however, were found to be significantly different between the two groups. The prior study 3, which found Lactobacillus beneficial in reducing intestinal inflammation in cystic fibrosis, used a different strain of Lactobacillus than was used in this study.
The researchers commented that the use of probiotics in cystic fibrosis is rational because cystic fibrosis patients are exposed to massive antibiotic treatments, causing an altered composition of the intestinal microbiota 4. This study demonstrated that a long-term administration of one exact strain of Lactobacillus reduced pulmonary exacerbations and upper respiratory infections in male patients with cystic fibrosis.
Source: Di Nardo et al 2013. Lactobacillus reuteri ATCC55730 in Cystic Fibrosis. JPGN, Volume 58, Number 1, January 2014
© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000000187
Posted March 28, 2017.
References:
- O’Sullivan B, Freedman S. Cystic Fibrosis. Lancet. 2009;373(May 30):1891-1904.
- MacKenzie T, Gifford AH, Sabadosa KA, et al. Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the cystic fibrosis foundation patient registry. Annals of internal medicine. 2014;161(4):233-241.
- Bruzzese E, Raia V, Gaudiello G, et al. Intestinal inflammation is a frequent feature of cystic fibrosis and is reduced by probiotic administration. Alimentary pharmacology & therapeutics. 2004;20(7):813-819.
- Di Nardo G, Oliva S, Menichella A, et al. Lactobacillus reuteri ATCC55730 in cystic fibrosis. Journal of pediatric gastroenterology and nutrition. 2014;58(1):81-86.
