Nebulised Colomycin Treatment

What does ‘nebulised’ mean?

Nebulised is a way of taking medicine via a device (a nebuliser) in the form of a mist that you inhale.

A nebuliser is a combination of a small machine (compressor) which attaches to a mouthpiece or a facemask. The mouthpiece or facemask has a small container attached into which liquid medicine can be poured.

The nebuliser then pumps air through this medicine and turns it into a fine mist, which you can breathe in to your lungs.

What is nebulised colomycin?

Colomycin is an antibiotic, also known as colistimethate sodium. It can either be given intravenously, or through a nebuliser to treat infections.

Why am I being asked to have this treatment?

You have a lung condition called bronchiectasis. This has caused scarring in your airways. This can lead to bacteria growing in the scarred airways. A type of bacteria called Pseudomonas aeruginosa has been found in a sputum (phlegm) sample you have provided.

This treatment is being offered either to:

• Try to get rid of Pseudomonas from your lungs if this is the first time it has been found. It is usually used alongside another antibiotic to treat this, but can be used on its own.

OR

• Suppress the Pseudomonas to a low level. This is usually if previous attempts to get rid of it have not worked and it is causing you problems.
  
  Pseudomonas can also very occasionally be found in  patients with other lung problems such as COPD or asthma. The same treatment will be given for these cases.

Why is it important to try to suppress or get rid of Pseudomonas?

If Pseudomonas get in the airways of a patient with bronchiectasis (or the other conditions mentioned above) it can cause:

• Worse day-to-day symptoms of cough, breathlessness and sputum (phlegm) production.

• More frequent and longer chest infections or flare ups of your chest condition.

• More likely hospital admissions during a chest infection or flare up.

• The function of your lungs to get worse faster than they normally would.

If Pseudomonas can be removed or suppressed to a very low level, these problems can be avoided or minimised.

What checks will I have before I start this treatment?

It is important that we have given you the right training and prescribed you the right medicines before we ask you to take another medicine. Before we think about giving you colomycin, we will consider the following:

Chest Physiotherapist

We will make sure a Physiotherapist specialising in chest illnesses has seen you. They will assess you and teach you all the different techniques for coughing and clearing your chest effectively.

The Physiotherapist will also consider whether using a device known as a ‘flutter’ valve would make it easier for you to cough up   more phlegm.

If you have seen the Physiotherapist previously, we may ask you to have a “refresher” visit to the Physiotherapist while we organise your colomycin treatment.

Mucous clearing medicine

A group of medicines called “mucolytics” can help break down your phlegm and make it easier to cough up. In the UK, the most commonly used one is called carbocisteine. This is taken as a capsule or as a solution, 2 – 3 times daily.

It can be very effective and most people have mild or no side effects. There are some other mucolytics, such as erdosteine and N-acetyl-cysteine, but these are rarely used.

Carbocisteine does not directly treat pseudomonas, but it does help to manage it.

Other chest medicine

If you have asthma or COPD, we will make sure you are given the right inhalers and tablets. We will also make sure that you know how to take them.

Medicines and allergies

Your Doctor or team will check that colomycin will not interfere with any of your normal medicines. They will also make sure that you are not already allergic to colomycin, or any of its related drugs.

Smoking

Smoking makes your airways inflamed. Inflamed airways produce much more mucous than normal and it is often very sticky.

This mucous makes it harder for your normal medicines to get into your airways. This sticky mucous allows the pseudomonas to grow.

Stopping smoking helps cut down the amount of mucous your lungs are producing, making it harder for pseudomonas to grow. If you want to stop smoking, please let us know and we can make it easier for you to access the right help.

After we have checked these things, we will then need to check, it is safe for you to take this treatment and that you do not have any serious side effects. This is done by:

Colomycin spirometry trial

If you have very narrow airways, then it is not safe for you to take this treatment. Patients who have normal or less narrow airways may become very wheezy when they take nebulised colomycin. To make sure it is safe for you to take the treatment, we will arrange a test to see how you respond to this.

• Where? – This would take place in the Lung Health Department in University Hospital of North Tees.

• How? – You would have a test called spirometry (a strong “blow” test to measure the width of you airways) before and after taking a dose of nebulised colomycin. If after the dose your test results show no significant fall and you have not become wheezy or breathless, you would be suitable to start the treatment.

After the test, you will not be given the nebuliser and treatment immediately.

We will arrange for you to be contacted and given the equipment and training on how to use it later.

How will I get the nebuliser and other equipment?

Equipment and training

Your Consultant will be sent the result of your nebulised colomycin spirometry trial. They will then arrange for one of the COPD (Chronic Obstructive Pulmonary Disease) team to contact you. This team who deal with airflow and breathing related problems are responsible for organising this treatment for everyone who needs it.

They will then organise the nebuliser equipment. They will teach you to give yourself the treatment and maintain the equipment.

Medication

Your Consultant will contact your GP and ask them to put nebulised colomycin on your repeat prescription.

What strength or does will I take?

You will be taking 1 – 2 million international units of colomycin, twice daily.

How do I use nebulised colomycin?

Before starting to prepare your nebulised colomycin, you must use your reliever inhaler or nebuliser.

You should:

• Open the colomycin bottle by flipping the plastic cap off

• Carefully remove the foil seal from around the top of the bottle

• Carefully remove the rubber bung

• Open the container of Sodium Chloride (0.9%) by snapping the top off – Your vial bottle could look different to the one pictured.

• Use a 5ml syringe and draw up 4ml of the Sodium Chloride solution

• Add the 4ml of Sodium Chloride to the colomycin bottle by gently pressing the plunger down on the syringe

• Re-attach the rubber bung and mix the solution. Wait for the powder in the colomycin bottle to dissolve.

• Pour the contents of the colomycin bottle into the Ventstream nebuliser drug container.
  
  Do not put the colomycin into the nebuliser chamber until just before you need it, or it may not be effective, as these medications do not contain preservatives. Keep your nebuliser upright.

• Ask everyone to leave the room and, if possible, open any windows

• Fix the large aerosol hose to the nebuliser compressor and place the other end out of the window. This will allow any of the colomycin you breathe out, when nebulising, to be removed from the room and prevent other members of your household breathing in colomycin.
  
  It is best that other people avoid breathing in any chemicals unnecessarily.

• Place the mouthpiece into your mouth, or the mask over your nose and mouth and take normal steady breaths. Switch on your nebuliser and breathe in the nebulised colomycin for about 10 minutes.
  
  When using your nebuliser you should sit up straight. Do not talk while you are using your nebuliser.

• Rinse your mouth with water after taking your nebulised colomycin to prevent a mouth infection or a sore throat developing.

How long will it take?

It will take about 10 minutes for all of your medication to be delivered into your airways. When you hear a spluttering noise, continue to use your nebuliser for another minute.

Try to make sure that as much of your liquid medication as possible has been used up, even though there will always be a small amount left in the chamber.

Can I take any other medications while I am having this treatment?

You will continue to take all of your normal medicines as usual.

Very occasionally, some people feel wheezy after a few days of using nebulised colomycin.

If you are well otherwise and you are feeling the benefits of the treatment, we may consider giving you some medicine to counteract the wheeze. This is usually salbutamol (2.5mg) given by your nebuliser, 15 minutes before each dose of colomycin.

How long will I have this treatment for?

You will usually have the treatment for a minimum of 6 months. If you are feeling better and your health has improved, you will usually stay on it long term.

How will I be monitored while I am having this treatment?

COPD team

You will be contacted regularly by a member of the COPD team. They will make sure you are comfortable using the equipment and arrange for regular nebuliser servicing and supplies of new facemask and tubing.

Clinic

You will be seen regularly in the clinic to check how you are doing. You may have follow up breathing tests and X-rays as part of monitoring.

How will you know if the treatment is working?

Your Doctor and team will speak to you in clinic and will assess how you are responding to the treatment. They will look for the following as signs that the treatment is working:

• You are having fewer and shorter chest infections.

• Your sputum samples are no longer growing pseudomonas.

• Your cough is better.

• You are coughing up phlegm easily and feel that your chest is fully clear.

• Your breathing test results are better.

Are there any side effects I should know about?

Nebulised colomycin is inhaled into the lungs and the majority of it stays there. Only a small amount enters your blood stream, so the risk of side effects is very low.

Most people have no side effects, or only mild ones.

The possible side effects include:

Tell your COPD team as soon as possible, if you experience any side effects then stop the treatment and contact either the Consultant in charge of your case or the COPD team based at North Tees hospital.

If the effect occurs outside normal working hours (Monday to Friday 9 am to 5pm) contact 111 for further advice.

Will this treatment affect any other medicines I am taking?

This may look like a worrying list. The team looking after you will always check all of your medicine to make sure it does not cause problems.

• Some antibiotic types – Antibiotics from the groups of cephalosporins or aminoglycosides. The use of colomycin at the same time as an antibiotic from either of these groups can increase the risk of kidney and nerve problems.

• Muscle relaxing medicines – Specifically the type used during operations with general anaesthetics. Colomycin can increase or prolong the effects of these drugs.

• Myasthenia gravis (a condition where your muscles become weak) – If colomycin is used at the same time as antibiotics from the groups of macrolides or fluoroquinolones, it can make myasthenia gravis worse.

What should I do if I take too much nebulised colomycin?

You should phone your Doctor or Nurse immediately for advice. If they are not available, then you should make your way to the nearest accident and emergency department.

What should I do if I forget to take my nebulised colomycin?

Do not worry. You should just take your next dose as scheduled. The chance of your chest getting worse due to one missed dose is very small.

Will I still be able to have this treatment if I get a chest infection?

Yes, you can have any treatment you would normally get for a chest infection. It is safe to take antibiotics and steroid tablets while you are taking this treatment.

If you get a chest infection, you should keep taking your colomycin treatment unless any antibiotics or other treatment interacted with this medicine.

Stopping the treatment during a chest infection could mean it takes you longer to get better.

Will I be able to take this treatment if I am trying for a baby, pregnant or breast-feeding?

There is no evidence that colomycin reduces your fertility or makes it harder to get pregnant.

There is no evidence of any harm to mother or developing baby if colomycin is taken during pregnancy. As with all medicines and pregnancy, these should only be taken if they are absolutely necessary.

Breast feeding

A small amount of colomycin may enter the breast milk. The manufacturer advises to avoid breast-feeding while taking colomycin. Speak to your midwife if you have any concerns.

Is it safe to have an operation while I am having this treatment?

Yes, if you need an operation it should be safe. You should tell the Anaesthetist who is giving you the anaesthetic, as they may have to change the drugs they use.

Can I drink alcohol while I am having this treatment?

Yes, this is not usually a problem. We would recommend you stay within the national safe recommended intake of 2 units of alcohol per day, 14 units per week.

Will I need to take my nebulised colomycin with me if I am going on holiday?

Yes. If you are flying it is small enough to fit into luggage, hold or carry-on as it is not pressurised.

It is a good idea to take a clinic letter or some other document that will let people know why you are taking this treatment and who has prescribed it. This will also help if you become unwell, or are admitted to hospital while you are on holiday.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

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Email: [email protected]

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Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1395
Date for review: 08/12/2024