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Background There are no published data on real-life clinical experience comparing inhaled antibiotic therapy via new rapid delivery systems with nebulised antibiotic therapy in CF. This real world study compares safety, effectiveness and tolerability using tobramycin inhaled powder (TIP) versus tobramycin inhaled solution (TIS). Methods Adult patients with CF commencing TIP ( n = 78) completed a questionnaire assessing safety, efficacy, tolerability, patient-satisfaction and self-reported adherence to TIS at baseline and during 12 months of TIP therapy. FEV 1 % predicted and exacerbation rate were recorded at each visit. Results There was a significant improvement in adherence scores, with a significant decrease in the number of intravenous antibiotic courses received during 12 months of TIP compared with the preceding 12 months using TIS. 94% of patients who had previously used TIS preferred TIP therapy over TIS. Conclusions Inhaled powder tobramycin in CF is associated with improved adherence, tolerability and decreased exacerbation rates compared to nebulised treatment in real-life practice. [ABSTRACT FROM AUTHOR]

A 2-year whole-farm system study compared the accumulation, utilization and nutritive value of grass in spring-calving grass-based systems differing in stocking rate ( SR) and calving date ( CD). Six treatments (systems) were compared over two complete grazing seasons. Stocking rates used in the study were low (2·5 cows ha−1), medium (2·9 cows ha−1) and high (3·3 cows ha−1), respectively, and mean CDs were 12 February (early) and 25 February (late). Each system had its own farmlet of eighteen paddocks and one herd that remained on the same farmlet area for the duration of the study. Stocking rate had a small effect on total herbage accumulation (11 860 kg DM ha−1 year−1), but had no effect on total herbage utilization (11 700 kg DM ha−1 year−1). Milk and milk solids ( MS; fat + protein) production per ha increased by 2580 and 196 kg ha−1 as SR increased from 2·5 to 3·3 cows ha−1. Milk production per ha and net herbage accumulation and utilization were unaffected by CD. Winter feed production was reduced as SR increased. Increased SR, associated with increased grazing severity, resulted in swards of increased leaf content and nutritive value. The results indicate that, although associated with increased milk production per ha, grazed grass utilization and improved sward nutritive value, the potential benefits of increased SR on Irish dairy farms can only be realized if the average level of herbage production and utilization is increased. [ABSTRACT FROM AUTHOR]

Objective CF is associated with altered digestive function and thus nutrient availability for gut microbes in addition to altered gut microbiota, compared with healthy controls. Equally intensive antibiotic and nutritional therapy may further compound this. We present results from the largest CF gut microbiota study to date. Methods The gut microbiota of 43 stable adults with CF was compared to 69 age-matched controls. DNA was extracted from faecal samples and the V4 region of the 16S rRNA gene was sequenced using 454-pyrosequencing. Results were correlated with baseline %FEV 1 results and to total courses of IVs in the previous 12 months. Results The gut microbiota diversity of patients with CF was significantly reduced compared to controls (p<0.05 for all a diversity tests). Significantly increased proportions of Firmicutes (p = 0.029) and decreased Bacteroidetes (p<0.001) occurred in those with CF compared to controls. There were significant reductions in proportions of bacteria associated with gut health in those with CF, including decreased Faecalibacterium, Roseburia and Bifidobacterium (p<0.001). A negative correlation between the number of IV courses and gut diversity [Simpson's diversity index: correlation coefficient (r) = –0.383, p = 0.0111] and a positive correlation between FEV 1 and gut diversity (Simpson's diversity index: r = 0.47, p = 0.0015) was found in those with CF. Conclusion This study highlights that patients with CF have an altered gut microbiota which correlates with clinical outcomes. Further longitudinal studies will enable us to interrogate the causality of such microbiota alterations and determine the potential role of probiotics in CF therapy. [ABSTRACT FROM AUTHOR]