TY - JOUR T1 - Role of inhaled antibiotics in the era of highly effective CFTR modulators JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0154-2022 VL - 32 IS - 167 SP - 220154 AU - J. Stuart Elborn AU - Francesco Blasi AU - Pierre-Régis Burgel AU - Daniel Peckham Y1 - 2023/03/31 UR - http://err.ersjournals.com/content/32/167/220154.abstract N2 - Recurrent and chronic bacterial infections are common in people with cystic fibrosis (CF) and contribute to lung function decline. Antibiotics are the mainstay in the treatment of exacerbations and chronic bacterial infection in CF. Inhaled antibiotics are effective in treating chronic respiratory bacterial infections and eradicating Pseudomonas aeruginosa from the respiratory tract, with limited systemic adverse effects. In the past decade, highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulators have become a new therapy that partially corrects/opens chloride transport in patients with selected CFTR mutations, restoring mucus hydration and improving mucociliary clearance. The recent triple CFTR modulator combination is approved for ∼80–90% of the CF population and significantly reduces pulmonary exacerbations and improves respiratory symptoms and lung function. CFTR modulators have shifted the focus from symptomatic treatment to personalised/precision medicine by targeting genotype-specific CFTR defects. While these are highly effective, they do not fully normalise lung physiology, stop inflammation or resolve chronic lung damage, such as bronchiectasis. The impact of these new drugs on lung health is likely to change the future management of chronic pulmonary infections in people with CF. This article reviews the role of inhaled antibiotics in the era of CFTR modulators.Studies are needed to determine whether discontinuing maintenance therapy is safe in people with cystic fibrosis receiving CFTR modulators. Until then, people with CF are recommended to continue their prescribed medications, including antibiotic therapy. https://bit.ly/3ML3nYw ER -