Improvement of nebulised antibiotic delivery in cystic fibrosis
a Department of
Medical Physics, St James's University Hospital, Beckett Street, Leeds
LS9 7TF, UK, b Regional Paediatric Cystic
Fibrosis Unit, St James's University Hospital, c Department of Radiology, St James's
University Hospital
Correspondence to: Dr Wilson. email: djw{at}medphys.clara.net
Accepted 5 October
1998
AIM
To investigate
deposition patterns and to assess the delivery rate of two nebuliser
systems in children with cystic fibrosis (CF).
METHODSThirty three
children with CF on regular treatment with nebulised antibiotics had
radioisotope scans performed using technetium-99m labelled aerosol
antibiotic generated by a Ventstream nebuliser (median mass diameter
(MMD), 3.3 µm; delivery rate, 0.075 ml/min) under conditions
similar to their routine home practice. The inhomogeneity of the images
was scored on a 1-10 rating scale (a low score indicating even
distribution of the antibiotic), and stomach deposition was measured as
a percentage of overall deposition. Twenty patients had a repeat scan
using an Optimist nebuliser (MMD, 1.8 µm; delivery rate,
0.02 ml/min).
RESULTSThe mean
inhomogeneity scores were 5.4 in the Ventstream group and 3.5 in the
Optimist group. Mean stomach deposition was 17.3% in the 33 patients
using the Ventstream nebuliser. There was an inverse relation between
height and stomach deposition (r = 0.69).
In the 20 patients who had both nebulisers, the mean percentages of
stomach deposition for the Ventstream and Optimist nebulisers were
11.8% and 1.6%, respectively. The Ventstream nebuliser delivered
antibiotic at an average 2.8 times faster rate than the Optimist nebuliser.
IMPLICATIONSA smaller
particle size results in a more homogenous distribution of the
antibiotic in the lungs with decreased stomach deposition. This should
not be seen as a recommendation to use the Optimist nebuliser because
more antibiotic was delivered to most parts of the lung with the
Ventstream because of its increased delivery rate.
© 1999 by Archives of Disease in Childhood
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