Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis.

Elena Fernández Fernández,Andrew O’Sullivan,Mary Joyce,Ronan Macloughlin

doi:10.3390/antibiotics10050472

Elena Fernández Fernández, Andrew O’Sullivan + Show 2 more

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https://doi.org/10.3390/antibiotics10050472

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Abstract

Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF). CF patients inhale antibiotics regularly as treatment against persistent bacterial infections. The goal of this study was to investigate the effect of clinical intervention on aerosol therapy during the escalation of care using a bench model of adult CF. Droplet size analysis of selected antibiotics was completed in tandem with the delivered aerosol dose (% of total dose) assessments in simulations of various interventions providing oxygen supplementation or ventilatory support. Results highlight the variability of aerosolised dose delivery. In the homecare setting, the vibrating mesh nebuliser (VMN) delivered significantly more than the jet nebuliser (JN) (16.15 ± 0.86% versus 6.51 ± 2.15%). In the hospital setting, using VMN only, significant variability was seen across clinical interventions. In the emergency department, VMN plus mouthpiece (no supplemental oxygen) was seen to deliver (29.02 ± 1.41%) versus low flow nasal therapy (10 L per minute (LPM) oxygen) (1.81 ± 0.47%) and high flow nasal therapy (50 LPM oxygen) (3.36 ± 0.34%). In the ward/intensive care unit, non-invasive ventilation recorded 19.02 ± 0.28%, versus 22.64 ± 1.88% of the dose delivered during invasive mechanical ventilation. These results will have application in the design of intervention-appropriate aerosol therapy strategies and will be of use to researchers developing new therapeutics for application in cystic fibrosis and beyond.

Highlights

Cystic fibrosis (CF) is one of the most commonly diagnosed genetic diseases worldwide
The result of droplet size characterisation for a selection of commonly nebulised antibiotic formulations using the Aerogen Solo vibrating mesh nebuliser are presented in Table 1 below
This would indicate that whilst some differences are noted between formulations, they all remain within the respirable range

Summary

Introduction

Cystic fibrosis (CF) is one of the most commonly diagnosed genetic diseases worldwide It is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene [1]. The production of sticky mucus in the lumen of the lungs impedes mucociliary clearance [5] This manifests as chronic inflammation and recurrent bacterial infections by pathogens such as Pseudomonas aeruginosa and Staphylococus aureus [6]. Survival of patients with CF has continued to improve to a median age of 46.2 years This has resulted in a rapid increase in the adult CF population and complications arising from the disease are becoming more common [9]. Nebuliser performance is a key factor when optimising the delivery of inhaled medications

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