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Improvement of nebulised antibiotic delivery in cystic fibrosis
D Wilson1, M Burniston, E Moya
1Department of Medical Physics, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. djw@medphys.clara.net
Insights
Smaller nebulizer particles improve lung antibiotic distribution in cystic fibrosis (CF) patients, reducing stomach deposition. However, faster delivery systems like Ventstream may offer greater overall lung delivery despite less homogenous distribution.
Area of Science:
- Pulmonary Medicine
- Pediatric Respiratory Care
- Medical Device Technology
Background:
- Cystic Fibrosis (CF) management often involves nebulized antibiotics for lung infections.
- Nebulizer system performance, including particle size and delivery rate, impacts drug deposition.
- Optimizing nebulizer use is crucial for effective CF treatment in children.
Purpose of the Study:
- To compare deposition patterns of nebulized antibiotics in children with CF using two different nebulizer systems.
- To assess and compare the delivery rates of the Ventstream and Optimist nebulizer systems.
Main Methods:
- Radioisotope scans using technetium-99m labeled antibiotic aerosol were performed on 33 children with CF.
- Two nebulizer systems, Ventstream (MMD 3.3 µm, 0.075 ml/min) and Optimist (MMD 1.8 µm, 0.02 ml/min), were evaluated.
- Lung deposition inhomogeneity and stomach deposition were quantified; 20 patients used both devices.
Main Results:
- The Optimist nebulizer (smaller particle size) showed significantly lower inhomogeneity scores (3.5 vs. 5.4) and reduced stomach deposition (1.6% vs. 11.8%).
- Ventstream nebulizer demonstrated a faster delivery rate, approximately 2.8 times that of the Optimist.
- A significant inverse relationship was observed between patient height and stomach deposition (r = 0.69).
Conclusions:
- Smaller nebulizer particle size leads to more homogeneous lung antibiotic distribution and less systemic absorption in CF patients.
- Despite better homogeneity, the Ventstream's higher delivery rate may result in greater overall antibiotic deposition in the lungs.
- Nebulizer choice in CF treatment should balance particle size, delivery efficiency, and desired lung deposition.
Aim:
To investigate deposition patterns and to assess the delivery rate of two nebuliser systems in children with cystic fibrosis (CF).
Methods:
Thirty 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 microm; 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 microm; delivery rate, 0.02 ml/min).
Results:
The 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.
Implications:
A 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.