New nebulizer technology to monitor adherence and nebulizer performance in cystic fibrosis

Topical delivery of aerosolized therapies is an established treatment for chronic airway infection and inflammation in cystic fibrosis (CF). Recent developments in nebuliser technology have enabled Adaptive Aerosol Delivery (AAD) of mesh generated aerosol particles resulting in more efficient airway deposition than existing jet nebulizers. An additional feature of these new devices is the ability to record and examine the performance of the device by downloading stored data (electronic data capture). In a series of studies we have used this downloading facility to monitor treatment times and examine adherence to nebulizer therapy in our pediatric patients. We found routine adherence monitoring is possible in busy CF clinic. We have shown that good adherence to treatment can be maintained in both patients chronically infected with Pseudomonas aeruginosa on long-term therapy, and in patients with first/new growths of Pseudomonas on short-term eradication therapy. When adherence was examined from an individual perspective, we demonstrated a wide variation both between and within individual patients. A further modification of AAD technology, Target Inhalation Mode (TIM) optimises patient inhalations through a direct feedback mechanism. This new breathing mode has also been evaluated in our pediatric CF clinic in a recent randomized controlled trial (RCT) and we have shown that children maintain adherence to treatment through the TIM mouthpiece and average treatment times reduced from 6.9 to 3.7 min when using TIM. This is a new era of aerosol delivery and novel advances in medical devices need to be monitored and assessed rigorously, particularly as new and potentially expensive therapies emerge from translational studies. Electronic data capture enables CF teams to work in an open partnership with patients to achieve the common goals of improving drug delivery and reducing patient burden.