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Inhalation of antibiotics against Pseudomonas aeruginosa slows the decline in lung function and increases survival in patients with cystic fibrosis. The Pari LC Plus is the breath enhanced nebuliser most commonly used for administering aerosolised antibiotics. Drug delivery can be lengthy and unpredictable. The HaloLite analyses the patient’s respiratory cycle, delivering a pulse of drug during the initial phase of inspiration.
This randomised crossover trial examined the delivery of nebulised colomycin by the HaloLite and Pari LC Plus nebulisers in 15 patients with cystic fibrosis. Patients were initially assessed for lung deposition of 1 mega unit of radiolabelled colomycin following nebulisation to dryness with the Pari and following a 1 button press dose from the HaloLite (manufacturer’s recommended dose). Sputum colomycin levels and Pseudomonas load were assayed after 1 week with each nebuliser in turn.
There was greater lung uptake of colomycin with the Pari nebuliser, but lung uptake calculated as a percentage of total drug used was significantly lower and nebulisation time was longer. Sputum levels of colomycin were higher following use of the Pari nebuliser but there was no significant difference in sputum Pseudomonas loads between the delivery systems, although the authors accept this may represent a less reliable method of measurement than the radionuclide assay.
The concept of adaptive aerosol delivery is advantageous, but dose modification may be required for the HaloLite to improve effectiveness. This study emphasises the need for objective assessment of individual nebuliser devices with specific drugs used in patients with cystic fibrosis.