• Cystic Fibrosis

Cystic fibrosis (CF) airways disease is unique, with chronic infection causing a localised but intense inflammatory process, acute in nature, but lasting for years.1 Prevention, eradication and suppression of airway infection have been the cornerstones of CF management, and success with these strategies has been a key factor in improving the outlook for people with CF.2 An armamentarium is available to achieve this goal, including a variety of aerosolised therapies. The evidence base to support these therapies ranges from good to poor.3 ,4 Individual patients respond uniquely, with therapeutic strategies working for some but not for others. It is complicated, and a team approach (including the patient) is essential to deliver the best regimen for each individual. What we do know with some certainty is that an aerosolised therapy does not work if it stays in the box or at the pharmacy.

Sustaining time-consuming treatments is a difficult challenge for people with CF. Recent innovations in aerosol delivery have provided some help. Devices that generate aerosol through mesh technology have reduced treatment times and improved deposition.5 ,6 Some devices, by monitoring inspiratory and expiratory flow, provide a pulsed delivery that synchronises with the respiratory cycle to optimise lower airway deposition.7 In a randomised controlled trial, we were able to show that the addition of a simple manoeuvre to guide breathing with such a device (a vibration at the end of inspiration) reduced treatment times to 3–4 min.8 Reduction in treatment time was associated with maintenance of adherence, which faltered in the control group.

A feature of these new types of adaptive aerosol delivery devices is that data can be downloaded that record the performance of the device.9 Electronic data …