Lung function in adult patients with cystic fibrosis after using the eFlow®rapid for one year

Naehrig S, Schiffl H, Fischer, Lang S, Huber Rm, Fischer R

Description

The new generation nebuliser PARI eFlow ® rapid allows a highly efficient aerosol delivery at reduced inhalation time. However, lung function data during long-term use of this device are not available until now. Methods 70 clinically stable adult cystic fibrosis patients participated in this observation study. Lung function tests were performed prospectively 12 weeks after and again 9 to 12 months after switching the inhalation device from a conventional jet nebulizer to the PARI eFlow ® rapid. Lung function data were collected retrospectively from the visits 1 year as well as 12 weeks prior to the switch-over. Lung function data for all time points were only available for 59 patients. Treatment time and patient's satification were recorded for both conventional and new nebuliser in all 70 patients. Results After 1 year of inhalation with eFlow ® rapid, the mean change in FEV1% was -- 1.4% (n = 59 patients). The decrease in FEV1 was smaller than the change in FEV1 after 1 year of inhalation with the conventional jet nebuliser (control period, -3.1%), although this difference was not statistically significant. The same effect was seen in MEF25[%] '(-2.6% with conventional nebuliser compared to --1.6% after eFlow ® rapid). Concerning the FVC, there was a greater improvement after 1 year of inhalation with the eFlow ® rapid than with the jet nebuliser (+ 2.9% vs. +1.1%). For PEF%, there was an increase during the control period, whereas after inhalation with eFlow ® rapid there was a decrease (+1.1% vs. --2.9%). All changes were not significantly different. The eFlow ® rapid reduced total daily inhalation time by two-thirds (conventional nebuliser: 31.1 min/day; eFlow ® rapid: 10.2 min/day, n = 70 patients) Conclusion Inhalation with the new nebuliser eFlow rapid does not alter FEV1, FVC or PEF significantly after 1 year of inhalation. The treatment time could be reduced significantly by the eFlow ® rapid.

Sujets

• Cystic fibrosis
• Inhalation
• Nebulizer
• Spirometry

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 7
• Langue: English

Extrait

FeBrUarY 24, 2011

EUr J MeD ReS (2011) 16: 63-66

EuRoPEAn JouRnAL oF MEdIcAL REsEARcH

63 © I. HOlzapfel PUBliSherS 2011

L ung F unctIon In A duLt P AtIEnts wItH c ystIc F IbRosIs AFtER ® u sIng tHE E F Low RAPIdFoR o nE y EAR

1 23 11 s. naehriG , s. LaNG , H. sChiffl , R. M. HUBer , R. FiSCher

1 ceNTer fOr ADUlT cYSTiC FiBrOSiS PaTieNTS, deparTmeNT Of PNeUmOlOGY, MeDiziNiSChe KliNik INNeNSTaDT, uNiverSiTY Of MUNiCh, 2 sRH walD-KliNikUm gera gmBH, INNere MeDiziN II, gera, 3 KUraTOriUm für HämODialYSe, MüNCheN, germaNY

Abstract Backgr ound:the NeW GeNeraTiON NeBUliSer PARI ® eFlOW rapiDallOWS a hiGhlY effiCieNT aerOSOl DeliverY aT reDUCeDiNhalaTiON Time. HOWever, lUNG fUNCTiON DaTa DUriNG lONG-Term USe OfThiS DeviCe are NOT avail- aBle UNTil NOW. Methods:70 CliNiCallY STaBle aDUlT CYSTiC fiBrOSiS pa- TieNTS parTiCipaTeD iN ThiS OBServaTiON STUDY. LUNG fUNCTiON TeSTS Were perfOrmeD prOSpeCTivelY 12 WeekS afTer aND aGaiN 9 TO 12 mONThS afTer SWiTChiNG The iN- halaTiON DeviCe frOm a CONveNTiONal jeT NeBUlizer TO ® The PARI eFlOWrapiD. LUNG fUNCTiON DaTa Were COl- leCTeD reTrOSpeCTivelY frOm The viSiTS 1 Year aS Well aS 12 WeekS priOr TO The SWiTCh-Over. LUNG fUNCTiON DaTa fOr all Time pOiNTS Were ONlY availaBle fOr 59 paTieNTS. treaTmeNT Time aND paTieNT’S SaTifiCaTiON Were reCOrD- eD fOr BOTh CONveNTiONal aND NeW NeBUliSer iN all 70 paTieNTS. ® Results:AfTer 1 Year OfiNhalaTiON WiTh eFlOWrapiD, The meaN ChaNGe iN FEV1% WaS – 1.4% (N = 59 pa- TieNTS). the DeCreaSe iN FEV1 WaS Smaller ThaN The ChaNGe iN FEV1 afTer 1 Year OfiNhalaTiON WiTh The CONveNTiONal jeT NeBUliSer (CONTrOl periOD, -3.1%), al- ThOUGh ThiS DiffereNCe WaS NOT STaTiSTiCallY SiGNifiCaNT. the Same effeCT WaS SeeN iN MEF25[%] (-2.6% WiTh CONveNTiONal NeBUliSer COmpareD TO –1.6% afTer ® eFlOW rapiD).cONCerNiNG The FVc, There WaS a GreaTer imprOvemeNT afTer 1 Year OfiNhalaTiON WiTh ® The eFlOWrapiD ThaN WiTh The jeT NeBUliSer (+ 2.9% vS. +1.1%). FOr PEF%, There WaS aN iNCreaSe DUriNG The CONTrOl periOD, WhereaS afTer iNhalaTiON WiTh ® eFlOW rapiDThere WaS a DeCreaSe (+1.1% vS. –2.9%). All ChaNGeS Were NOT SiGNifiCaNTlY DiffereNT. the ® eFlOW rapiDreDUCeD TOTal DailY iNhalaTiON Time BY TWO-ThirDS (CONveNTiONal NeBUliSer: 31.1 miN/DaY; ® eFlOW rapiD:10.2 miN/DaY, N = 70 paTieNTS) Conclusion:INhalaTiON WiTh The NeW NeBUliSer eFlOW rapiD DOeS NOT alTer FEV1, FVc Or PEF SiGNifiCaNTlY afTer 1 Year OfiNhalaTiON. the TreaTmeNT Time COUlD Be reDUCeD SiGNifiCaNTlY BY The eFlOW® rapiD.

Key words:cYSTiC fiBrOSiS, iNhalaTiON, NeBUliSer, eFlOW®rapiD, iNhalaTiON Time, lUNG fUNCTiON

I ntRoductIon :

cYSTiC fiBrOSiS iS a mUlTiOrGaN DiSeaSe iN WhiCh reSpira- TOrY failUre aCCOUNTS fOr NearlY 85 % OfThe mOrTaliTY.

LUNG DeSTrUCTiON iS CaUSeD BY OBSTrUCTiON OfThe air- WaYS DUe TO DehYDraTeD, ThiCkeNeD mUCUS, BY reSUlTaNT eNDOBrONChial iNfeCTiON, aND aN exaGGeraTeD iNflamma- TOrY reSpONSe leaDiNG TO DevelOpmeNT OfBrONChieCTa- SiS aND prOGreSSive OBSTrUCTive pUlmONarY DiSeaSe. AG- GreSSive mUlTimODal maNaGemeNT OfThe CYSTiC lUNG DiSeaSe haS reSUlTeD iN GreaT imprOvemeNTS iN leNGTh aND qUaliTY Oflife [1]. the DeliverY OfaerOSOlizeD meDiCaTiON BY NeBUliSer iS aN impOrTaNT parT OfpharmaCOTherapY fOr maiNTe- NaNCe OflUNG fUNCTiON iN CYSTiC fiBrOSiS [2]. the USe Of iNhaleDaerOSOlS prOviDeS a SeleCTive TreaTmeNT Of The lUNGS aS hiGh DrUG CONCeNTraTiONS CaN Be aChieveD iN The airWaYS WiThOUT majOr SYSTemiC aDverSe eveNTS. cUrreNTlY, The mOST COmmON NeBUliSerS are COm- preSSeD air DriveN jeT NeBUliSerS, e.G. The aDvaNCeD BreaTh eNhaNCeD NeBUliSerS PARI Lc PlUS Or PARI Lc sTar. ReCeNTlY, NeW TeChNOlOGieS have emerGeD BaSeD ON a perfOraTeD viBraTiNG memBraNe. the mOTiON Of The memBraNe iS CreaTeD BY aN aNNUlar piezO-eleCTriC elemeNT, ThUS exTrUDiNG liqUiD via The laSer DrilleD per- fOraTeD memBraNe aND DiSperSiNG iT iNTO fiNe reGUlarlY SizeD DrOpleTS. the NeW eleCTrONiC NeBUliSer Pari ® eFlOW rapiDmaY repreSeNT a SiGNifiCaNT aDvaNCe iN aerOSOl DeliverY TO The lUNGS, aS The variaTiON Of DrOpleT Size iS SiGNifiCaNTlY lOWer áS WiTh CONveNTiONal jeT NeBUliSerS. the reSpiraBle fraCTiONS are COmparaBle (71.3% WiTh eFlOW, 70.1% WiTh Lc PlUS). wiTh The ® eFlOW ,TreaTmeNT Time CaN Be reDUCeD SiGNifiCaNTlY frOm 17.4 miNUTeS TO 6.0 miNUTeS fOr tOBramYCiN aND frOm 4.4 miNUTeS TO 1.6 miNUTeS fOr SalBUTamOl, al- ThOUGh iN ThaT STUDY The iNhaleD vOlUmeS Were NOT ex- aCTlY The Same [3]. therefOre leSS Time BUrDeN miGhT imprOve TreaTmeNT aDhereNCe. HOWever, liTTle iS kNOWN aBOUT The lONG-Term effeCT OfThiS NeW TeChNOlOGY ON lUNG fUNCTiON iN cF paTieNTS. ® AfTer The laUNCh OfThe eFlOWrapiD iN germaNY iN earlY 2005, mOST OfOUr paTieNTS aSkeD fOr a preSCrip- TiON fOr The NeW iNhalaTiON DeviCe DUriNG Their rOUTiNe viSiTS. thiS STUDY aSSeSSeD lONG-Term lUNG fUNCTiON Over 12 mONThS iN ThOSe paTieNTS WiTh CYSTiC fiBrOSiS WhOSe healTh iNSUraNCe COmpaNieS permiTTeD The preSCripTiON ® aND TherefOre COUlD USe The eFlOWrapiD.

M AtERIALs And M EtHods

Patients: thiS prOSpeCTive OBServaTiONal STUDY WaS CONDUCTeD aT