Effect of High-Frequency Chest Wall Oscillation on the Central and Peripheral Distribution of Aerosolized Diethylene Triamine Penta-acetic Acid as Compared to Standard Chest Physiotherapy in Cystic Fibrosis: Conclusions

Effect of High-Frequency Chest Wall Oscillation on the Central and Peripheral Distribution of Aerosolized Diethylene Triamine Penta-acetic Acid as Compared to Standard Chest Physiotherapy in Cystic Fibrosis: ConclusionsWhen comparing the severity of obstruction (FEV1 percentage of predicted, FVC percentage of predicted, FEV1/FVC) with the mean C/P ratio, we could not demonstrate the expected inverse correlation between these two variables. This, in part, may be because the range of lung function for our population was somewhat narrower. Our population contained patients with more severe disease not uncommon in adults with CF (Table 1). Hence, in this population, differences in lung function may not play as great a role in determining drug deposition. Investigations with larger numbers of patients in different subgroups of obstruction are necessary to analyze this further. further
Aerosolized medications are becoming an increasingly important component of the treatment regimen for CF patients. To reduce chronic Pseudomonas colonization, aerosolized aminoglycosides are commonly administered to CF patients, thus providing high concentrations of antibiotics to the lungs without concomitant systemic toxicity. Currently, an aminoglycoside formulated specifically for inhalation therapy (TOBI; Chiron Corporation; Seattle WA) is approved for endobronchial suppressive therapy. Ilowite et al showed that increased sputum concentration of the administered aerosolized aminoglycoside correlated with enhanced central deposition, reflecting poor peripheral deposition. A relatively small percentage of the nebulized medication was actually delivered to the lung. Results further suggested that the amount delivered is highly variable and is dependent on many factors, including the breathing pattern. This underscores the importance of understanding the effects of delivery systems and therapy combinations on aerosol deposition. As the treatment of CF, as well as other diseases, becomes more dependent on the appropriate administration of aerosolized medications, further studies are necessary to distinguish which modalities enhance or hinder their delivery.
CF patients will continue to depend on airway clearance techniques and aerosol medications for management of pulmonary complications. HFCWO is an effective form of chest physiotherapy that allows CF patients more independence, and when combined with administration of aerosol therapy simplifies their lives. In order to improve the quality of life by increasing independence and decreasing treatment time, many CF patients in our center self-initiated combining HFCWO with their aerosolized medications.
The sample size for our study was small; however, our results offer preliminary reassurance to care providers and their patients that combining these treatment modalities can be done safely without concern for diminished deposition to the peripheral airways. Further study is necessary to better understand these interventions, to identify combinations and newer protocols that may enhance delivery of aerosolized medications to the peripheral airways, and to determine whether distribution is affected by additional factors, including severity of obstruction.

This entry was posted in Cystic Fibrosis and tagged aerosol, airway clearance, central to peripheral deposition ratio, chest physiotherapy, cystic fibrosis, high-frequency chest wall oscillation, pulmonary, Xe.