Nebulised treatments
A nebuliser/compressor delivers a mist of drug solution that is inhaled directly in to the lungs. It is important that nebulisers are serviced regularly and kept clean so that they deliver drugs as prescribed. Nebulised drugs will usually be planned around physiotherapy sessions. It is convenient to set aside a time in the morning and evening of each day to do everything at once particularly if several drugs have to be given twice a day and physiotherapy has to be done twice a day as well. Some nebulised drugs must be given at least an hour before physiotherapy, some just before and some are best given when the lungs are clear.
Note that nebulised drugs cannot be mixed together and they may not be given at the same time. Depending on the brand of nebuliser each nebulised drug may take 3-4 minutes or 15 minutes to give and the drugs must be spaced out around the physiotherapy twice a day for example:
- rhDNase (Pulmozyme) –at least 1 hour prior to physiotherapy
- Bronchodilator (Salbutamol) – 10-15 minutes prior
- Hypertonic saline – immediately prior
- Steroids and antibiotics - after physiotherapy
Nebulised drugs tend to be given to school age children for whom the minimum recommended daily amount of physiotherapy is 10-15 minutes twice daily. Nebulised treatments are often twice daily also. This makes the nebulised drug/ physiotherapy routine a significant time commitment each day.
Nebulised drugs are given to:
1. Help clear sputum from the lungs, usually by diluting it to make it easier to cough up.
2. Antibiotics to prevent or treat infection with organisms that cause infection and lung damage in children with cystic fibrosis.
Nebulised treatments to aid clearance of sputum
- Pulmozyme (rhDNase) is a synthetic enzyme which aims to make sputum thinner making it easier to cough up. It tends to be used when the FEV1 is 70% or less than normal and the response to it is variable. It may be used in children with milder disease if there is a need for intravenous antibiotics and evidence of small airways disease on lung function. May be used daily or on alternate days and must be taken at least an hour before physiotherapy.
- Hypertonic saline is a concentrated salt solution that can be used to encourage coughing up of sputum. For example in a child who has a rattly cough who produces no sputum. It is given just before physiotherapy, up to twice daily.
- Bronchodilator used to counteract bronchoconstricting effect of other nebulised drugs (e.g. salbutamol). This is a bronchodilator used in asthma, it may be used in children without asthma who have cystic fibrosis to counteract the bronchoconstricting effect of hypertonic saline or other nebulised drug treatments that are being used.
Nebulised antibiotics
Are mainly used to treat colonisation with different organisms to prevent episodes of active infection (exacerbations) and reduce long term lung damage due to these. Some typical combinations are listed below:
- Gentamicin and Colistin (antibiotics, gentamicin and polymixin E)
- Double dose Colistin and Gentamicin (antibiotics, polymixin E and gentamicin)
- Nebulised TOBI (tobramycin an antibiotic) or
- Colistin (polymixin E an antibiotic) or
- Amphotericin (nebulised antifungal used to treat Aspergillosis)
- Amikacin (nebulised antibiotic used for mycobacterium infections)
