cystic fibrosis patients on maintenance treatment with 2.5 mL dornase alfa once daily
Interventions
patients on maintenance treatment with 2.5 mL dornase alfa once daily were switched to a smart nebuliser and randomised to small airway deposition (n = 24) or large airway deposition (n = 25) for 4 weeks.
Outcome measures
The primary outcome parameter was forced expiratory flow at 75% of forced vital capacity (FEF(75%)).
Main results
FEF(75%) increased significantly by 0.7 sd (5.2% predicted) in the large airways group and 1.2 sd (8.8% pred) in the small airways group. Intention-to-treat analysis did not show a significant difference in treatment effect between groups. Per-protocol analysis, excluding patients not completing the trial or with adherence <70%, showed a trend (p = 0.06) in FEF(75%) Z-score and a significant difference (p = 0.04) between groups in absolute FEF(75%) (L . s(-1)) favouring small airway deposition
Authors' conclusions
Improved delivery of dornase alfa using a smart nebuliser that aids patients in correct inhalation technique resulted in significant improvement of FEF(75%) in children with stable cystic fibrosis. Adherent children showed a larger treatment response for small airway deposition.
Keywords: Deoxyribonuclease; Airway clearance drugs -expectorants- mucolytic- mucociliary-; pharmacological_intervention; Respiratory System Agents; non pharmacological intervention - devices OR physiotherapy; Inhalation OR nebulised; nebuliser; Dornase alpha; Pulmozyme;