Nebulizer Care and Inhalation Technique in Children with Cystic Fibrosis

Abstract

Nebulizers are used by the great majority of cystic fibrosis patients for delivery of cornerstone treatments. Inhalation technique and adequate disinfection and maintenance are important for optimizing medication delivery. In this study, inhalation technique and nebulizer disinfection/maintenance were assessed in cystic fibrosis patients by direct observation in clinic and completion of a scoring sheet. A total of 108 patients were recruited. The maximum inhalation technique score was attained by 30.5% and adequate inhalation technique score by 74.08% of patients. The inhalation technique score was best with the vibrating mesh nebulizer (p = 0.038), while patient age and number of nebulized medications did not affect ITS significantly (p > 0.05). Nebulizer disinfection/maintenance score was excellent in only 31.48%. Most families kept the nebulizer clean and used appropriate disinfection method, but only half of them replaced the nebulizer and nebulizer cup at the recommended time intervals. Nebulizer disinfection/maintenance score was positively affected by a number of nebulized medications and negatively by years of equipment use (p = 0.009 and p = 0.001, respectively). Even though inhalation technique and disinfection/maintenance practices were found to be adequate in a large proportion of cases, there is still a need for regular review and education. The type of nebulizer was associated with improved inhalation technique, but more data are required before making specific recommendations.

Caregiver burden in cystic fibrosis: a systematic literature review

“…Following diagnosis, caregivers, who are usually a parent or close family member, are required to carry out or assist with daily treatments, such as physiotherapy to clear static mucus from the respiratory tract 4 and the administration of nebulized treatments, along with many other different medications to treat and prevent organ damage. 5 These therapies are intended to alleviate symptoms and reduce the severity of respiratory events, such as exacerbations and infections, 6 but are time-consuming. Children with CF spend an average of 75 min/day receiving treatment, 7 which must be performed by caregivers in addition to other familial and occupational commitments.…”

The effects of nebulizer hygiene training on the practices of cystic fibrosis patients and caregivers

“…Current study showed that 80% of the patients were using their nebulizers longer than the recommended time period. Prolonged use of the nebulizer can cause fissures on the surface which makes cleaning and disinfection process less effective and increase the risk of contamination 19,30 . In addition, it is also important to replace the nebulizer every 6 months per manufacturer recommendations because the nebulizer parts begin to wear down and that impacts particle size which will cause a reduction in medication dose administered.…”