Nebuliser therapy in patients with cystic fibrosis

The lack of effective removal of mucus initiates and exacerbates the lung disease cystic fibrosis and gives rise to the inability to prevent and eradicate the bacterial infection effectively.

In cystic fibrosis, inhalation therapy improves:

• The properties and mobility of the mucus
• The hydration of the airway surface
• Mucociliary clearance and pulmonary function

Aerosol therapy

Aerosol therapy is a treatment method based on administering substances in aerosol form by inhalation. An aerosol is a stable suspension of solid or liquid particles in the air, like oxygen.

The main advantage of aerosol therapy is that the aerosol is deposited directly on the respiratory tract, which allows greater concentrations of the substance converted into aerosol form to reach the bronchi and lungs, and with fewer side effects than if the blood stream is used. 

Types of nebuliser therapy most used in cystic fibrosis

A nebuliser is a device used to administer drug solutions or suspensions, in liquid form, via inhalation through a mask or a pipette (depending on the patient’s personal preferences and the indications of medical personnel).

Nebulisers may be classified according to the type of compressor that they use to generate the particles to be inhaled. Models that are easy to assemble and disassemble for patients are preferable.

There are currently three types of nebuliser:

• Pneumatic or jet nebulisers are the ones that are most used in clinical practice and come in different sizes. The nebuliser generally functions using compressed air or oxygen that enters through a small hole. The increased speed of the air causes a fall in pressure, which sucks the liquid to be nebulised through a feeding tube towards to outlet at great speed and in small drops.
• Ultrasonic nebulisers. Their function is based on applying a high frequency electric current to a quartz glass, which gives rise to a vibration that is transmitted to a liquid medium, which then transmits it to the substance to be nebulised and thus is able to produce steam or mist. Once the aerosol has been produced, it is pushed by a flow of air towards the patient. 
• Mesh nebulisers. In these devices, the aerosol is created by passing the liquid through a mesh.

Using nebulisers

Nebulisers comprise a nebulisation chamber, where the liquid to be nebulised is introduced and the aerosol created, and an energy source to allow the nebuliser to function.

One of the risks associated with using nebulisers is pulmonary infection, so the reservoir needs to be cleaned properly each time it is used.

Once nebulisation is complete, all the pieces need to be disassembled in order to clean them with hot water and soap. They must then be cleared, dried completely by air and stored in a dry place.

It is recommended that the first dose of a new drug is administered at the hospital to check that it has no adverse effects.

Nebuliser therapy is given to patients and caregivers and they are educated in handling, use, cleaning and maintenance of different devices, as well as in how to prepare the medication, focusing on and emphasising correctly following the treatment plan.

Steps to follow to administer nebulised medication

• Wash your hands
• Prepare and administer the medication correctly and safely: dose, drug, day, expiry date.
• Prepare and check the nebuliser.
• Fast-acting bronchodilator (salbutamol inhaler with spacer chamber). Bronchospasm should be avoided.
• Wait 15 minutes and then inhale the prescribed medication.
• Once the therapy is finished, good hygiene should be followed and the mouth rinsed to avoid infections and bad breath.