Cork Adult Cystic Fibrosis Centre, Department of Respiratory Medicine, Cork University Hospital, University College Cork, Wilton, Cork, Ireland.
Respir Care. 2011 Jun;56(6):771-5. doi: 10.4187/respcare.00866. Epub 2011 Feb 11.
Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization.
In 4 consecutive adult CF patients who were intolerant of hypertonic saline via jet nebulizer, we nebulized 6% hypertonic saline via a PEP nebulizer. We measured the number of days the patients required intravenous antibiotics from enrollment to study end, compared to an equal period before PEP, and the mean time between the patients' 3 most recent infective pulmonary exacerbation episodes before PEP to their next exacerbation after PEP. Patients also completed a Likert-scale adverse-effects questionnaire on hypertonic saline via PEP versus jet nebulizer.
The 4 patients had severe CF pulmonary disease and all fully tolerated hypertonic saline via PEP, for 77, 92, 128, and 137 days, respectively until the study end date. There were fewer days of antibiotics in 3 of the 4 patients, from 45 to 20 days, 66 to 14 days, and 28 to 0 days (mean relative risk reduction 53%, P = .11). The other patient had 63 days of antibiotics during both the PEP and the jet nebulizer periods. There was a mean 3.6-fold longer time to next infective pulmonary exacerbation during the PEP period (P = .07). Adverse effects were less with PEP: chest tightness 68% (P = .04), bad taste 62% (P = .06), cough 47% (P = .10), and sore throat 50% (P = .20).
Hypertonic saline via PEP nebulizer benefits CF patients who do not tolerate hypertonic saline via jet nebulizer.
雾化高渗盐水是治疗囊性纤维化（CF）患者的一种非常有效的方法，但仍有 10%的患者不能耐受射流雾化器给予的高渗盐水。呼气正压（PEP）雾化器可撑开气道，并提供更受控的雾化速率。
在 4 名连续的 CF 成年患者中，他们对射流雾化器给予的高渗盐水不耐受，我们通过 PEP 雾化器雾化 6%高渗盐水。我们测量了从入组到研究结束时患者需要静脉用抗生素的天数，与 PEP 前的同等时间段进行比较，以及在 PEP 前患者最近 3 次感染性肺部恶化发作之间的平均时间到 PEP 后的下一次恶化。患者还通过 Likert 量表对 PEP 与射流雾化器给予高渗盐水的不良反应进行了评分。
这 4 名患者均患有严重 CF 肺部疾病，均完全耐受 PEP 给予的高渗盐水，分别持续了 77、92、128 和 137 天，直到研究结束日期。在 4 名患者中的 3 名中，抗生素的使用天数减少了，从 45 天减少到 20 天，从 66 天减少到 14 天，从 28 天减少到 0 天（平均相对风险降低 53%，P =.11）。另一名患者在 PEP 和射流雾化器期间均使用了 63 天的抗生素。在 PEP 期间，下一次感染性肺部恶化的时间平均延长了 3.6 倍（P =.07）。PEP 的不良反应较少：胸部紧迫感 68%（P =.04），口感差 62%（P =.06），咳嗽 47%（P =.10），喉咙痛 50%（P =.20）。
对于不能耐受射流雾化器给予的高渗盐水的 CF 患者，PEP 雾化器给予高渗盐水有益。
