Abstract
Introduction Many children with CF are treated with inhaled antibiotics, mostly by nebulisation, although first generation capsule-based dry powder inhalers (DPIs) with antibiotics are now available. Such inhalers generally require inhaled volumes ≥1 L and high flow rates (≥60 L/min) to deliver the entire dose.
Aim To determine whether children with CF are able to perform the inspiratory manoeuvres needed to operate a capsule-based DPI effectively and how their inhalations are affected by the inhaler resistance and their disease.
Methods We recorded inspiratory flow manoeuvres of children with and without CF (n=35 and n=103 respectively, 4-14 years old) through a test inhaler with variable airflow resistance and calculated total inhaled volume (V) and peak inspiratory flow rate (PIF).
Results Minimal V (0.5 L) and PIF values (20 L/min) of children with CF and healthy controls were the same, but the age-related increases of both parameters were slightly higher for the healthy controls (p<0.01 and p=0.08 respectively; see Figure). Resistance in the range 0.31-0.45 kPa0.5.L.min-1 (medium to high) affected PIF but not total inhaled volume.
Conclusions Our findings indicate that inhaled volumes and PIFs of the youngest children (with and without CF) are too low to operate currently marketed antibiotic DPIs effectively. By implication, the development of DPIs specifically for children is highly desired.
- Copyright ©the authors 2016
