Pulmonary deposition of nebulised amiloride in cystic fibrosis: comparison of two nebulisers.

BACKGROUND Preliminary evidence suggests that regular inhalation of nebulised amiloride reduces sputum viscoelasticity, increases the clearance of sputum by mucociliary mechanisms and by coughing and reduces the rate of deterioration in lung function in patients with cystic fibrosis. These effects depend on adequate delivery of amiloride to the airways. This study was performed to quantify and compare pulmonary deposition of amiloride produced by two different nebuliser systems. METHODS The pulmonary deposition of nebulised amiloride (1 mg in 3 ml saline) was measured in eight patients with cystic fibrosis when given via a jet (System 22 with CR 60 compressor) and an ultrasonic (Fisoneb) nebuliser. Human serum albumin labelled with technectium-99m was used as an indirect marker for amiloride and its deposition in the lung was detected with a gamma camera. RESULTS Amiloride inhalation caused no side effects or changes in spirometric indices. The mean (SD) total pulmonary amiloride deposition was 57 (24) micrograms with the System 22 and 103 (53) micrograms with the Fisoneb nebuliser. Pulmonary deposition was completed more rapidly with the Fisoneb (4-5 minutes) than with the System 22 nebuliser (7-8 minutes) and the Fisoneb was preferred by the patients. CONCLUSIONS Both nebulisers appeared to deliver adequate amounts of amiloride to the lungs, but treatment with the Fisoneb nebuliser was quicker, more efficient, and more acceptable to the patients. Of the two nebulisers assessed, the Fisoneb would be preferred for clinical trials.

[1]  M. Knowles,et al.  Increased bioelectric potential difference across respiratory epithelia in cystic fibrosis. , 1981, The New England journal of medicine.

[2]  M. O'Doherty,et al.  Pulmonary deposition of nebulised pentamidine isethionate: effect of nebuliser type, dose, and volume of fill. , 1990, Thorax.

[3]  S. Anderson,et al.  Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline. , 1981, British medical journal.

[4]  J. Gatzy,et al.  Deposition, clearance, and effects of aerosolized amiloride in sheep airways. , 1986, The American review of respiratory disease.

[5]  S. Clarke,et al.  Deposition of carbenicillin aerosols in cystic fibrosis: effects of nebuliser system and breathing pattern. , 1988, Thorax.

[6]  M. K. James,et al.  Acute cardiovascular and pulmonary effects of intravenous and aerosolized amiloride in the dog. , 1987, Toxicology and applied pharmacology.

[7]  M. Newhouse,et al.  The effects of preferential deposition of histamine in the human airway. , 2015, The American review of respiratory disease.

[8]  M. King,et al.  Acute and long-term amiloride inhalation in cystic fibrosis lung disease. A rational approach to cystic fibrosis therapy. , 1990, The American review of respiratory disease.

[9]  M. King,et al.  A pilot study of aerosolized amiloride for the treatment of lung disease in cystic fibrosis. , 1990, The New England journal of medicine.

[10]  J. L. Potter,et al.  Studies on pulmonary secretions. II. Osmolality and the ionic environment of pulmonary secretions from patients with cystic fibrosis, bronchiectasis, and laryngectomy. , 1967, The American review of respiratory disease.

[11]  J. Markham,et al.  The measurement of regional ventilation in man: a new method of quantitation. , 1973, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[12]  M. Knowles,et al.  Bioelectric properties and ion flow across excised human bronchi. , 1984, Journal of applied physiology: respiratory, environmental and exercise physiology.

[13]  M. O'Doherty,et al.  DIFFERENCES IN RELATIVE EFFICIENCY OF NEBULISERS FOR PENTAMIDINE ADMINISTRATION , 1988, The Lancet.

[14]  M. O'Doherty,et al.  Which apparatus for inhaled pentamidine? A comparison of pulmonary deposition via eight nebulisers. , 1991, The European respiratory journal.

[15]  G. Smaldone,et al.  Quantitative deposition of aerosolized gentamicin in cystic fibrosis. , 1987, The American review of respiratory disease.

[16]  J. Elborn,et al.  Cystic fibrosis. 2. Lung injury in cystic fibrosis. , 1990, Thorax.

[17]  C. Hardy.  Inhaler therapy. , 1991, The Practitioner.

[18]  M. Knowles,et al.  Evidence for reduced Cl‐ and increased Na+ permeability in cystic fibrosis human primary cell cultures. , 1988, The Journal of physiology.