Using New Nebulizer Technology to Monitor Adherence: You Never Stop Learning!

Background: Time spent by patients in daily management of cystic fibrosis (CF) affects adherence, therefore the choice of aerosol delivery device system becomes important, in order to achieve good lung deposition and satisfactory compliance. The I-Neb Adaptive Aerosol Delivery (AAD) system results in shorter treatment times and better deposition of the drug, if used properly. Most importantly, this device allows patients, caregivers and CF team to have feedback on the ongoing therapy. The aim of this study was to evaluate the change in recorded adherence and inhalation technique of patients with CF using I-Neb after an educational intervention (EI). Methods: This descriptive study was run at the CF Paediatric Centre of Milan. All patients using I-Neb and registered to online software “Insight Online” (IoL) were evaluated by respiratory physiotherapists during regular outpatient visits. EI consisted of 2 sessions: some theory to explain the technical characteristics of the device and cleaning and disinfection procedures, and some practice using a training software with visual feedback to optimize inhalation. Baseline and one-month follow-up data about adherence, inhalation, nebulization time before and after EI was analysed. Privacy rule authorization was obtained according to the local Ethics Committee. Results: 24 patients (14 females) with CF, aged 5 to 34 y old, with a mean (SD) kg/m2 of 78(22)%pred. were included: 22 used Target Inhalation Mode (TIM) and 2 Tidal Breathing Mode (TBM). I-Neb compliance before EI was 74.5(33.7)%. Using TIM, mean nebulization time was 2.8(2.2) min; mean time with TBM was higher: 5.5(1.2) min. The mean inhalation time per breath using TIM was 2.8(2.5) s while using TBM was 1.4(1.1) s. The mesh performance was 84.6(38.5)%. After EI, the I-Neb use increased by 11.8%, the mesh performance grew of 6.4%. The rest time decreased by 2.9%. The inhalation time per breath using TIM increased of 1.2 s, using TBM 0.7 s. Nebulization time decreased for patients using TIM (0.4 min) while increased of 2.7 min using TBM. Conclusions: There was space for little improvements in the inhalation technique and device maintenance in the observed sample, even considering the optimal starting level. TIM offers several advantages over TBM, increasing the likelihood of a more effective inhaled therapy with shorter administration time. EI should be always part of the routine evaluation of patients with CF.