A randomised, cross-over trial of upright sitting versus alternate side lying during nebulised delivery of medication to improve the pattern of aerosol deposition in participants with cystic fibrosis

None listed

Research question: To determine whether alternate side lying improves uniformity of deposition of an inhaled aerosol compared to upright sitting in participants with cystic fibrosis (CF). Methods: Inclusion criteria: greater than or equal to 18 years of age, confirmed CF, stable lung function. Participants will inhale a 4mL radioaerosol in two positions in random order throughout the nebulisation period of 20 minutes: 1. Upright sitting: or 2. Alternate Side Lying: (alternated between left and right at each minute) After each nebulisation a gamma camera will perform a 20 minute deposition scan incorporating a 2 minute transmission scan to outline the three-dimensional margin of the lung fields. This data will be reconstructed to determine the distribution of the deposited radioaerosol in the lungs. A 15% improvement in uniformity of deposition is the proposed minimum difference that would make the alternate side lying strategy worthwhile in CF patient populations. Significance of project: In many patient populations (for example, cystic fibrosis, HIV, asthma and bronchiectasis), the pattern of deposition of inhaled medication is poor and non-uniform. Typically the upper lobes receive a reduced dose compared to the rest of the lung. The ability to deliver a drug more uniformly to the lung using the simple strategy of side lying may have a significant impact on treatment efficacy, acceptability and compliance for people with lung disease.