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Randomized Controlled Trial
. 2019 Jul 16;19(1):128.
doi: 10.1186/s12890-019-0886-7.

Side lying during nebulisation can significantly improve apical deposition in healthy adults and adults with mild cystic fibrosis lung disease: a randomised crossover trial

Ruth L Dentice  1 , Mark R Elkins  2   3 , Jordan Verschuer  4 , Stefan Eberl  4 , Genevieve Dwyer  5 , Peter T P Bye  3   6
Affiliations
Randomized Controlled Trial

Side lying during nebulisation can significantly improve apical deposition in healthy adults and adults with mild cystic fibrosis lung disease: a randomised crossover trial

Ruth L Dentice et al. BMC Pulm Med. .

Abstract

Background: In people with and without Cystic Fibrosis (CF), does side lying during nebulisation change: the proportion of the dose loaded in the nebuliser that is deposited in the lungs; the uniformity of deposition throughout the lungs; or the apical drug density as a percentage of the drug density in the remaining lung? Do these effects differ depending on the degree of lung disease present?

Methods: A randomised crossover trial with concealed allocation, intention-to-treat analysis and blinded assessors, involving 39 adults: 13 healthy, 13 with mild CF lung disease (FEV1 > 80%pred), and 13 with more advanced CF lung disease (FEV1 < 80%pred). In random order, 4 mL of nebulised radioaerosol was inhaled in upright sitting and in alternate right and left side lying at 2-min intervals, for 20 min.

Results: Compared to sitting upright, lung deposition and the uniformity of deposition were not significantly altered by side lying in any of the three groups. In sitting, the density of the deposition was significantly less in the apical regions than in the rest of the lung in all participants. Side lying significantly improved apical deposition in healthy adults (MD, 13%; 95% CI, 7 to 19), and in minimal CF lung disease (MD, 4%; 95% CI, 1 to 7) but not in advanced disease (MD, 4%; 95% CI, - 2 to 9).

Conclusion: Alternating between right and left side lying during nebulisation significantly improves apical deposition in healthy adults and in adults with mild CF lung disease, without substantial detriment to overall deposition.

Trial registration: ACTRN12611000674932 (Healthy), ACTRN12611000672954 (CF) Retrospectively registered 4/7/2011.

Keywords: Body position; Cystic fibrosis; Lung deposition; Physical therapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Positioning methods adopted during inhalation with the LC Star jet nebuliser (LC plus nebuliser, Pari, Hamburg, Germany) with mouthpiece, filter and nose clip. Alternate side lying involved dropping the legs over the side of the bed to turn through upright and reposition on the other side every 2 minutes, when instructed by the supervising investigator. (Image with permission)
Fig. 2
Fig. 2
Representative images from one participant during simultaneous emission-transmission dynamic SPECT imaging of radioaerosol deposition: 1. The transmission data is primarily used for attenuation correction of the emission data 2. The emission data records the deposition of the inhaled radioaerosol 3. The transmission data is also used to segment the three-dimensional margin of the lung fields in order to determine the regional distribution of the deposited radioaerosol within the lungs
Fig. 3
Fig. 3
Consort flow diagram
Fig. 4
Fig. 4
Representative deposition scans for the participant group in sitting
Fig. 5
Fig. 5
The change in apical deposition in response to the repositioning from upright to side lying for nebulisation. The 13 participants with advanced CF are depicted in green, mild CF in orange and healthy in purple
See this image and copyright information in PMC

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