HOME NEBULIZER USE AMONG PATIENTS WITH CYSTIC-FIBROSIS

Objective: To describe current patterns of home nebulizer use among pa tients with cystic fibrosis. Study design: A population-based survey o f home nebulizer practices among 227 patients with cystic fibrosis usi ng nebulizers from 1993 to 1994 (Objective 1), and a prospective study of ''typical'' home use, including testing of performance and bacteri al cultures in nebulizers after use, completed by 36 subjects (Objecti ve 2). Results: Objective 1: 85% of subjects reported using jet and 8% ultrasonic nebulizers (categories not mutually exclusive); 15% used u nknown brands. Most jet nebulizers were disposable models, which were used for > 14 days by more than half the subjects. Mixing of medicatio ns in a single treatment (other than cromolyn and a bronchodilator) wa s reported by 28% of patients. Objective 2: no apparent deterioration in aerosol particle size or output rate of returned nebulizers compare d with new units was observed. Staphylococcus aureus was cultured from 55% and Pseudomonas aeruginosa from 35% of returned nebulizers. Conco rdance between nebulizer and sputum cultures was poor. Conclusions: Al though not generally tested for reusability, disposable nebulizers are generally used by patients for long periods. Medication mixing is com mon, although its effects on aerosol properties are unknown. Cystic fi brosis respiratory pathogens are frequently isolated from used nebuliz ers. Patient guidelines for home nebulizer use need to be established.