title: A randomised controlled trial of breathing modes for adaptive aerosol delivery in children with cystic fibrosis.
abstract: BACKGROUND
  Aerosol delivery is a cornerstone of CF airways disease management. New nebulisers have reduced treatment times by utilising mesh technology for aerosol production. We have evaluated a further modification (target inhalation mode (TIM)) that may reduce treatment delivery times further.
  
  
  METHODS
  Following a baseline period on tidal breathing mode (TBM), children with CF on long-term aerosol therapy were randomly allocated to either TIM, which optimises patient inhalations through a direct feedback mechanism, or to continue TBM. The primary outcome was nebuliser treatment times with secondary outcomes being adherence and patient preference.
  
  
  RESULTS
  The ten children allocated TIM reduced their mean (SD) treatment times from 6.9(2.9) to 3.7(2.3) minutes (p<0.001). In contrast, treatment times were unchanged in the ten children allocated TBM. Mean adherence was maintained in the TIM group but declined in patients allocated TBM by >5%. All children preferred TIM to TBM.
  
  
  CONCLUSIONS
  TIM reduces nebuliser treatment times and may positively impact on adherence, although longer duration studies are required to examine this. (ISRCTN65617839).
authors.affiliation: Department of Physiotherapy, Alder Hey Children's NHS Foundation Trust Hospital, Eaton Rd, Liverpool, L12 2AP United Kingdom. mcnamp@liv.ac.uk
authors.forename: Pamela
authors.initials: P
authors.lastname: McCormack
authors.forename: Paul S
authors.initials: PS
authors.lastname: McNamara
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Southern
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000188:drug therapy*; D003850:Deoxyribonuclease I / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance; D057240:Patient Preference; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012462:Saline Solution, Hypertonic; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I