Spring 1998 ~ Newsletter
Resistance To Medicine
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News From The 1997 CF Conference
The annual North American Cystic Fibrosis Conference was in Nashville, Tennessee last year. Our CF Center was honored to have 12 staff members represented at the conference. Each one was asked to share their thoughts from the conference to give you a taste of what's new on the horizon for CF.
Julie McDougal, RTIn October 1997, a study was published in The Journal of Pediatrics comparing Positive Expiratory Pressure (PEP) to CPT in patients with CF. Forty patients participated in this year long study, some using 30 minutes of CPT twice per day and others using 20 minutes of PEP twice per day. Over the course of the year, those using PEP showed a slight improvement in their pulmonary functions. Otherwise, there were no differences at the end of the year between the two groups in the number of hospitalizations, chest X-ray scores, or sputum cultures. After the study, many patients reported they preferred PEP.During PEP, secretions are mobilized by increasing pressure during exhalation. Patients sit and breathe several times though a mask attached to a device with adjustable resistance. Then they perform a cough-like maneuver ("huffing") to clear the mobilized secretions to large airways. This is followed by a period of relaxed, controlled breathing. This sequence is repeated several times and takes approximately 20 minutes. At this point, the use of PEP will be limited to patients who can perform pulmonary function tests well (usually patients 6 years and older). If you are interested in learning more about this new chest clearance therapy, please call (205) 939-9583 and ask to speak to a respiratory therapist. We can answer any questions you may have and set up a training appointment outside of your regular Pulmonary Clinic appointment. So, to answer a big question: "CPT: When can we try something else?" -- the answer is "Now!"
Dr. Raymond K. LyreneControlling lung infections in patients with CF is difficult, especially when the bacteria Pseudomonas is present. Patients work hard to clear their lungs of infected secretions by chest therapy, coughing, aerosols, and exercise. Sometimes, though, these therapies are not enough. For those of you who have unstable lungs (frequent infections requiring oral or intravenous antibiotics), a new treatment is now available. TOBI, an easy to use tobramycin aerosol, improves lung function and reduces hospitalizations and sick days in certain patients with CF. Some of you have used Tobramycin aerosols in the past, but the treatments were long and the equipment cumbersome. TOBI aerosols are administered with a PulmoAide air compressor with a PARI LC Plus nebulizer over 15-20 minutes twice a day. TOBI will be used in monthly on - and - off cycles. As usual, you will want to speak with your Cystic Fibrosis physician to see whether this therapy is right for you. The down side to this therapy is the possibility of developing resistance to tobramycin, an important antibiotic in treating Cystic Fibrosis infections. The good news is that resistance appears to develop slowly, but the recommendation is to monitor resistance patterns through periodic sputum cultures.Krista Delsarbo, PTThe conference provided an excellent opportunity to see and learn about the new advances in research and product development as well as opportunities to network with CF clinicians from the US, Canada, and around the globe.