Nebulisng – Hypertonic Saline, Pulmozyme & Antibiotics

By Cath Lamont, CF Nurse Specialist, Auckland Hospital

(This article was originally published in the Auckland E-News in April 2015)

It has come to our attention; both in Starship and Adult Services, that PWCF are nebulizing hypertonic saline (HTS) but, are not doing any physiotherapy afterwards. This means that the secretions just sit (and fester) in the lungs.

The aim of HTS is to aid physiotherapy in moving secretions out of the lungs. Some PWCF nebulize their HTS in conjunction with using their PEP device and this is a very good way to combine nebulisation and physiotherapy. Basically, as you are aware, HTS provides moisture to your secretions; if you are on Pulmozyme this helps to break up your secretions but, both need airway clearance /physiotherapy to move the secretions out of the airways.

Pulmozyme needs time to work so wait at least an hour before doing any physiotherapy. Some PWCF take their Pulmozyme at night after they do physio and let it sit in their lungs overnight ready to aid in their morning physiotherapy session. Pulmozyme is meant to be taken at approximately the same time every day so either in the morning or at night. All nebulized antibiotic’s need your airways to be as “clean and clear” as can be in order to work effectively on your airways. Nebulised antibiotics are always performed after physiotherapy. A filter device is attached to the Pari nebilising bowl and this prevents others in the room becoming resistant to the antibiotic being nebulised.

Resistance is developed by others inhaling the nebulised particles that go into the air if no filter is present. For those who prefer not to use a filter they need to go into a closed room, on their own, by an open window to nebulize their antibiotics. Please allow time for the air to clear in the room before opening the door when doing antibiotics in this manner.