Nebulised dornase alpha: adherence in adults with cystic fibrosis

Burrows, Jacqueline M.; Bunting, J.; Masel, P.; Bell, Scott C.

doi:10.1016/s1569-1993(02)00095-4

Cited by 36 publications

(29 citation statements)

References 13 publications

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“…15 Even when dornase alfa is demonstrated to improve lung function in an individual, adherence to therapy is often less than the physician presumes. 7 Consequently, the demonstration in this study of equal utility of dornase alfa before or after physiotherapy provides the first evidence for the clinician to advocate more flexibility with this therapy in relation to physiotherapy, which …”

Section: Discussionmentioning

confidence: 71%

“…7,16 In addition, the individual response of a patient to a therapeutic trial of dornase alfa may differ when used before or after physiotherapy as shown in this study. Although a standardized trial of dornase alfa is considered to be 4 weeks, previous work has shown that a therapeutic response can be seen within 2 weeks and dissipate within 2 weeks.…”

Section: E552mentioning

confidence: 91%

“…As has been shown in adults who are prescribed dornase alfa, patients and families will vary their therapies because of time constraints. 7 Thus, it is important to establish whether this will have an impact on their response to therapy. Although the dornase alfa product information leaflet suggested that its administration could precede or follow physiotherapy, we could find no evidence to support the majority of our patients' preferring to use the medication before physiotherapy.…”

mentioning

confidence: 99%

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A Crossover, Randomized, Controlled Trial of Dornase Alfa Before Versus After Physiotherapy in Cystic Fibrosis

et al. 2005

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ABSTRACT. Objective. Although dornase alfa is a widely used, aerosolized, mucolytic agent in patients with cystic fibrosis (CF), its efficacy in relation to the timing of physiotherapy has not been tested. We sought to determine whether dornase alfa is more efficacious when it is administered 30 minutes before versus 30 minutes after physiotherapy/positive expiratory pressure (PEP) therapy in clinically stable children.Methods. Using a crossover, randomized, doubleblind, and placebo-controlled trial, we undertook a 6-week study of the efficacy of dornase alfa in relation to the timing of physiotherapy at home. There were 2 treatment orders. Dornase alfa before ؉ placebo after physiotherapy/PEP for 2 weeks was followed by a 2-week washout and then the reverse order placebo before and dornase alfa after physiotherapy/PEP for the final 2 weeks. The second treatment order reversed the placebo and dornase alfa therapy for the first and last 2-week blocks. The main outcome measures used included the change in predicted percentage of forced expiratory volume in 1 second (FEV 1 ), a composite quality of wellbeing score (QWB), and a measure of aerobic fitness (maximal oxygen consumption, [VO 2max ]), determined using shuttle testing.Results. Fifty-two patients who had CF (27 female) with mild to moderate suppurative lung disease, were a mean ؎ SD age of 10.7 ؎ 3.2 years, had Shwachman scores of 86 ؎ 11.8, had predicted FEV 1 of 83% ؎ 18%, had quality of well-being score of 0.76 ؎ 0.08, and had VO 2max of 42.6 ؎ 6.3 ml/kg per min were enrolled. Fifty patients completed the study. Intention-to-treat analysis was used. Nonsignificant mean (95% confidence interval) differences in FEV 1 ABBREVIATIONS. CF, cystic fibrosis; FEV 1 , forced expiratory volume in 1 second; PEP, positive expiratory pressure; VO 2max , maximal oxygen consumption; QWB, quality of well-being score; CI, confidence interval; FEF , mid expiratory flow rate. P hysiotherapy and systemic and nebulized antibiotics have been the cornerstones of treatment in cystic fibrosis (CF) for many years. [1][2][3] The introduction of the nebulized mucolytic agent dornase alfa (Pulmozyme [Hoffman-La Roche, Dee Why, Sydney, Australia]) in the 1990s proved to be an innovative adjunct to the management of lung disease in terms of reduced pulmonary exacerbations, improved lung function, and quality-of-life measures. 3-5 Dornase alfa use varies from country to country, on the basis of patient preference, physician prescribing practices, measured benefit in an individual, and health funding arrangements. In Australia, most recent figures indicate that dornase alfa is used by 22.1% of school-aged children (5-18 years), all of whom have demonstrated a Ͼ10% improvement in forced expiratory volume in 1 second (FEV 1 ) after 4 weeks of therapy. 6 However, despite the evaluation of dornase alfa in Ͼ15 years of clinical trials, there is no evidence as to whether dornase alfa is more efficacious when delivered before or after physiotherapy. As has been shown in adults who are prescri...

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Section: Discussionmentioning

confidence: 71%

Section: E552mentioning

confidence: 91%

mentioning

confidence: 99%

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A Crossover, Randomized, Controlled Trial of Dornase Alfa Before Versus After Physiotherapy in Cystic Fibrosis

et al. 2005

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“…3,10,11,20,[22][23][24][25][27][28][29][31][32][33][34][35][36][37][38][39] Eighteen papers were of low quality, and 2 were of moderate quality. The categories of medications are summarized below (Table 3).…”

Section: Medicationmentioning

confidence: 99%

“…A number of strategies were used to determine adherence. Two studies used pharmacy refill data, 35,36 3 used participant questionnaires, 3,25,31 2 used parent questionnaires, 3,31 one used participant interviews, 36 one used a collection of empty medication vials, 11 and one used daily telephone diaries. 3 Mean adherence ranged from 54% by participant interview 36 to 77.8 Ϯ 44.1% by patient questionnaire.…”

Section: Medicationmentioning

confidence: 99%

Adherence of Subjects With Cystic Fibrosis to Their Home Program: A Systematic Review

O'Donohoe

Fullen

2014

Respir Care

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BACKGROUND: The management of cystic fibrosis (CF) includes adherence to a home management program (airway clearance, medication, nutritional advice, and exercise). This has led to an increase in life expectancy, although the benefits depend greatly on a patient's level of adherence to daily treatments at home. To date, no systematic review has established adherence rates to all World Health Organization guidelines in the home setting; hence, this review was undertaken. METHODS: The review comprised 3 phases. A methodological assessment of databases (Embase, CINAHL, PsychINFO, PEDro, PubMed, Cochrane Central Register of Controlled Trials) identified potentially relevant papers. These papers were screened for inclusion criteria by 2 independent reviewers, data were extracted, and the internal validity was rated using a valid and reliable scale. Results were categorized into 4 themes: medication, nutrition, airway clearance techniques, and exercise. RESULTS: The search generated a total of 26 papers, 24 of which were rated as being poor quality. Adherence to a treatment program for CF patients is generally low (from 22% for nutritional guidelines to 130% for oral antibiotics), and it varies greatly depending on the type of treatment and the method of assessment employed (objective tool vs self-reported questionnaires). CONCLUSIONS: Consensus on how to measure adherence is lacking, and the quality of studies addressing adherence in this population is generally poor. Overall, studies using self-reported measures yielded higher adherence scores than those that used objective measures, suggesting that current efforts to improve methods of adherence are appropriate. The prevalence of non-adherence remains unclear due to these limitations.

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Dornase alfa in the treatment of cystic fibrosis in Europe: A report from the Epidemiologic Registry of Cystic Fibrosis

Hodson

McKenzie

Harms³

et al. 2003

Pediatric Pulmonology

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Dornase alfa (Pulmozyme) treatment for patients with cystic fibrosis (CF) has been shown to improve pulmonary function and reduce exacerbations of infection in a number of placebo-controlled double-blind studies. Data in the Epidemiologic Registry of Cystic Fibrosis (ERCF) in November 1998 were used to assess the long-term effectiveness in routine clinical practice of dornase alfa in terms of pulmonary function and frequency of acute pulmonary exacerbations in CF. At that time, the ERCF contained data on 13,684 CF patients, with a mean observation period of 2.3 years. To be included in the analysis, patients had to have 2 years of data in the Registry in appropriate detail. Overall, untreated patients showed a decline in forced expiratory volume in 1 sec over a 2-year period of -2.3% predicted, but treated patients were stable, showing a change of 0.3% predicted, i.e., a treatment benefit of 2.5%. Compared to untreated patients, there were 25 fewer exacerbations per 100 treated patients per year. The analysis suggested that younger patients were likely to benefit more from treatment. The findings of randomized clinical trials were supported by the data collected in routine clinical practice.

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Nebulised dornase alpha: adherence in adults with cystic fibrosis

Cited by 36 publications

References 13 publications

A Crossover, Randomized, Controlled Trial of Dornase Alfa Before Versus After Physiotherapy in Cystic Fibrosis

A Crossover, Randomized, Controlled Trial of Dornase Alfa Before Versus After Physiotherapy in Cystic Fibrosis

Adherence of Subjects With Cystic Fibrosis to Their Home Program: A Systematic Review

Dornase alfa in the treatment of cystic fibrosis in Europe: A report from the Epidemiologic Registry of Cystic Fibrosis

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