Nebulization of a bovine surfactant in cystic fibrosis: a pilot study

Abstract

Cystic fibrosis (CF) is a lethal disorder which results in excessive airway secretions and in chronic inflammation of the airways. In vitro and in vivo studies have shown that a lack of surfactant results in the closure of the small airways. In this pilot study, we aimed to determine whether surfactant administered by aerosol might improve lung function on a short-term basis in patients with CF.In a randomized, crossover double-blind pilot study, 120 mg of a lipid-extracted bovine surfactant (Alveofact) or placebo was aerosolized to five young adult patients with CF over a period of 30 min for five consecutive days. The sample size had the power of 90% to detect an increase in forced expiratory volume in one second (FEV1) of 15% (p<0.05).Jet nebulization of surfactant produced particles of which more than 75% were the respirable range (<5 µm). The inhalations were well tolerated. No changes in serum antibody titres against the surfactant proteins-B and -C (SP-B/SP-C) were observed. No differences in FEV1 and forced vital capacity were found before, and 30 or 90 min after, the inhalation. This pilot study shows no acute or short-term benefits of surfactant inhalation in young adults with cystic fibrosis. However, a beneficial effect of exogenous surfactant cannot be excluded before other reasons for a lack of effect, such as insufficient quantity delivered, inhomogeneous distribution or inhibition of the surfactant in the lungs, have been completely ruled out.

Surfactant and Perfluorocarbon Aerosolization by Means of Inhalation Catheters for the Treatment of Respiratory Distress Syndrome: An In Vitro Study

“…(4)(5)(6) Aerosolized PFC has been proven effective in the experimental treatment of RDS, showing a sustained improvement in oxygenation and a reduction of the early inflammatory response, in a surfactant-depleted piglet model of RDS. (22) However, other authors did not find any beneficial effects on lung function after PFC-aerosolization in surfactantdepleted rabbits.…”

“…Inhalation of PFC and surfactant has been suggested as a new and promising technique for drug delivery in various different form of severe lung injury, including mucus clearance in cystic fibrosis, (4) severe asthma, (5) and paediatric and adult acute RDS. (6,7) However, the use of nebulized PFC or surfactant is not always effective in vivo.…”

Lung surfactant in subacute pulmonary disease

“…Surface tension lowering function of surfactant from CF patients is also impaired, and alterations in surfactant lipid composition may contribute to this impairment. A pilot study investigating the consequences of administering a natural surfactant aerosol to CF patients daily for five days showed no evidence of acute or short-term benefit [20]. …”

Lung Deposition of Nebulized Surfactant in Newborn Piglets

“…We used this nebulizer to perform a feasibility study on the deposition of porcine surfactant in the lungs and upper airway. There are many studies of surfactant deposition during inhalation via tracheal tube [13], but relatively few with other interfaces [3,14,15,16]. We therefore studied three interfaces: mask, nasal prongs, and tracheal tube.…”