Cochrane · systematic review · CD007639
Nebuliser systems for drug delivery in cystic fibrosis
Stanford, G, Morrison, L, Brown, C · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
Cystic Fibrosis and Genetic DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
98
current version
GRADE rated
42
No studies
56
Included studies
NR
No studies 56 · 57.1%Ungraded 0 · 0%Very low 35 · 35.7%Low 7 · 7.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems compared
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time: time for a single nebulised treatment (min) | no estimate extracted | 3 studies · 88 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life | no estimate extracted | NR | No studies |
Serum deposition: Cmax (µg/mL) | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events: bronchoconstriction | no estimate extracted | 20 studies · 78 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FEV1: change in FEV1 % predicted | no estimate extracted | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Time to next exacerbation | no estimate extracted | NR | No studies |
Participant satisfaction or preference | RR 2.33 [0.83, 6.54] | 101 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems compared to VMT
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time: mean treatment time (min) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | 4 studies · 103 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | NR | No studies |
Serum deposition Cmax (µg/mL) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | 5 studies · 126 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | RR 0.78 [0.37, 1.64] | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision |
FEV1:change in FEV1 % predicted Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems compared to VMT and AAD
Population: children aged 6 ‐ 18 with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time nebulisation time (min) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | NR | No studies |
Serum deposition Cmax (µg/mL) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | NR | No studies |
FEV1 Change in FEV1 % predicted Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | no estimate extracted | NR | No studies |
Participant satisfaction or preference Satisfaction scale Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs VMT and AAD | MD 2.7 [1.35, 4.05] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems compared to AAD
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (min) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | NR | No studies |
Serum deposition: Cmax (mg/L) Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
FEV1 Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | NR | No studies |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering tobramycin: conventional systems vs AAD | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) compared to VMT and AAD target inhalation mode (TIM)
Population: people with cystic fibrosis (age not given)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (min) Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
FEV1 Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering tobramycin: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering colistin: conventional systems compared to AAD
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (seconds) Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | NR | No studies |
Serum deposition (Cmax) Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | NR | No studies |
FEV1 change from baseline Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | no estimate extracted | 1 study · 259 participants | Very low Downgraded: risk of bias, imprecision |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering colistin: conventional systems vs AAD | RR 0.45 [0.35, 0.57] | 1 study · 259 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) compared to VMT and AAD target inhalation mode (TIM)
Population: children with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (minutes) Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Quality of life Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
FEV1 Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering colistin and dornase alfa: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering dornase alfa: conventional systems compared
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (minutes) | no estimate extracted | 3 studies · 932 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life | no estimate extracted | NR | No studies |
Serum deposition Cmax | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | 2 studies · 922 participants | Very low Downgraded: risk of bias, imprecision |
FEV1 | no estimate extracted | 2 studies · 1146 participants | Low Downgraded: risk of bias, imprecision |
Time to next exacerbation | no estimate extracted | NR | No studies |
Participant satisfaction or preference | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering dornase alfa conventional system compared to AAD
Population: children with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Quality of life Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
FEV1 Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering dornase alfa conventional system vs AAD | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system compared to VMT
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (minutes) Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | 1 study · 85 participants | Low Downgraded: risk of bias, imprecision |
Quality of life CFQ‐R scores (treatment burden domain and respiratory domain) Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | 1 study · 85 participants | Very low Downgraded: risk of bias, imprecision |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | 1 study · 85 participants | Very low Downgraded: risk of bias, imprecision |
FEV1 FEV1 % predicted Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | 1 study · 85 participants | Low Downgraded: risk of bias, imprecision |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | no estimate extracted | NR | No studies |
Participant satisfaction or preference: Summary of findings ‐ nebulisers for delivering dornase alfa: conventional system vs VMT | RR 0.48 [0.31, 0.76] | 1 study · 68 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems compared
Population: adults and children with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Serum deposition Cmax | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | NR | No studies |
FEV1 | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision |
Time to next exacerbation | no estimate extracted | NR | No studies |
Participant satisfaction or preference | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems compared to AAD
Population: adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | NR | No studies |
Quality of life Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | 1 study · 6 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FEV1 change from baseline Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | 1 study · 6 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs AAD | no estimate extracted | NR | No studies |
Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) compared to VMT and AAD target inhalation mode (TIM)
Population: adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (minutes) Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FEV1 Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering other aerosolised medications: VMT and AAD tidal breathing mode (TBM) vs VMT and AAD target inhalation mode (TIM) | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems compared to ultrasonic nebulisers
Population: children and adults with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment time (min) Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | 2 studies · 8 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | NR | No studies |
Serum deposition Cmax Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
FEV1 (L) Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Time to next exacerbation Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | NR | No studies |
Participant satisfaction or preference Summary of findings ‐ nebulisers for delivering other aerosolised medications: conventional systems vs ultrasonic nebulisers | no estimate extracted | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |