Time intervall between Colistin/DNAse

Question

Dear expert team,
my 11-year old son inhales with the e-flow:
-in the mornings and in the evenings 5ml NaCl and afterwards Colistin
- in the middle of the day DNAse (does not have mucus, that has to be mobilized)

Is it possible on holidays to change the order due to lack of time e.g.
-in the mornings DNAse, then in the same inhalette NaCl and afterwards Colistin
- in the evenings NaCl and Colistin???

Is it possible exeptionally to inhale both Colistin ampules directly after the other? and the DNAse at another timepoint?
Which order resp. timeintervals have to be stuck to in any case??
Many thanks for your answer

Answer

Dear questioner,
the right order of the inhalations in CF patients arises mainly from the effect of the inhaled substances, but also due to the time-consuming therapy from the individual needed panning of the day (work, school other duties). Antibiotic drugs (e.g. Tobramycin or Colistin) do have mainly an antibacterial and also an anti-inflammatory effect and should be inhaled 2 times a day. DNAse shows and mucus-mobilizing and also an anti-inflammatory effect and the therapy frequency is one time per day.
Antibiotics should be inhaled in a so-called "clean lung", that means after a broncho-dilaiting inhalation and after a done drainage (when the mucus has been coughed away). At an inhalative therapy which is composed only by antibiotics, it makes sense to inhale in the mornings and in the evenings (before the antibiotic-inhalation, it is frequently recommended to do an broncho-dilating humid-inhalation or with spray or powder). In widening the therapy with inhalative DNAse it has to be taken into account, that the drug leads to a liquefaction of the mucus and therfore to better coughing away of the mucus. It does not make sense to inhale an antibiotic drug in the effective time of DNAse, because then the antibiotic drug would be coughed away again partly with the mucus. Therefore it makes sense, to inhale antibiotics after the regression of the DNAse effective-time and if the course of the day does allow it, then antibiotic 2 times a day: in the mornings and in the evenings, DNAse one time a day in the middle of the day. In case an inhalation in the middle of the day is for time reasons not possible, it is recommendable to use the DNAse before the antibiotic inhalation in such a way, that inbetween drainage can be made and coughing away.
Yous sincerely,
Dr. C. Smaczny

06.07.2009