Frequency of inhalation

Question

Dear expert team.
My daughter, 5, CF, has so far a mild course, only the lung is involved. We do daily 2x inhalations with beclomethasone, salbutamol and sodium chloride solution, additionally usage of the flutter.
She is only rarely phlegmy, the last infection was about 6 months before.
Every second day she gets 7ml acithromycin.
Now to my question: is it necessary to inhale 2 times a day, if she does not have an infection, or is also one time sufficient?
I know, that some CF patients do inhale only 1 time, as far as they are doing well.
What would be the consequences if we inhale only one time?
Many thanks.

Answer

Dear questioner,
as you write, your daughter inhales two times a day with sodium chloride solution as well as with a bronchodilating drug and a local steroide preparation. I assume that your question touches the more time-intensive inhalation of sodium chloride, as salbutamol and beclomethasone are inhaled assumably via a spacer/aerochamber which does take only few time.
The question, if the inhalation of sodium chloride should be done one time or two times has so far not been investigated by studies. One assumes, that the sodium chloride wettens the airways which some patients do feel also subjectively and has concluded from that that an inhalation therapy from the diagnosis on would make sense. I personally do believe, that the inhalation therapy also has an effect in that way, to make children familiar with that kind of therapy and therefore increase the acceptance for this form of therapy. This aim could certainly also be achieved with a one time daíly inhalation. It is important that your child at the age of 5 performs this inhalation with a mouth piece and that the inhalation device is cleaned regularly and correctly.
Yours sincerely,
E. Rietschel

16.11.2009