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PubMed1993

Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department.

STUDY OBJECTIVE: To compare continuously nebulized albuterol with intermittent bolus nebulization of albuterol. DESIGN: Consecutive block enrollment in groups of ten to continuous or intermittent therapy. SETTING: Urban emergency department. TYPE OF PARTICIPANTS: Patients who presented to the ED with moderate to severe asthma and did not improve after one treatment with nebulized albuterol. INTERVENTIONS: All patients received an initial nebulized treatment with 2.5 mg albuterol followed by 125 mg solumedrol. Patients in the intermittent group received 2.5 mg nebulized albuterol at 30, 60, 90, and 120 minutes after the initial treatment. Patients in the continuous group received 10 mg albuterol nebulized in 70 mL over two hours. RESULTS: There was no difference between groups in age, sex, or initial peak expiratory flow rate (PEFR). Ninety-nine patients were included in the study (47 continuous and 52 intermittent). There was no statistically significant difference in PEFRs or admission rate between groups over the two-hour study period. One subgroup analysis was performed on patients with PEFRs on presentation to the ED of 200 L/min or less. Mean +/- SD baseline PEFR at presentation to the ED was 135 +/- 35 in the 35 patients in the continuous group and 137 +/- 45 in the 34 patients in the intermittent group). At 120 minutes, PEFR was 296 +/- 98 in the continuous group and 244 +/- 81 in the intermittent group (P = .01). Admission: discharge ratios for this subgroup analysis were 11:24 in the continuous group and 19:14 in the intermittent group (P = .03). Mean +/- SD heart rate in the subgroup analysis was 102 +/- 21 at baseline for the continuous group and 109 +/- 22 at baseline in the intermittent group. At 120 minutes, heart rate was 90 +/- 18 in the continuous group and 104 +/- 16 in the intermittent group (P = .002). CONCLUSIONS: Continuous nebulization offers no benefit over intermittent therapy in patients with an initial PEFR of more than 200 L/min. In PEFRs of 200 or less, continuous nebulization may decrease admission rate and improve PEFRs when compared with standard therapy.

Acute Disease↗

PubMed1989

Thimble glass frit nebulizer for atomic spectrometry.

A thimble-shaped glass frit nebulizer has been developed for atomic spectrometry. The thimble glass frit was pressurized internally by gases such as helium (He) or argon (Ar) while the test solution was applied externally to the frit. The pressurized gas exited through the pores of the glass frit and shattered the thin liquid film flowing on the surface of the thimble-shaped device to form small droplets. A small spray chamber surrounded the nebulizer to remove the large droplets. Small droplets were then introduced into inductively coupled plasmas (ICP) sustained in either Ar or He. To reduce the memory effect noted in the frit-type nebulizers, a clean-out system was also devised. Detection limits, signal-to-background ratios (S/B), precision, memory effects, noise power spectra (NPS), and particle size distributions measured with the new nebulizer were compared to those of disk and cylindrical glass frit nebulizers and the commonly used pneumatic nebulizer for Ar ICP atomic emission spectrometry (AES). Analytical performance was also measured for He ICP by using frit-type nebulizers and an ultrasonic nebulizer.

Nebulizers and Vaporizers↗

PubMed1995

Some factors associated with the ultrasonic nebulization of proteins.

Ultrasonic nebulization of lactate dehydrogenase (LDH) was investigated using a DeVilbiss "Aerosonic" nebulizer. The enzyme (8ml, 0.025 mg/ml Na2HPO4, pH 7.0) was completely inactivated after 20 minutes of operation. However, the inactivation profile observed during ultrasonic nebulization was different from that previously observed using air-jet nebulization. At least two mechanisms are involved, one associated with heating and the other with aerosol production. By preventing heating of the nebulizer fluid during operation, the denaturation profile was dramatically altered. By additionally including 0.01% w/v Tween 80 or 1% w/v PEG 8000, almost all activity was retained. Similar results were obtained by preventing aerosol production and heating. However, 100% of activity was lost when heating was allowed to occur without aerosol formation. The results demonstrate that cooling in conjunction with a surfactant is one approach that could be used to stabilize proteins to ultrasonic nebulization. However, cooling also significantly reduced solute output from the nebulizer. When operated at 10 degrees C output was negligible. At 50 degrees C the output was 5x greater than that found at room temperature. The median droplet size (micron(s)) was not significantly influenced by the operating temperature of the nebulizer fluid (3.6 +/- 0.4, 21 degrees C; 3.9 +/- 0.2, 50 degrees C, p = NS (n = 6)) although the size distribution was noted to increase at the higher temperature.

Aerosols↗

PubMed2000

Hydraulic high-pressure nebulization of solutions and dispersions for respiratory drug delivery.

The purpose of this investigation was to assess hydraulic high-pressure nebulization as a means for respiratory drug delivery. A hydraulic high-pressure nebulizer was designed and constructed. In a design study, the output efficiency and the aerosol particle size were determined for the nebulizer as a function of nozzle diameter (5, 10, and 20 microns), gas flow rate (2 and 8 l/min), applied hydraulic pressure (2200 and 4000 psig), and distance between the nozzle orifice and impaction surface (0.25-4 cm) with an aqueous solution of fluorescein. The output efficiency was also measured with an ethanol solution and an aqueous phospholipid dispersion of liposomes. For the design study, each factor had an effect. The efficiency tended to increase with a decrease in the nozzle diameter, although the differences between the 5- and 10-micron nozzle were more sensitive to the air flow rate and nozzle-to-impaction-surface distance. Greater efficiencies were always obtained at the higher ancillary air flow rates. Operating the nebulizer at different pressures caused a change in the functional relationship between the efficiency and the nozzle-to-impaction-surface distance. For the 5-micron nozzle at high pressure, efficiency fell with increasing nozzle-to-impaction-surface distance, whereas for the data obtained with the 20-micron nozzle, the efficiency increased with nozzle-to-impaction-surface distance, with lower efficiencies obtained at the higher pressures. For the remaining observations made with the 5- and 10-micron nozzles, the efficiency as a function of nozzle-to-impaction-surface distance appeared to be variable. For the 5- and 10-micron size nozzle, there was no significant effect of the air flow rate, pressure, or nozzle-to-impaction-surface distance on the mass median aerodynamic diameter and geometric standard deviation. For the 20-micron size nozzle, the particles were not completely dried. Ethanol solutions gave somewhat higher efficiencies, whereas the phospholipid dispersion gave efficiencies comparable to the aqueous solutions nebulized under similar conditions. The efficiency of the hydraulic high-pressure nebulizer appears to be correlated with the calculated properties of the liquid jet. For respiratory drug delivery, the hydraulic high-pressure nebulizer provides reasonably high outputs of respirable particles independent of time from a single pass of liquid through the nebulizer.

Administration, Inhalation↗

PubMed2006

Liquid atomizing: nebulizing and other methods of producing aerosols.

Liquid atomization (or nebulization) is the most traditional method of drug delivery to the lung. Although other methods seem to often be preferred for the delivery of new drugs, nebulizers are experiencing a revival, with new devices based on different atomization techniques, and the more traditional jet nebulizers evolving to become "smart nebulizers." These smart devices synchronize delivery with the patient's breath, estimate or measure delivered dose, provide feedback and data storage, and in some cases control breathing maneuvers. Besides adding new features, new nebulizers are also addressing traditional shortcomings, namely, reducing size, bulkiness, and power consumption. But in the longer term, nebulizers are expected to offer even more important features. Following the trend toward individually optimized therapy, nebulizers will be able to estimate deposited dosage and concentrations in the lung. In addition, as progress in nanotechnology allows the development of smart drug carrying particles, advanced liquid nebulization is expected to be the delivery mode of choice for these smart particle aerosols.

Administration, Inhalation↗

PubMed2001

Ultrasonic versus jet nebulization of iloprost in severe pulmonary hypertension.

Inhalation of iloprost, a stable prostacyclin analogue, is a promising perspective in the treatment of pulmonary hypertension. In initial clinical studies, a conventional jet nebulizer system was successfully used to decrease pulmonary vascular resistance and pressure, requiring however, up to twelve inhalations of 12-15 min per day. The aim of this study was to investigate if the application of an equal dose of iloprost at a drastically reduced duration of inhalation with the use of a more efficient ultrasonic nebulizer, leads to comparable haemodynamic effects, without escalation of side effects. The physical features of the jet nebulizer system (Ilo-Neb) and the ultrasonic nebulizer (Multisonic Compact) were characterized by laser diffractometry and a Tc99m-tracer technique. Mass median aerodynamic diameters were 3.2 microm for the jet and 3.9 microm for the ultrasonic nebulizer. Total output (mean+/-SD) was 60+/-7 microL.min(-1) (jet) and 163+/-15 microL.min(-1)(ultrasonic), and efficiency of the devices was 39+/-3% (jet) and 86+/-5% (ultrasonic). Based on these data, a total inhalative dose of 2.8 microg iloprost was delivered by jet nebulization within 12 min and by ultrasonic nebulization within 4 min, in 18 patients with severe primary and secondary pulmonary hypertension (New York Heart Association class III and IV), in a randomized crossover design. Haemodynamics were assessed by right heart catheterization. Inhalation with the ultrasonic device and jet nebulizer, reduced mean+/-SEM pulmonary artery pressure from 54.3+/-2.1 to 47.1+/-2.0 and from 53.5+/-2.2 to 47.0+/-2.2 mmHg, respectively, and mean+/-SEM pulmonary vascular resistance from 1,073+/-109 to 804+/-87 and from 1,069+/-125 to 810+/-83 dyn.s.cm(-5), respectively. Both modes of aerosolization were well tolerated. In conclusion, due to the markedly higher efficiency and output of the ultrasonic device, wastage of drug is largely avoided and the duration of inhalation can be shortened to one-third, with comparable haemodynamic effects and without enforcing side effects.

Administration, Inhalation↗

PubMed1997

Variation in nebulizer aerosol output and weight output from the Mefar dosimeter: implications for multicentre studies.

The active aerosol component of nebulizers is less than 100% of output by weight, and may vary between nebulizers in different batches from the same manufacturer. A measure of bronchial responsiveness to methacholine, which can overcome this problem, is required. One hundred and sixty nebulizers from 21 centres in the European Community Respiratory Health Survey (ECRHS) were calibrated for aerosol and weight output. Methacholine challenge data were obtained for 1,021 subjects in three English centres of the ECRHS. The dose producing a 20% fall in forced expiratory volume in one second (PD20), and log-slope, the regression slope of percentage decline in FEV1 with log (dose), were calculated, with and without calibration of nebulizers by weight. Within-centre variation in nebulizer percentage aerosol output had a coefficient of variation of less than 10%. Unlike PD20, log-slope is unaffected by constant percentage overestimation of nebulizer output. Variation in output by weight of nebulizers of 10% had little affect on log-slope. It is, however, affected by the scheduled range of doses. Log-slope shows advantages in analysis, and is less affected by variation in nebulizer output. It can be used for multicentre comparisons, with restriction to a common dose protocol.

Aerosols↗

PubMed2006

Nebulized magnesium sulfate in the management of acute exacerbations of asthma.

OBJECTIVE: To evaluate the efficacy and safety of nebulized magnesium sulfate in the treatment of acute exacerbations of asthma. DATA SOURCES: MEDLINE, EMBASE, and PubMed (all to October 2005) were searched using the key words magnesium, magnesium sulfate, magnesium compounds, nebulise, nebulize, vaporise, vaporize, nebulizers and vaporizers, aerosols, asthma, exacerbation, bronchial spasm, and bronchospasm. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials that evaluated efficacy and safety endpoints of nebulized magnesium sulfate in the management of acute exacerbations of asthma were included. All studies were evaluated independently by both authors. Efficacy outcomes included pulmonary function, clinical disease severity (as defined by each study), and rate of hospitalization. Safety outcomes were as described by each trial. DATA SYNTHESIS: Six prospective trials met the study criteria. Nebulized magnesium alone failed to demonstrate any benefit compared with beta(2)-agonists alone at improving pulmonary function. In trials in which nebulized magnesium was used as a vehicle for albuterol, there appear to be additional benefits to albuterol therapy in terms of improvements in pulmonary function in a population with mild-to-moderate asthma. The heterogeneous patient populations, study designs, magnesium doses, and the delivery methods preclude the extrapolation of these results to current clinical practice. CONCLUSIONS: The studies included in this review fail to clarify the role of nebulized magnesium sulfate; therefore, this therapy cannot be recommended at this time. Future studies evaluating the role of nebulized magnesium as an adjunct therapy to beta(2)-agonist, anticholinergic, and corticosteroid therapy are necessary to determine whether a clinically relevant benefit of this intervention exists.

Acute Disease↗

PubMed1993

Optimal duration of nebulized albuterol therapy.

The output from a jet nebulizer was analyzed for aerosol profile, solution output, and delivery of albuterol at three different initial volume fills to determine the changes that occur during the course of nebulization. Increasing diluent volume led to significantly greater delivery of the albuterol initially placed in the nebulizer. Albuterol delivery from the nebulizer ceased completely following the onset of inconsistent nebulization (sputtering) as determined audibly and by laser particle analysis. Aerosol output rate declined by one-half within 20 s of the onset of sputtering. The albuterol concentration in the nebulizer solution increased significantly once the aerosol output declined. The weight of solution delivered as determined by change in weight of the nebulizer could not be fully accounted for as aerosol volume. It appeared that this discrepancy represented loss of water by evaporation. Aerosolization past the point of initial jet nebulizer sputtering is unproductive.

Administration, Inhalation↗

PubMed1998

Comparison of the Maxair Autohaler to wet nebulizer in patients with acute asthma.

STUDY OBJECTIVE: Patients with acute asthma often have difficulty using a conventional metered-dose inhaler. The Maxair Autohaler (3M Pharmaceuticals; St. Paul, MN) is a hand-held breath-actuated device developed to help patients coordinate drug administration. The study objective is to compare the efficacy of the Autohaler with inhaled beta-agonist administered by wet nebulizer in treating acute asthma exacerbations. DESIGN: Parallel, randomized, placebo-controlled clinical trial. SETTING: Emergency department (ED) of a university-affiliated hospital. PARTICIPANTS: Patients aged 18 to 55 years presenting to the ED with acute asthma and an FEV1 40 to 70% on hospital arrival. INTERVENTIONS AND MEASUREMENTS: Patients were given either six puffs of the Maxair Autohaler (1,200 microg pirbuterol) plus saline solution by nebulizer (active Autohaler group) or six puffs placebo by Autohaler plus 2,500 microg albuterol via nebulizer (active nebulizer group). Treatment was repeated at 30 and 60 min, with clinical evaluation performed before each treatment and again at 120 min. At 120 min, the protocol was completed. RESULTS: Twenty-four patients were enrolled, with 5 excluded because of protocol violations. Baseline FEV1 percent predicted values for the active Autohaler group were 53% vs 51% for the active nebulizer group (p=not significant [NS]). At time 120 min, values were 66% for Autohaler and 64% for nebulizer (p=NS). The average time to administer Autohaler was 2.9 min, vs 9.1 min for nebulizer. No patient was excluded because of the inability to use the Autohaler device adequately. CONCLUSION: In patients with moderate asthma exacerbations, similar improvements in pulmonary function are obtained when beta-agonists are given by either the Maxair Autohaler or a wet nebulizer device.

Acute Disease↗

PubMed1990

Droplets produced by medical nebulizers. Some factors affecting their size and solute concentration.

The effect of nebulizer solution temperature and dilution air humidity on the size and solute concentration of aqueous aerosol droplets were studied. Four combinations of jet-nebulizers with air compressors or oxygen sources and one ultrasonic nebulizer were tested. The temperature to which the nebulizer solution of each system fell during generation was measured. The nebulizers were then kept at set temperatures, generated aerosols collected and either droplet size or solute concentration measured. The droplet solute concentration was found to increase. The droplet size decreased along with the droplet solute concentration increase. The ultrasonic nebulizer also was tested: its high output made the concentration of the solution in the droplets much more stable. However, the proportion of droplets depositing in the tubing and valves changed markedly with aerosol flow rate. The potential for large changes in droplet solute concentration, droplet size and output during nebulization should be considered in therapeutic and diagnostic applications of nebulized aerosols.

Aerosols↗

PubMed2006

Unlabeled uses of nebulized medications.

PURPOSE: The uses, dosing recommendations, benefits, and disadvantages of unlabeled drugs administered by nebulization are reviewed. SUMMARY: Nebulization is gaining popularity as a treatment alternative, and many drugs are used unlabeled in a nebulized form, including the opioids, lidocaine, magnesium sulfate, amphotericin B, and colistin. The opioids are frequently used to treat dyspnea in end-stage diseases. Common dosages include 1-2 mg every two hours as needed for hydromorphone and 25-50 microg every two hours for fentanyl citrate. Lidocaine can be used to relieve bronchoconstriction and cough symptoms as well as acting as a local anesthetic. It is typically given in a dose between 20 and 160 mg. Nebulized magnesium sulfate can be used in managing acute asthma and is given in dosages between 125 and 250 mg every 20 minutes, with no more than four consecutive doses. Nebulized amphotericin B can be used to prevent infections in immunocompromised patients. A typical amphotericin B regimen is 25 mg every 24 hours. Nebulized colistin is being studied in the prevention and treatment of gram-negative infections and in patients awaiting lung transplants. Colistin is often given as 75 mg every 12 hours to combat infections. CONCLUSION: Unlabeled nebulization of opioids, lidocaine, magnesium, amphotericin B, and colistin is an alternative method of treatment for patients with pulmonary problems or infections or for those undergoing bronchoscopy. More research is needed to develop guidelines for their use since nebulization may provide benefits to many patients who otherwise cannot be treated or would be at risk of systemic adverse effects of the drugs.

Aerosols↗

PubMed2006

Safety and usefulness of a novel eMotion electric mesh nebulizer in children with asthma.

BACKGROUND: A new electronic mesh nebulizer, eMotion is known to have higher performance compared to conventional nebulizers. However, there are some concerns about whether too much delivered dose might cause side effects with higher frequency. METHODS: To evaluate the safety and usefulness of the nebulizer, we measured changes in heart rates and lung functions of 73 asthmatic children when they inhaled 1 microg/kg of procaterol with eMotion or a conventional nebulizer, Junior BOY. RESULTS: In 34 children with mild asthma exacerbation, physical findings, lung function and transcutaneous oxygen saturation levels were improved after inhalation using both nebulizers. No adverse effects including significant increase of heart rate were found. Improvements in the rates of the parameters were comparable. When response to beta2-agonist inhalation was checked in 39 children in stable condition, similar degrees of improvement in lung function were observed, and heart rates did not change after inhalation with either nebulizers. CONCLUSIONS: Safety and efficacy was comparable between eMotion and a conventional nebulizer when it was used to administer beta2-agonists in asthmatic children. However, from the fact that eMotion needs only 3-4 minutes to inhale 2 mL solution, eMotion could be more useful for most children who usually do not prefer longer inhalation time with conventional compressor nebulizers.

Administration, Inhalation↗

PubMed1997

Improvement of mucosal pathology of the sinuses after exposure to sulfur dioxide by nebulization of S-carboxymethylcysteine.

Since s-carboxymethylcysteine (S-CMC) can directly enhance the ciliary activity in the maxillary sinus mucosa of patients with chronic sinusitis in the absence of significant organic changes of ciliated cells, the nebulization therapy using this medicine might be more effective in the treatment of chronic sinusitis than oral administration of the medicine. The safety of using 0.5-10% of S-SMC as a medicine for nebulization has been experimentally established. The present study was designed to experimentally examine the effectiveness of nebulization using 0.5-10% of S-CMC solution in the treatment of experimental chronic sinusitis in rabbits recurrently exposed to 20 ppm of sulfur dioxide. Thirty-three healthy rabbits were used; 3 of them were used as controls. The remaining 30 were exposed to 20 ppm of sulfur dioxide for 4 h a day for 4 successive weeks. Twelve animals were not treated with any medication during the post-exposure period, and sacrificed at 24 h or 15 days after completion of the final exposure to sulfur dioxide. The remaining 18 animals were treated with nebulization using 10%, 5% or 0.5% of S-CMC solution for 20 min a day for 14 successive days after the final exposure to sulfur dioxide, and they were sacrificed at 24 h after the final nebulization using S-CMC. At the time of sacrifice, the ciliary activity and the morphology of the sinus mucosa were observed to assess the effectiveness of S-CMC nebulization. In the animals sacrificed 24 h after the final exposure, the mucosa of the sinus demonstrated marked epithelial cell injuries, and the ciliary activity was extremely reduced. Complete recovery of the epithelium and the ciliary activity was not recognized in the animals sacrificed 15 days after completion of the exposure. By contrast, epithelial recovery was more accelerated in the animals treated with S-CMC nebulization during the 14 days after the exposure. In the animals treated with 0.5% of S-CMC, the ciliary activity was inferior to that of the control animals, and the epithelial repair was not complete. In the animals treated with 10% of S-CMC, however, ciliary activity and epithelial morphology were completely recovered. In conclusion, our study suggests that clinical application of 10% of S-CMC nebulization may provide otolaryngologists with a new tool in the treatment of sinus diseases such as chronic sinusitis.

Animals↗

PubMed2002

The future of nebulization.

Currently available nebulizers are inefficient, bulky, noisy, and take longer to use than other inhalation devices. Use of nebulizers is increasingly confined to patients who cannot use other devices or who require therapies not available in another form. In the future, nebulizers will be smaller and more efficient. "Smart" nebulizers that can monitor patient use and provide feedback to the patient and the caregiver will be developed. Critical study will be needed to determine whether these innovations improve patient compliance with therapy. Nebulizers will also be refined for delivering complex molecules for both pulmonary and systemic disease. One example is in the use of gene therapy, in which issues such as the best gene vector are unresolved. Nebulizing these complex molecules without damaging them may be difficult, and nebulizers of the future will have to be more efficient to avoid wasting expensive drugs. For the delivery of widely used, less expensive medications, such as some bronchodilators, these innovations will not be cost-effective, so cheaper, less efficient nebulizers will continue to be used.

Administration, Inhalation↗

PubMed2003

Comparison of the efficacy of beclometasone dipropionate and fluticasone propionate suspensions for nebulization in adult patients with persistent asthma.

The use of nebulization for the administration of inhaled steroids plays an important role in asthma patients who are unable to use pressurized aerosol or dry-powder inhalers effectively. Moreover, the type of nebulizer used may affect how much drug is delivered to the lungs. The objective of this multinational, multicentre, randomized, active-controlled, parallel-group study was to compare the efficacy and safety of nebulized corticosteroids in adult patients with chronic asthma. Following a 1-week placebo run-in period, 205 patients, aged 18-65 years, with moderate persistent asthma were randomized to one of two treatment groups for 12 weeks: beclometasone dipropionate (BDP) suspension for nebulization 2,400 microg day(-1) b.i.d. (n = 103), or fluticasone propionate (FP) suspension for nebulization 2,000 microg day(-1) b.i.d. (n = 102), both administered by a jet nebulizer Comparable efficacy in controlling asthma was demonstrated by the two treatments at study end, as evident when evaluating various efficacy parameters (pulmonary function tests, asthma exacerbations and symptoms, and the use of rescue salbutamol). The primary efficacy endpoint was the variation in the pulmonary expiratory flow (PEF) at treatment end over the baseline visit. For the intent-to-treat population, in the BDP group mean PEF values increased statistically significantly from 5.2 +/- 1.31 s(-1) to 5.7 +/- 1.61 s(-1), while in the FP group the increase was from 5.2 +/- 1.21 s(-1) to 5.8 +/- 1.81 s(-1). Mean PEF values as per cent of predicted also increased in a statistically significant way, from 71% to 77.1 % in the BDP group, and from 70.1% to 76.9% in the FP group. The two treatments were equally well tolerated.A total of 23 and 32 patients in the BDP and FP groups, respectively, reported adverse events during the treatment period, and these were generally mild. In conclusion, the results of this study demonstrate that BDP 2,400 microg day(-1) and FP 2,000 microg day(-1), both suspensions for nebulization administered via a jet nebulizer, are equally effective, with an acceptable safety and tolerability profile, when used in adult patients with moderate persistent asthma.

Administration, Inhalation↗

PubMedDate not supplied

GENEBU Project. Equipment and drugs used for home nebulizer therapy in Italy.

The GENEBU Project is an open, observational survey evaluating home nebulizer practices in Italy. It consecutively included patients who were referred to one of the 27 participating chest clinics from May to December 1999 and who had been using a home nebulizer in the previous six months. The information source was a self-administered questionnaire compiled by the enrolled subjects. We collected 1257 questionnaires. The nebulizer equipment was heterogeneous, with at least 92 different models. Jet nebulizers were 90% of the total; 53% of these had a glass reservoir. Almost 80% of the patients selected the nebulizer themselves without any medical advice. In addition, most patients (> 80%) did not receive information on both the interface system and the optimal fill volume of the nebulizer. Corticosteroid nebulisation was widespread (74%), for both occasional and regular daily use, for both acute and chronic diseases from upper to lower airways. Beta 2-agonist (55%), anticholinergic (37%), mucolytic (32%) drugs were also often nebulised. More than 90% of patients mixed some active drugs. We conclude that the nebulizer equipment for home aerosol therapy was very heterogeneous and, probably, not always utilised at its best in Italy. The mixing of drugs and the widespread use of corticosteroids were peculiarities of home nebulizer therapy in Italy.

Adrenergic beta-Agonists↗

PubMed2004

Performance comparison of nebulizer designs: constant-output, breath-enhanced, and dosimetric.

INTRODUCTION: Design differences among pneumatically powered, small-volume nebulizers affect drug disposition (percentage of the dose delivered to the patient, lost to deposition in the equipment, and lost via exhalation to ambient air) and thus affect drug availability and efficacy. OBJECTIVE: Evaluate in vitro the dose disposition with 5 nebulizer models, of 3 types (constant-output, breath-enhanced, and dosimetric), using simulated normal, adult breathing. METHODS: We compared 5 nebulizer models: 2 constant-output (Misty-Neb and SideStream), 1 breath-enhanced (Pari LCD), and 2 dosimetric (Circulaire and AeroEclipse). Each nebulizer was filled with a 3-mL unit-dose of albuterol sulfate and powered by oxygen at 8 L/min. The nebulizers were connected to an induction throat, connected to a breathing simulator. We measured (1) inhaled drug (subdivided into mass deposited in the induction throat and mass deposited in the filter at the distal end of the induction throat), (2) exhaled drug (lost to the ambient air), (3) drug lost to deposition in the apparatus, and (4) drug left in the unit-dose bottle. The duration of nebulization (until sputter) was measured with a stopwatch. All drug amounts were analyzed via spectrophotometry and expressed as a percentage of the total dose. RESULTS: The mean +/- SD inhaled drug percentages were: Misty-Neb 17.2 +/- 0.4%, SideStream 15.8 +/- 2.8%, Pari LCD 15.2 +/- 4.2%, Circulaire 8.7 +/- 1.0%, and AeroEclipse 38.7 +/- 1.3%. The mean +/- SD percentages of drug lost to the ambient air were: Misty-Neb 26.8 +/- 0.7%, SideStream 17.3 +/- 0.4%, Pari LCD 18.3 +/- 0.8%, Circulaire 12.3 +/- 0.8%, and AeroEclipse 6.6 +/- 3.3%. The mean +/- SD percentages of drug lost to deposition in the apparatus were: Misty-Neb 52.3 +/- 0.6%, SideStream 63.4 +/- 3.0%, Pari LCD 62.5 +/- 4.0%, Circulaire 75.8 +/- 0.5%, and AeroEclipse 51.0 +/- 2.1%. Duration of nebulization was shortest with the Circulaire and longest with the AeroEclipse (p < 0.05 via 1-way analysis of variance). CONCLUSIONS: The nebulizers we tested differ significantly in overall drug disposition. The dosimetric AeroEclipse provided the largest inhaled drug mass and the lowest loss to ambient air, with the test conditions we used. method.

Administration, Inhalation↗