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PubMed1977

Comparison between simple nebulization and intermittent positive-pressure in asthmatic children with severe bronchospasm.

Tweinty-three asthmatic children had severe sudden bronchospasm due to numerous factors. Baseline values for the peak expiratory flow rate were less than 25 percent of predicted. Utilizing an analysis of variance, three methods of administering isoproterenol hydrochloride (hand-held Freon-propelled nebulization, continuous nebulization, and intermittent positive-pressure breathing [IPPB]) were compared and found to be similar in reversing the bronchospasm (F = 1.56; degrees of freedom, 2/44; P = 0.22). There were no patients whose condition consistently improved with IPPB over the methods of therapy using simple nebulization. Therapy with IPPB did not offer any advantage over simple nebulization in patients with severe, reversible airway obstruction.

Adolescent↗

PubMed1975

Microorganisms in heated nebulizers.

Out of 353 heated nebulizers in actual use which were cultured in the Peter Bent Brigham Hospital, 118 (33%) were found to be contaminated. Gram-negative organisms predominated with rare micrococci and fungi. A slow-growing Vibrio was also recovered from 4 nebulizers. Heating of nebulizers above 46 C resulted in significant reduction of contamination. Types of heated nebulizers also figured significantly in the rate of contamination found. Carefully considered recommendations for the care and use of respiratory therapy equipment must be instituted and enforced. Techniques for terminal disinfection of equipment, followed by sterilization should result in the issue of sterile equipment for each patient. Rules for maintenance of equipment at the bedside are also needed.

Respiratory Therapy↗

PubMed1992

[Sodium cromoglycate nebulized solution has an acute bronchodilative effect in patients with aspirin-intolerant asthma (AIA)].

Sodium cromoglycate (SCG) (Intal) is a well-known anti-allergic agent which protects against allergen- and exercise-induced bronchospasms. The effect has been recognized non-acute, unlike that of bronchodilators. However, we have found that some patients with aspirin-intolerant asthma (AIA) show significant improvement soon after a single inhalation of SCG nebulized solution. In this study, we investigated the acute bronchodilator effect of SCG given by nebulizer in adult asthmatics, especially compairing AIA with non-AIA (aspirin-tolerant asthma) patients. Twenty patients with AIA and 11 with non-AIA participated in the study. After performing spirometry on remission, they inhaled either SCG via a nebulizer or 4 ml of placebo in a randomized double-blind fashion. After inhalation, spirometry was performed every ten minutes for one hour. The placebo used was a saline solution of the same osmolarity as that of the SCG nebulized solution. Placebo inhalation provoked asthmatic attacks in five of the patients with AIA and one with non-AIA, but SCG did not. In the AIA group, twelve out of the twenty patients also had improved nasal symptoms soon after inhalation of SCG. Forced expiratory volume in one second (FEV1) was significantly improved 10 minutes after inhalation of SCG. Fifty minutes after SCG inhalation, the percent degree of FEV1 improvement was approximately 17%. However, FEV1 was significantly decreased by approximately 14% after inhalation of placebo. In the non-AIA group, FEV1 was not increased after inhalation of SCG. V25 was not changed after inhalation of SCG in AIA and non-AIA groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗

PubMedDate not supplied

Bacterial contamination potential of sterile, prefilled humidifiers and nebulizer reservoirs.

Contaminated respiratory therapy equipment may be responsible for the spread of pathogens to hospital patients. This study focused on the potential for contamination of prefilled, sterile, disposable water and saline systems for humidification and nebulization. Gas and liquid samples from 48 prepacked oxygen humidifier/cannula and 26 prepacked nebulization setups were taken at the initial application of devices and at 8, 24, 48, and 72 hour intervals, totaling 386 cultures. All samples from the humidifier units were found to be pathogen-free for up to 3 days. A total of six or 3.84% of the nebulizer samples showed contamination with Enterobacter cloacae after 8 to 24 hours of operation. It was concluded that the potential for contamination of the humidifiers is low for up to 72 hours, but the nebulizer units should be changed after 24 hours even though their contamination rate is markedly lower than that of conventional nondisposable units.

Antisepsis↗

PubMed2025

Nebulization of an mRNA-encoded monoclonal antibody for passive immunization of foals against Rhodococcus equi.

Inhalation of Rhodococcus equi causes severe pneumonia in humans and animals worldwide, most commonly affecting horse foals. The standard for preventing R. equi pneumonia in foals is transfusion of hyperimmune plasma, which is expensive and carries the risk of adverse effects. Our goal was to passively immunize foals against R. equi by nebulizing mRNA encoding an equine monoclonal antibody (mAb) against the virulence-associated protein A (VapA) directly into the lungs. VapA-specific memory B cells from an immunized horse were used to identify and select the sequence for an equine immunoglobulin (Ig)G1 mAb. In vitro-transcribed mRNA encoding this sequence expressed full-length, VapA-specific mAbs in vitro and safely and effectively produced intrapulmonary mAb in foals for at least 5 days following nebulization. These findings establish a platform to generate mRNA-encoded mAbs for immunotherapeutic and immunoprophylactic applications in horses and demonstrate the feasibility of delivering nebulized mRNA-mAb for intrapulmonary mAb expression in neonates.

Animals↗

PubMed1992

Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia.

Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6-24 months, were treated with flunisolide, 187-250 micrograms q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5-20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P less than 0.05). No side-effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD.

Administration, Intranasal↗

PubMed1992

The use of nebulized albuterol in wheezing infants.

Using a double-blind, placebo-controlled protocol, we evaluated the efficacy of nebulized albuterol in the treatment of infants aged 0 to 24 months who presented to the emergency department with wheezing. Twenty-five infants were randomly assigned to receive two identical treatments of either nebulized albuterol (0.15 mg/kg) or placebo (saline). Assessment after each treatment included a wheeze and retraction score, respiratory and heart rates, and pulse oximetry. After two treatments, there was a significant improvement in the wheeze scores (P less than 0.05) and total scores (P less than 0.05) of the albuterol group compared with the placebo group. After one treatment, there was an initial decrease in oxygen saturation in the albuterol group, which improved after the second treatment. There were no significant differences between the two groups in heart rate or respiratory rate. This study supports the use of nebulized albuterol in the treatment of wheezing infants in the emergency department.

Albuterol↗

PubMed1992

Dose duration of nebulized nedocromil sodium in exercise-induced asthma.

The dose-duration effect of nebulized nedocromil sodium was studied in ten patients with exercise-induced asthma (7 males mean (SEM) age 30.1 (3.5) yrs and predicted forced expiratory volume in one second (FEV1) 102%). All of these patients showed > 40% protection of their exercise asthma with 4 mg of nedocromil sodium delivered via metered dose inhaler. Three concentrations of nedocromil sodium (0.5, 2.5 and 10 mg.ml-1) and placebo were administered in double-blind, randomized manner. One ml of each solution was nebulized via a Wright nebulizer. Effects were assessed from the mean maximal percentage fall in FEV1 after 6-8 min treadmill exercise at 15, 135 and 255 min following each treatment and expressed as percentage protection. The mean baseline FEV1 values before and after treatments were comparable on four days of testing. Nedocromil sodium inhibited exercise-induced fall in FEV1 at all concentrations (p < 0.001) and the inhibitory effect was still present at 255 min. No differences were observed between active treatments.

Adult↗

PubMed1992

Protective effect of levodropropizine against cough induced by inhalation of nebulized distilled water in patients with obstructive lung disease.

Levodropropizine is a recently developed, peripherally active antitussive agent which is widely used in clinical practice. In order to obtain further information on the spectrum of activity of this compound in experimental clinical models, a double-blind controlled study was carried out to evaluate the potential effect of the drug against cough and bronchoconstriction induced by inhalation of an ultrasonically nebulized solution of distilled water in patients with obstructive lung disease. Twenty patients were randomly divided into two groups, which received levodropropizine (60 mg t.i.d.) or placebo respectively for 7 consecutive days. Parameters evaluated at baseline and on the last day of treatment included (i) results of respiratory function tests (FEV1, IVC, FVC, TIFF, PEF, MEF75, MEF50, MEF25) performed before the stimulation test with nebulized water; (ii) total number of coughs during a 2-hour period after the stimulation test; (iii) bronchial responsiveness, quantified by calculating the volume of nebulized water required to induce a 20% reduction of FEV1 below the basal level. At pretreatment, the tussive response was very similar in the two groups. A significant decrease in number of coughs (from 34.4 +/- 8.4 at baseline to 15.6 +/- 4.9 post-treatment, p less than 0.01) was observed after administration of levodropropizine, whereas placebo treatment produced no significant effect (number of coughs: 29.6 +/- 4.9 at baseline vs 24.8 +/- 9.6 post-treatment, N.S.). Bronchial responsiveness decreased significantly (compared to baseline) in both treatment groups, without any significant difference between drug and placebo. Respiratory function tests were not significantly affected by either treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

The prehospital use of nebulized albuterol on patients with wheezing whose chief complaint is shortness of breath.

The use of prehospital nebulized beta-agonists has become widespread, and their safety and efficacy has been documented. Our purpose was to study their broadened use and determine their effectiveness in specific sub-sets of wheezing patients. We conducted a six and one-half month prospective study to determine the benefit of nebulized albuterol treatments on a variety of wheezing patients whose chief complaint to paramedics was shortness of breath. Sixty-two patients were enrolled in the study and were subdivided into four groups based on patient history; asthma, COPD, asthma & COPD (A/C), and non-Asthma/non-COPD (NANC). The effectiveness of the treatment was evaluated objectively by peak expiratory flow rates (PEFR) obtained before and immediately after treatment and subjectively by the patients' evaluation of their own dyspnea. Changes in PEFR were subjected to analysis by a paired T-test. Albuterol was effective in increasing the PEFR in patients with asthma, COPD and NANC. Patients with both asthma and COPD did not demonstrate increased PEFR after treatment. The majority of all patients were subjectively improved after nebulized albuterol treatments. We conclude that aerosolized albuterol is safe and effective in the prehospital treatment of patients complaining of dyspnea who are wheezing.

Adult↗

PubMed1978

A comparison of salbutamol given by pressure-packed aerosol or nebulization via IPPB in acute asthma.

Salbutamol was given by pressure-packed aerosol or nebulizer via IPPB to patients with acute asthma to compare the effectiveness of these methods of inhalation. The results show that both methods produce significant bronchodilatation even in patients admitted with moderately severe asthma (FEV1 about 38% predicted) but a slightly greater improvement may be achieved by IPPB nebulization. Our findings indicate that supervised inhalation of a pressure-packed aerosol of salbutamol may be useful for the initial treatment of asthmatic attacks but confirm the marginal advantage of IPPB nebulization, which should be reserved for patients unable to inhale from a pressure-packed aerosol or failing to respond to its treatment.

Acute Disease↗

PubMed1975

Comparative studies of six nebulizers with Congo Red millipore technique.

If the particle size is the important factor to be considered in case of droplet size spectrum then from our results it can be said that Gauchard with 6 1/min. flow and Bird Asmastik with 95 1/min. are producing the particle size classes which can reach most easily the lower respiratory passage. The nebulizers which are producing droplets of a mass median diameter bigger than 10 mu, send only an unpredictable portion of their liquid output into the lower respiratory system. Smaller particles are representing very little weight and carry only small quantities of liquid material unless present in vast majority in the aerosol. To recommend an ideal nebulizer is yet a long way to go but considering the very big quantitative influence of a few big droplets, a small mass median diameter (1-7 mu) is an important factor on the credit of any nebulizer.

Aerosols↗

PubMed1975

Effect of nebulized lidocaine on reactive airways.

Fourteen subjects with reversible obstructive lung disease inhaled one per cent lidocaine mist delivered by an ultrasonic nebulizer. The effect of ultrasonic nebulization per se was evaluated by a control study utilizing normal saline. After lidocaine inhalation there was a significant decrease in expiratory flow and an increase in airway resistance compared with either baseline or post-saline values. The changes were mild and do not preclude the continued use of nebulized lidocaine as an adjunct to bronchoscopy, but caution in its use is indicated.

Adult↗

PubMed1977

Effect of ultrasonic nebulization on arterial oxygen saturation in chronic obstructive pulmonary disease.

Twenty patients with mild to severe chronic obstructive pulmonary disease received ultrasonic nebulization to assess the danger of short-term changes in blood gas levels during this therapy. The status of arterial oxygenation was monitored during 20 minutes of therapy and for 20 minutes following therapy. In nine patients with periodic studies of arterial blood, the mean change in arterial oxygen pressure from base line was a decrease of 0.8 mm Hg at ten minutes into therapy, 2.8 mm Hg at the conclusion of therapy, and 2.9 mm Hg 20 minutes after therapy. In all 20 patients, ear oximetric studies showed only a small mean change at ten minutes into therapy, at the end of therapy, and at 20 minutes after therapy. Changes in the status of arterial oxygenation during and after therapy with ultrasonic nebulization in a group of patients with chronic obstructive pulmonary disease are generally small and of no statistical and limited clinical significance; however, alarming falls in arterial oxygenation can occur and cannot be predicted by base-line testing of pulmonary function or studies of arterial blood. It would be prudent to monitor patients with chronic obstructive pulmonary disease during therapy with ultrasonic nebulization or to withhold therapy altogether.

Adult↗

PubMed1992

Delivery of micronized budesonide suspension by metered dose inhaler and jet nebulizer into a neonatal ventilator circuit.

We compared the delivery of a micronized suspension of budesonide by a metered dose inhaler (MDI) with two different spacers (Aerochamber and Aerovent) and by two jet nebulizers (MAD2 and Ultravent) to a ventilated neonatal test-lung using a standard neonatal ventilator circuit. The combination of MDI and Aerochamber was significantly better at delivering budesonide to a filter in front of the test lung (14.2% of aerosolized dose) than were either the MDI and Aerovent (3.6%) or the Ultravent or MAD2 jet nebulizers (0.02% and 0.68% of initial reservoir dose). Of the droplets emerging from the MDI, Aerochamber, and ET tube, 18% of the initial dose was in droplets less than 4.7 microns. Assuming that the test-lung model accurately reflects in vivo deposition, the combination of MDI and Aerochamber appears to be an extremely effective way of delivering budesonide aerosol to ventilated newborn infants.

Aerosols↗

PubMed1992

Frequently nebulized beta-agonists for asthma: effects on serum electrolytes.

STUDY OBJECTIVE: To determine the magnitude of the changes in serum potassium, magnesium, and phosphate during the treatment of acute bronchospasm with repeated doses of beta-adrenergic agonists. DESIGN: Prospective study of a convenience sample of asthmatic patients. SETTING: University teaching hospital emergency department. TYPE OF PARTICIPANTS: Twenty-three patients met the inclusion criteria of age of more than 16 years; a history of asthma or chronic obstructive pulmonary disease; and an acute exacerbation. INTERVENTIONS: Baseline peak expiratory flow rate and serum potassium, magnesium, and phosphate levels were measured. Nebulized albuterol (2.5 mg) was administered every 30 minutes until the patient was discharged from the ED. Before each albuterol treatment, repeat serum levels of potassium, magnesium, and phosphate were determined. MEASUREMENTS AND MAIN RESULTS: Baseline peak expiratory flow rate averaged 188 +/- 119 L/min. Serum potassium levels decreased significantly (P = .0001 by repeated-measures analysis of variance) from 4.10 +/- 0.468 (baseline) to 3.55 +/- 0.580 mmol/L (90 minutes) and 3.45 +/- 0.683 mmol/L (180 minutes). Potassium decreased to less than 3.0 mmol/L in 22% of patients at some point during the study. Magnesium decreased from 1.64 +/- 0.133 mmol/L (baseline) to 1.48 +/- 0.184 mmol/L (90 minutes) and 1.40 +/- 0.219 mmol/L (180 minutes) (P = .0001). Phosphate levels also decreased, from 3.74 +/- 1.029 (baseline) to 2.84 +/- 0.957 mmol/L (90 minutes) and 2.55 +/- 0.715 mmol/L (180 minutes) (P = .0001). CONCLUSION: Aggressive administration of nebulized albuterol during the emergency treatment of acute bronchospasm is associated with statistically significant decreases in serum potassium, magnesium, and phosphate. The mechanism and clinical significance of these findings are unknown and warrant further study.

Adolescent↗

PubMed1992

Pulmonary granulocyte accumulation is reduced by nebulized corticosteroid in septic pigs.

Nebulized beclomethasone dipropionate was administered to 14 anesthetized and artificially ventilated pigs at 6-hourly intervals after infusion of live S. aureus (BDP group). Changes in pulmonary activity from autologous granulocytes labeled with In-111 was detected externally for 12 (n = 8) to 44 h (n = 6). The changes were compared with those in ten pigs (12 h n = 7, 44 h n = 3) subjected to the same insults but given no corticosteroid (placebo group). Serial measurements of blood radioactivity, and cardiac output were performed in animals observed for 12 h. Corticosteroid-treated pigs showed a gradual decline in decay-corrected pulmonary In-111 activity. The placebo group displayed a more varied reaction, but most animals had an increased activity compared to the corticosteroid group. The difference between the groups was significant at 8 h (BDP-group 92% (88-98), placebo-group 107% (97-121), median (lower-upper quartiles), baseline = 100%. P < 0.01, U-test). Blood radioactivity and cardiac output did not differ significantly between the two groups. Nebulized corticosteroid thus diminished pulmonary granulocyte accumulation, which may be of value in the treatment of septic respiratory distress.

Aerosols↗

PubMed1975

Ultrasonic nebulizer in local anesthesia for bronchoscopy.

A method of utilizing an ultrasonic nebulizer (De Vilbiss 35 A) in local anesthesia for bronchoscopy is described. 10 ml of 4% Licocaine without adrenaline was used as anesthetic agent. Blood levels of Lidocaine were determined on 12 patients. The maximum blood levels were reached 6-8 min after the end of anesthesia. Blood lelvels ranged from 0.37 to 3.28 mug/ml being so in the nontoxic dosage range. A satisfactory anesthesia was achieved in 95% of the 1,043 patients subjected to bronchoscopy, while 5% felt that laryngeal anesthesia was not complete. In no case was it necessary to use the conventional way to complete the anesthesia. Nebulizer anesthesia was preferred by 100 persons who had been anesthetized by both the conventional method and the ultrasonic technique.

Adult↗