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PubMed1995

Stability of recombinant consensus interferon to air-jet and ultrasonic nebulization.

The stability of recombinant consensus alpha-interferon (rConIFN) to air-jet and ultrasonic nebulization was evaluated. Volumes of 10 mL of 0.5 mg/mL rConIFN in phosphate-buffered saline (PBS) at pH 6.3 were nebulized with a Collison three-jet nebulizer at 40 psig (10 L/min) for up to 25 min. The effects of pH (3.0, 6.3, and 9.0), additive (0.1% w/v Tween 80, 0.1% w/v Tween 20, and 1% w/v PEG 8000), and ionic strength (0, 0.25, and 1.0) were examined. The effects of ultrasonic nebulization were studied using three devices (DeVilbiss "Aerosonic"; Mountain Medical "Microstat", and Medix "Easimist"). Stability of rConIFN was assessed by size exclusion chromatography and native and sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE). Structural effects were examined by circular dichroism spectroscopy and bioactivity was assessed by an in vitro mitogenic inhibition bioassay. rConIFN is destabilized by air-jet nebulization. Insoluble noncovalent aggregates are produced rapidly, and only approximately 25% of the initial monomeric protein remains after 25 min of nebulization. This correlates with a decrease in in vitro bioactivity. Aggregation during nebulization is influenced by pH (9.0 < 6.3 < 3.0) but even at the highest pH, > 25% aggregation is observed. Ionic strength does not appear to influence aggregation. rConIFN is also seen to adhere to glass after nebulization. Samples from a rinse of the emptied reservoir with 0.1% w/v SDS, after thorough rinsing with water (three times), show a strong rConIFN band on SDS-PAGE gels. The use of PEG 8000 and Tween mitigate aggregate formation and adhesion (< 20%). The cumulative output collected as a wet or dry aerosol is not aggregated to the same extent as the residual protein remaining in the nebulizer. Ultrasonic nebulization also results in aggregation, but the extent of denaturation is dependent upon the nebulizer used and is related to the heating of nebulizer solutions. Cooling of the nebulizer solution during operation (< 30 degrees C) minimizes aggregation (< 5%), and bioactivity is retained.

Adsorption↗

PubMed1992

A long-term prospective assessment of home nebulizer treatment.

Forty-nine patients (15 asthma, mean FEV1/FVC 1.3/2.1; 34 COPD, mean FEV1/FVC 0.7/1.8) were referred for consideration of home nebulizer treatment. All were monitored for 2 weeks while using their usual inhaled treatment followed by 2 weeks using a 'Nebuhaler' spacer to deliver 1 mg of terbutaline and 80 micrograms of ipratoropium bromide (IB) four times daily. They then borrowed a System 22 nebulizer to self-administer salbutamol nebulizer solution (5 mg), IB unit dose vials (0.5 mg) or a mixture of these drugs four times daily for 1 month each. Both asthmatic and bronchitic patients had a significant rise in their mean daily peak flow rate (PFR) during home nebulizer treatment (P < 0.03) and the COPD patients also had a significant PFR rise during Nebuhaler treatment (P = 0.0004). The mean daily peak flow rates (PFR 1 min-1 were: baseline 179, Nebuhaler 195, salbutamol nebulizer 200, IB nebulizer 198, mixed nebulizer 216). Four patients failed to respond subjectively or objectively to either Nebuhaler or nebulizer treatment. Five patients responded well to Nebuhaler treatment and did not proceed to a home nebulizer trial. Eight further patients preferred Nebuhaler to nebulizer treatment or could not tolerate nebulizer treatment (two cases). Thirty-two patients requested home nebulizer treatment for long-term use (nine salbutamol, five IB, 18 mixture). Twenty-seven of these patients had an increased mean daily PFR (compared to their usual therapy) while using their chosen nebulized treatment. The mean increase in PFR for all 32 patients was 191 min-1 (11%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

Comparison of volume output from two different continuous nebulizer systems.

BACKGROUND: Continuous nebulization is a safe and practical method of administration of beta 2-adrenergic agonists during acute asthma. There are essentially two types of continuous nebulizer systems; one utilizes a large volume nebulizer and the other a small volume nebulizer attached to a constant volume infusion pump. OBJECTIVES: We compared the volume output characteristics of these two systems. METHODS: Study performed at Danbury Hospital. Both types of continuous nebulizers were reconstructed as reported in the literature and output monitored hourly for four hours. A total of nine nebulizers from each type of continuous nebulizer was evaluated, three from each of three different lots. RESULTS: The volume output of the large volume nebulizer ranged from 37.7 to 55.4 mL/h with a mean of 45.96 mL/h (P = .0001). Contrasts within the repeated measure ANOVA revealed that all pairwise contrasts in time were significant (P < .05) except for the 60 and 120 minute means. The volume output of the small volume nebulizer ranged from 15.0 to 16.6 mL/h with a mean of 15.88 mL/h. There was a significant difference in the mean volume output across time for the 60-minute value only. No other significant differences were found. CONCLUSION: These data suggest that the small volume nebulizer utilized in this manner for continuous nebulization is a more consistent delivery device than the large volume nebulizer. Further data are required on both actual drug output and mass median aerodynamic diameter of the particles generated by these nebulizers before one can recommend a particular system.

Adrenergic beta-Agonists↗

PubMed1992

Measurement of particle and mass distribution of pentamidine aerosol by ultrasonic and air jet nebulizers.

The use of appropriate nebulizers is a major precondition for a successful treatment and prevention of Pneumocystis carinii pneumonia with pentamidine aerosol. The apparatus should supply a sufficient amount of pentamidine with adequate particle size. Using Fisons ultrasonic nebulizer FISO Neb, model FZV 40 BAMKI, De Vilbiss ultrasonic nebulizer, Porta-Sonic, model 8500 GB, and the Marquest Medical Products jet nebulizer Respirgard II, two pentamidine concentrations (300 mg/6 ml and 60 mg/6 ml) were compared by measuring nebulized pentamidine mass distribution and particle size distribution under in vitro conditions by means of a laser light-scattering particle sizer of the type Malvern Master sizer. It was found that there were significant differences among nebulizers. Mass distribution experiments with air flow 6 l/min showed that using FISO Neb the quantity of nebulized pentamidine was 201.4 mg and 36.7 mg, whereas using Porta-Sonic the values found decreased to 85.2 mg and 23.6 mg. Using Respirgard II the values were 80.0 mg and 10.64 mg. The measured total duration times of nebulization were 6 - 8.5 min, 12 min and 25 min for the nebulizers FISO Neb, Porta-Sonic and Respirgard II. A decomposition of pentamidine during nebulization in the case of ultrasonic nebulizers doesn't take place. The measured mass median diameters (MMD) were 5.6 - 6.9 mum, 1.96 - 3.04 mum and 1.9 - 2.5 mum for the nebulizers FISO Neb, Porta-Sonic and Respirgard II. Using 300 mg pentamidine the nebulized amounts of pentamidine containing particles sizes less than or equal to 2 mum predominately available for alveolar deposition were with values of about 43 mg markedly higher for Respirgard II and Porta-Sonic than the measured 10.5 mg for FISO Neb.

Aerosols↗

PubMed1989

Importance of evaporative water losses during standardized nebulized inhalation provocation tests.

Evaporative water losses from jet nebulizers produce temperature drop, reduction in total nebulizer output with increased nebulization time, and increasing concentration of solute remaining in the nebulizer. These were documented and quantitated for the Wright nebulizer which is used for one histamine/methacholine inhalation test method. Indirect determination of nebulizer aerosol output, made by estimation of total sodium lost from the nebulizer, was about 25 percent of total output as determined by weight change. A similar tendency was seen for a De Vilbiss 40 nebulizer for both reduction in total nebulizer output with increasing duration of nebulization, and increased solute concentration remaining in the nebulizer. These data must be taken into account when standardizing inhalation provocation tests. Nebulizers should be calibrated under the same conditions that they are used during the test. Histamine and methacholine solutions should be discarded after a single use in the 2-min tidal breathing Wright nebulizer method.

Aerosols↗

PubMed2005

Impact of a criteria-based reimbursement policy on the use of respiratory drugs delivered by nebulizer and health care services utilization in Nova Scotia, Canada.

BACKGROUND: In February 2000, the Nova Scotia Seniors' Pharmacare Program announced a change in the reimbursement of respiratory drugs that added specific reimbursement criteria for wet nebulization therapy. Policy implementation coincided with multifaceted interventions to assist patients and providers with the change. OBJECTIVE: To assess the impact of the new policy and associated interventions on the use of wet nebulization and portable inhaler delivery systems of respiratory drugs and on the utilization of health services. METHODS: The administrative claims database identified all beneficiaries (age > or = 65 yrs) who received at least one respiratory drug prescription in the 12 months before the study. These patients were then grouped into the wet nebulization cohort or the control cohort receiving a metered-dose or a dry-powder inhaler. The study period was from April 1998-February 2002. Use of respiratory drugs, physician visits, and hospitalizations were compared between study cohorts using an interrupted time-series design. RESULTS: A sharp decrease was noted in use of wet nebulization after the policy announcement, along with an increase in use of short-acting beta2-agonists and anticholinergic agents delivered by metered-dose or drypowder inhaler. From December 1999 to December 2001, in the heavy wet nebulization cohort (a subset of the wet nebulization cohort), wet nebulization use dropped from 100% to 35%; in the wet nebulization cohort, wet nebulization use decreased from 67% to 20%. Rates of spacer device use were 42%, 31%, and 17% in the heavy wet nebulization, wet nebulization, and control cohorts, respectively, in December 2001. Rates of general practitioner visits and hospitalizations for respiratory conditions did not increase in the intervention cohorts after the policy announcement. In fact, relative to the control cohort, health services use in response to the policy and interventions in the wet nebulization cohort decreased. CONCLUSION: The reimbursement policy resulted in decreased use of respiratory drugs delivered by wet nebulization without a negative impact on general practitioner visits and hospitalizations for respiratory conditions.

Adrenergic beta-Agonists↗

PubMed2004

Is nebulized saline a placebo in COPD?

BACKGROUND: Many trials of nebulized therapy have used nebulized saline as a "placebo". However, nebulized isotonic saline is sometimes used to assist sputum expectoration and relieve breathlessness in COPD patients. We designed this study to establish if nebulized saline had a placebo effect or a clinical effect. METHODS: 40 patients were studied following hospital admission for exacerbated COPD (mean FEV1 30% predicted). Patients were randomised to single-blind administration of either 4 mls of nebulized isotonic saline using an efficient nebulizer (active group n = 20) or an inefficient nebulizer (placebo group n = 20). Spirometry and subjective breathlessness scores (Modified Likert Scale) were measured before nebulized treatment and 10 minutes after treatment. RESULTS: There was no significant change in FEV1 after active or placebo nebulized saline treatment. Patients reported a 4% improvement in mean breathlessness score following placebo (Wilcoxon test; p = 0.37) compared with 23% improvement following active nebulized saline (p = 0.0001). 65% of patients given active nebulized saline but only 5% of the placebo group reported that mucus expectoration was easier after the treatment. CONCLUSIONS: This study lends support to the current use of nebulized saline to relieve breathlessness (possibly by facilitating sputum clearance) in COPD patients. Lung function was not affected. Nebulized saline can therefore be used as a placebo in bronchodilator studies involving COPD patients but it cannot be used as a placebo in trials assessing symptom relief.

Clinical Trial↗

PubMed2003

Comparison of the bioavailability and systemic effects of beclometasone dipropionate suspension for nebulization and beclometasone dipropionate via a metered-dose inhaler after single-dose administration in healthy male volunteers.

Pharmacokinetic properties of a drug, and selection and correct usage of an appropriate delivery device, are factors that can affect the outcome of inhaled therapyThe use of nebulization can overcome problems that are associated with other delivery systems used for inhalation therapyThe objective of this open, randomized, single-dose study was to compare the systemic exposure and safety of beclometasone dipropionate (BDP) suspension for nebulization with BDP via metered-dose inhaler (MDI) in healthy subjects. Following a run-in period to assess basal 24-h serum cortisol levels and cortisol urinary excretion, 12 healthy males were administered BDP 1,600 microg given via MDI and were then randomized to receive a single dose of either 1,600 microg (n = 6) or 3,200 microg BDP (n = 6) suspension for nebulization given via a nebulizer Results with respect to systemic exposure to beclometasone-17-monopropionate (B17MP) (the active metabolite of BDP) and systemic effects on the hypothalamic-pituitary-adrenal (HPA) axis were determined by evaluation of a number of pharmacokinetic parameters for plasma B17MP and serum and urinary cortisol, respectively. A statistically significantly greater peak plasma concentration (Cmax) of B17MP was reported with BDP via MDI (1,587 pg ml(-1)) compared with BDP 1,600 microg (455 pg ml(-1)) and BDP 3,200 microg suspensions for nebulization (758 pg ml(-1)), and was achieved more rapidly (Tmax) (1.3 h, 3 h, and 2.5 h, respectively). In addition, elimination half-life (t 1/2(el)) was statistically significantly shorter with BDP via MDI (4.6 h) than with both dosages of BDP suspensions for nebulization (7.4 h and 6.3 h with 1600 microg and 3,200 microg, respectively), as was mean residence time (MRT) (5.4 h, 11.1 h, and 10.0 h, respectively). Total systemic exposure to B17MP (as determined by the area under the concentration-time curve: AUCinfinity) was comparable for BDP via MDI (6,883 pg ml(-1) h(-1)) and BDP 3,200 microg suspension for nebulization (8,201 pg ml(-1) h(-1)), but significantly greater than with BDP 1,600 microg suspension for nebulization (4,870 pg ml(-1); P < 0.05 vs BDP via MDI). All treatments were well tolerated, and no significant differences were found between them with respect to the serum or urinary cortisol pharmacokinetic parameters assessed. In conclusion, the results of this study demonstrate that BDP suspension for nebulization 3,200 microg given via a nebulizer and BDP 1,600 microg given via an MDI are equivalent in terms of systemic exposure to B17MP and systemic effects on the HPA axis, with BDP suspension for nebulization having a potentially more prolonged activity. It confirms that use of a double dose of BDP suspension for nebulization administered by nebulizer compared with BDP given via metered-dose inhalation is justified and poses no risk with regard to safety.

Administration, Inhalation↗

PubMed1998

Home nebulizer use among patients with cystic fibrosis.

OBJECTIVE: To describe current patterns of home nebulizer use among patients with cystic fibrosis. STUDY DESIGN: A population-based survey of home nebulizer practices among 227 patients with cystic fibrosis using nebulizers from 1993 to 1994 (Objective 1), and a prospective study of "typical" home use, including testing of performance and bacterial cultures in nebulizers after use, completed by 36 subjects (Objective 2). RESULTS: Objective 1: 85% of subjects reported using jet and 8% ultrasonic nebulizers (categories not mutually exclusive); 15% used unknown brands. Most jet nebulizers were disposable models, which were used for > 14 days by more than half the subjects. Mixing of medications in a single treatment (other than cromolyn and a bronchodilator) was reported by 28% of patients. Objective 2: no apparent deterioration in aerosol particle size or output rate of returned nebulizers compared with new units was observed. Staphylococcus aureus was cultured from 55% and Pseudomonas aeruginosa from 35% of returned nebulizers. Concordance between nebulizer and sputum cultures was poor. CONCLUSIONS: Although not generally tested for reusability, disposable nebulizers are generally used by patients for long periods. Medication mixing is common, although its effects on aerosol properties are unknown. Cystic fibrosis respiratory pathogens are frequently isolated from used nebulizers. Patient guidelines for home nebulizer use need to be established.

Child↗

PubMed1999

An in vitro analysis of the output of salbutamol from different nebulizers.

The objective of this study was to determine the particle size and mass output of salbutamol from different nebulizers used under simulated breathing conditions. Seven nebulizer/compressor combinations were assessed. Each nebulizer was charged with 5 mg salbutamol solution and connected to a breathing simulator operating at tidal volumes of 150 mL and 600 mL. Nebulizers were operated for 15 min. Salbutamol collected on the filters was measured by liquid chromatography. Aerosol particle size was determined separately by laser diffraction. The Pari LC Star nebulizer delivered the most salbutamol at both tidal volumes. The maximal output of the Medicaid Ventstream and Sidestream nebulizers was two-thirds that of the LC Star, and they delivered less salbutamol than the LC Star or LC Plus nebulizers. The Intersurgical Cirrus nebulizer delivered the least salbutamol at both tidal volumes, although there was only a small difference between the Cirrus and Ventstream or Sidestream nebulizers at 150 mL tidal volume. The LC Plus nebulizer produced larger particles, mass median diameter 5.3 microm, compared with 3.6-4.0 microm for the other nebulizers. In conclusion, there were large differences in the delivery of salbutamol between the nebulizers studied, even between nebulizers of apparently the same class, and this should be borne in mind by regulatory authorities, clinicians and researchers.

Administration, Inhalation↗

PubMed2001

Study of the technological parameters of ultrasonic nebulization.

The principle of an ultrasonic nebulizer is based on the vibrations of a piezoelectric crystal driven by an alternating electrical field. These periodic vibrations are characterized by their frequency, their amplitude, and their intensity, which corresponds to the energy transmitted per surface unit. When the vibration in tensity is sufficient, cavitation occurs, and droplets are generated. Ventilation enables airflow to cross the nebulizer and to expel the aerosol droplets. For a given nebulizer, the vibration frequency of the piezoelectric crystal is fixed, often in the range 1-2.5MHz. In most cases, an adjustment in vibration intensity is possible by modifying vibration amplitude. The ventilation level is adjustable. The vibrations may be transmitted through a coupling liquid--commonly water--to a nebulizer cup containing the solution to be aerosolized. In this work, we studied the influence of the technological parameters of ultrasonic nebulization on nebulization quality. Our study was carried out with a 9% sodium chloride solution and a 2% protein solution (alpha1 protease inhibitor). Three different ultrasonic nebulizers were used. An increase in vibration frequency decreased the size of droplets emitted. The coupling liquid absorbed the energy produced by the ultrasonic vibrations and canceled out any heating of the solution, which is particularly interesting for thermosensitive drugs. An increase in vibration intensity did not modify the size of droplets emitted, but decreased nebulization time and raised the quantity of protein nebulized, thus improving performance. On the other hand, an increase in ventilation increased the size of emitted droplets and decreased nebulization time and the quantity of protein nebulized because more drug was lost on the walls of the nebulizer. High intensity associated with low ventilation favors drug delivery deep into the lungs.

Algorithms↗

PubMed2001

The equivalence of compressor pressure-flow relationships with respect to jet nebulizer aerosolization characteristics.

Manufacturers of aerosolized medications, approved by the Food and Drug Administration, specify the nebulizer(s) and compressor to be used with their product, in an attempt to achieve efficacy comparable to that obtained in the clinical trials. The need to limit the compressor to that used in the trials has not been investigated in detail. We suggest a technique to determine the equivalency of different compressors such that a chosen nebulizer's performance is not significantly altered. Aerosol particle size (MMD) was measured with a laser; compressor flow and pressure were measured with a mass flow meter and pressure gauge, respectively. For all models of nebulizer, increased flow or driving pressure caused a decrease in aerosol MMD. The flow resistance of nebulizer models varied, and the flow output of compressors decreased as imposed nebulizer resistance increased. However, for any specific compressor-nebulizer combination there is a unique flow and pressure, and the nebulizer generates a given MMD. We demonstrate methods to choose alternate compressors that may be used to drive a nebulizer and yet keep the nebulizer's MMD and performance within predetermined limits. Once an acceptable range of variance in a nebulizer's MMD is defined, alternate compressors may be safely chosen. We recommend that these techniques be used by manufacturers of medications and of compressors to safely determine the acceptability of several rather than a single model compressor to drive a chosen nebulizer. The techniques assure consistency of the nebulizer's clinically demonstrated performance characteristics.

Aerosols↗

PubMed1994

An in vitro method for determining regional dosages delivered by jet nebulizers.

A methodology for determining the regional dosages delivered to the respiratory tract by a jet nebulizer is presented and applied to the DeVilbiss PulmoNeb disposable nebulizer delivering a 2.5 ml nebule of Ventolin (1 mg/ml salbutamol sulphate). Results are obtained both with tapping of the nebulizer, which enhances nebulizer performance, and without tapping. The nebulizer output is characterised by measuring the total mass and the mass of solids leaving the nebulizer per minute, and performing a control volume analysis of the nebulizer. Particle size distributions are determined by phased Doppler anemometry. Deposition probabilities are calculated using a semi-empirical model for the deposition of hygroscopic aerosol particles in healthy adult Caucasian males. Deposition probabilities are then converted to regional dosages using the measured nebulizer output characteristics. The regional dosages (% of initial dose in nebulizer) of Ventolin delivered to the extrathoracic, bronchial, and alveolar regions of the respiratory tract are 0.248 +/- 0.005 mg (9.9%), 0.034 +/- 0.001 mg (1.4%), and 0.071 +/- 0.002 mg (2.8%) respectively when the nebulizer was tapped during operation, and 0.184 +/- 0.005 mg (7.4%), 0.025 +/- 0.001 mg (1.0%), and 0.052 +/- 0.002 mg (2.1%) when tapping was not used. This methodology provides a well controlled and rapid means of comparing the effectiveness of different nebulizers for use in aerosol therapy.

Adult↗

PubMed1997

Effect of nebulizer configuration on delivery of aerosolized tobramycin.

Differences in the reported efficacy of aerosolized aminoglycosides may be due, in part, to differences in aerosol delivery. Optimization of delivery systems of bench testing of nebulizers in a manner that simulates clinical conditions can lead to enhanced lung deposition in subsequent clinical studies. In the present study, we assessed the effects of varying nebulizer configuration on the performance of ultrasonic and jet nebulizers. Tobramycin was mixed with a radiotracer (99mTc) to facilitate measurement of nebulizer output and particle size. A piston ventilator provided a simulated breathing pattern, and the dose delivered to a filter corresponded to what would have been inhaled by a patient (percentage of nebulizer charge inhaled). Particle size was measured using a cascade impactor, sampling at 1 L/min. An ultrasonic nebulizer (Ultra-Neb; DeVilbiss, Somerset, PA), ventilated at 20 breaths per minute, charged with 600 mg of tobramycin (in 30-mL volume) and fitted with its standard tubing, was tested with and without the addition of one-way valves to the inspiratory and expiratory ports of the mouthpiece. In order to assess the degree of environmental contamination associated with jet nebulizer therapy, a filter was placed at the expiratory port of all jet nebulizer experiments. The addition of the valves reduced the percentage of charge inhaled from a mean +/- standard deviation (SD) of 29.2% +/- 1.4% to 7.6% +/- 2.3% and reduced mass median aerodynamic diameter [MMAD (sigma g) from 4.3 microns (2.1) to 1.45 microns (1.65)]. A Circulaire (Westmed, Tucson, AZ) jet nebulizer (7 L/min flow, 50 pounds per square inch gauge (psig), 20 breaths per minute, containing 160 mg of tobramycin in a 4-mL volume) was tested in two configurations: using a plain T-piece and using a valved inflatable aerosol chamber. The use of the holding chamber resulted in an almost twofold reduction in MMAD [MMAD (sigma g) = 2.45 microns (2.0); T-piece; 1.25 microns (2.0), holding chamber]. A slight reduction in the percentage of nebulizer charge inhaled using the holding chamber, compared to the plain T-piece, was not statistically significant (mean +/- SD of percentage inhaled with holding chamber = 20.8% +/- 1.6%; with T-piece = 23.6% +/- 0.5%). With both the jet and ultrasonic nebulizers, breathing frequency influenced percentage inhaled, with a higher percentage inhaled at 20 breaths per minute compared to 15 breaths per minute. The use of the plain T-piece at 20 breaths per minute was associated with more environmental contamination than the use of the holding chamber with the same breathing pattern (26.7% +/- 1.0%, T-piece; 4.5% +/- 0.3%, holding chamber, P < 0.0001). We conclude that nebulizer configuration can potentially affect both the amount of aerosol inhaled and the particle size, and needs to be specified precisely in treatment protocols.

Administration, Inhalation↗

PubMed2001

GENebu Project: home nebulizer use and maintenance in Italy.

Due to the lack of information on this topic, the Educational Group of the Italian Association of Hospital Pneumologists performed an open, multicentre, observational survey to evaluate home nebulizer practices in Italy. From May-December 1999, all patients attending one of the 27 participating chest clinics throughout Italy and who were or had been using a home nebulizer in the previous 6 months were consecutively enrolled. All patients completed a self-administered questionnaire on their current practices of home nebulization. Of the 1,721 questionnaires delivered, 1,257 were returned with an overall response rate of 73%. Most patients (82.8%) reported using their nebulizer for bronchopulmonary symptoms and the remaining patients only used theirs for upper respiratory tract diseases. Subjects using their nebulizer for lower respiratory symptoms were older (p<0.001), predominantly female (p<0.001) and used their nebulizer more frequently (p<0.001). Forty per cent of patients >60 yrs old used their nebulizer regularly, at least once a day. More than 60% of respondents never received any information from healthcare workers on the correct usage of their nebulizer, and >75% received no information on nebulizer hygiene and care. Patients who received information on the use and maintenance of their nebulizer from caregivers more commonly attended to these practices (p<0.01). The present survey suggests that home nebulizer use and maintenance in Italy are heterogeneous, and there is the need to implement better nebulizer practice.

Adolescent↗

PubMed1997

Comparison of drug delivery from conventional versus "Venturi" nebulizers.

Attempts to improve drug delivery from conventional jet nebulizers have included the use of storage systems to reduce drug wastage during exhalation. Venturi nebulizers enhance drug delivery during inhalation, reducing treatment times and drug wastage. This study investigated the effect of age on inhaled dose from a conventional jet nebulizer (Acorn) used both with and without a storage chamber (Mizer), compared to two Venturi nebulizers (Ventstream and Pari LC). Filters were attached to the four nebulizer systems, containing salbutamol, and 18 children with cystic fibrosis (3-16 yrs) inhaled through these devices. The quantity of drug collected on the filter was assessed using ultraviolet spectrophotometry. The particle size distribution of the aerosol from each nebulizer system was measured using laser diffraction. Inspiratory filter deposition using the Acorn was lower than the Acorn with Mizer, and both Venturi nebulizers. Filter deposition using the Acorn with Mizer was lower than the Pari LC. No trend with age, height or weight was noted using any nebulizer. Aerosol particle size using the Ventstream was lower than the other nebulizer systems. Drug output from both Venturi nebulizers was more efficient than from the jet nebulizer, used with and without the storage chamber, during inhalation by children with cystic fibrosis. The inhaled dose did not change with the patient's age or size using both types of nebulizer.

Administration, Inhalation↗

PubMed1998

A comparison of the availability of tobramycin for inhalation from vented vs unvented nebulizers.

STUDY OBJECTIVE: To compare drug output from a vented nebulizer (Pari LC Jet Plus) with a traditional unvented nebulizer (Hudson 1730 T Up-Draft 11) using aerosolized tobramycin, which is frequently used in the treatment of cystic fibrosis. DESIGN: Six nebulizers of each type were filled with a 4 mL tobramycin (80 mg) solution and were driven by a compressor (Pulmo-Aide). Various inspiratory flows (VI) (0, 5, 10, 15, 20 L/min for the Pari LC Jet Plus and 0, 5, and 10 L/min for the Hudson 1730, all at 40% relative humidity) were directed through each nebulizer. Drug output was measured from changes in weight and concentration (assessed by changes in osmometry) within the nebulizer. Particle size distributions were determined by laser diffraction allowing the calculation of the amount of aerosol output in the respirable range (<5 microm). The nebulizers were first run until end-nebulization to establish total drug output and then for either 4 or 5 min to determine the rate of drug output (mg/min) before intermittent aerosol output. RESULTS: The total drug output without VI for both the unvented and the vented nebulizers was not significantly different, 55 (51, 60) mg for the Hudson 1730 vs 51 (49, 53) mg for the Pari LC Jet Plus (mean [95% confidence limits]). Inspiratory flow had no effect on the unvented Hudson 1730 nebulizer but significantly increased the rate of total drug output and the rate of drug output in the respirable range for the vented Pari LC Jet Plus nebulizer (VI=0, 3.35 [2.84, 3.85] and 1.72 [1.48, 1.96] compared with VI=20, 9.87 [9.03, 10.70] and 6.11 [5.33, 6.88] mg/min). CONCLUSIONS: These findings indicate that the increase in the rate of drug output with VI for the vented nebulizer would result in shorter nebulization times and a relative decrease in drug loss during the expiratory phase.

Anti-Bacterial Agents↗

PubMedDate not supplied

Effectiveness of beclomethasone dipropionate aerosolized through different nebulizers to asthmatic patients.

The aim of our study was to verify if the type of nebulizer used could influence the results of aerosol therapy with beclomethasone dipropionate (BDP) in mild allergic asthma. We assigned 27 asthmatics allergic to grasses to 3 groups and treated them from May to July 1998 with aerosol therapy with BDP (800 microg) b. i. d. via nebulizer + pMDI salbutamol (200 microg) if necessary. Each group used a different type of nebulizer: jet nebulizer with glass ampoule (group JG); jet nebulizer with polycarbonate ampoule (group JP); ultrasonic nebulizer (group US). During the study patients underwent periodic lung function tests and methacholine bronchial challenges, recorded twice a day self-monitoring PEF and filled out a daily diary for the presence and intensity of asthmatic symptoms. At the end of the study the provocative dose of methacholine causing a 20% fall in FEV1 (PD20), the self-monitoring PEF and the clinical scores were all greatly improved, but without any statistically significant difference among the three groups. On the contrary, the variations during the study of basal spirometric parameters (specifically FEV1, PEF, FEF25) were significantly better in jet nebulizer groups than in group US. The results coming from the aerosol characterization that we carried out for each of the three nebulizers confirmed the clinical findings, since jet nebulizers showed greatly lower MMAD than the ultrasonic nebulizer (2.9 and 3.7 vs 5.8). Our data suggest that jet nebulizers are more appropriate than ultrasonic nebulizers for delivering BDP in aerosol therapy.

Administration, Inhalation↗