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PubMed1992

Disposable jet nebulizers. How reliable are they?

We studied the frequency of malfunction, variability in rate of nebulization, and effect of this variability on aerosol particle size of eight disposable jet nebulizer models produced by six manufacturers. Four of eight models showed visual signs of malfunction, including spraying of large, individually visible droplets, leaking of nebulizer solution, and air leaks that completely prevented nebulization. Variability of nebulization rate within specific models ranged from 57 to 129 percent. The model with the largest variability of nebulization rate was also associated with an unacceptably large variability in particle size. In contrast, two models with smaller variability in nebulization rate had greater consistency of particle size. These results indicate poor quality control by some manufacturers in the disposable nebulizer industry. The data suggest that purchasing agents should consider reliability as well as cost before selecting a specific nebulizer model and that their evaluation should include physical testing of multiple units of each model under consideration.

Disposable Equipment↗

PubMed1993

A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma.

BACKGROUND: Comparative studies of albuterol by wet nebulizer or metered dose inhaler have tested fixed doses of medications. We compared the dose-response relationship to albuterol by wet nebulization or metered dose inhaler in acute asthma. METHODS: Randomized, double-blind, placebo-controlled trial. Patients with acute asthma received either albuterol, 0.4 mg, by metered dose inhaler (and holding chamber) or albuterol, 2.5 mg, by wet nebulizer every 30 min until maximal bronchodilation. Forty patients (forced expiratory volume in 1 s [FEV1]: 1.15 +/- 0.43 L; 36 +/- 12 percent predicted) received metered dose inhaler and 40 others (FEV1: 1.08 +/- 0.52 L; 35 +/- 16 percent predicted) received wet nebulization. RESULTS: Twenty-six patients (65 percent) receiving metered dose inhaler and 30 (75 percent) receiving wet nebulization achieved maximal bronchodilation after two doses. Almost all reached maximal bronchodilation by four doses. The FEV1 improved by 0.72 +/- 0.49 L for metered dose inhaler and 0.68 +/- 0.61 L for wet nebulizer (p = 0.71). A significant linear relationship was seen in both groups (metered dose inhaler r = 0.94; wet nebulizer r = 0.98) between the log dose of albuterol and change in FEV1. About 1/6 the wet nebulizer dose of albuterol was needed to achieve similar response to the metered dose inhaler. CONCLUSIONS: Albuterol by metered dose inhaler provided similar bronchodilation to that achieved by wet nebulization in patients with acute asthma. The cumulative dose-response technique is applicable in the emergency department setting and is helpful in comparing the relative utility of various bronchodilator regimens.

Acute Disease↗

PubMed2005

Medical nebulizer performance: effects of cascade impactor temperature.

BACKGROUND: During operation of a jet nebulizer, the temperature of the nebulizer outlet could decrease by more than 10 degrees C, depending on the nebulizer type and operating conditions, such as driving flow rate and fill volume. The droplet size distribution generated from the nebulizer can be measured by a cascade impactor. However, when the cascade impactor is operated at ambient room temperature, the droplets could evaporate because of the temperature difference between the nebulizer outlet and the body of the impactor. METHODS: An 8-stage cascade impactor was used to measure the particle size distribution from 4 different types of jet nebulizer (LC Plus, Side-Stream, VixOne, and Micromist) in 2 temperature conditions: ambient (22 degrees C) and low (10 degrees C). Two different formulations, albuterol (aqueous solution) and budesonide (suspension), were used. RESULTS: There was a significantly larger (p < 0.05) mass median aerodynamic diameter and smaller respirable fraction for each nebulizer with the impactor at low temperature than with the impactor at ambient temperature. The mass median aerodynamic diameter of the nebulizers with the impactor operating at low temperature appeared 15-130% larger than with the impactor operating at ambient temperature, for both formulations. The respirable fraction also changed from 10% when the impactor was operated at low temperature to 65% when the impactor was operated at ambient temperature. CONCLUSION: The results provide important information for the use of a cascade impactor to measure the particle-size distribution of nebulizer aerosols.

Administration, Inhalation↗

PubMed1987

Particle-size distribution of bitolterol mesylate solution delivered by four compressed-air nebulizer devices.

The particle-size distribution of bitolterol mesylate solution delivered by four types of compressed-air nebulizers was determined. Before nebulization, bitolterol mesylate solution 0.2% w/v was diluted to 0.0833% w/v with 0.9% sodium chloride solution. The following commercially available nebulizers were tested: DeVilbiss Nebulizer Model 645, Hudson 1720 (Updraft) Hand Held Nebulizer, Bard Inspiron 002220 Mini-Neb Nebulizer, and Bunn Mini Mist Set model 0140-041. The particle-size distribution of nebulized solutions was determined with a cascade impactor contained in an in vitro apparatus designed to simulate use by a patient. Assays of bitolterol mesylate in the cascade impactor apparatus were done by high-performance liquid chromatography. Only slight differences were found in the particle-size distributions among the four types of nebulizers; the calculated average particle size ranged from 3.0 to 3.6 micron. All nebulizers tested showed satisfactory, comparable particle-size distributions and performance with bitolterol mesylate solution.

Aerosols↗

PubMed1994

Radioaerosol 99mTc-DTPA characterization produced by some nebulizers.

1. The radioaerosol 99mTc-DTPA produced by jet and ultrasonic nebulizers was characterized by measuring the median mass diameter (MMD) and geometric standard deviation (sigma g) and these characteristics were interpreted in terms of the aerodynamic principles of inertial impactation. 2. Jet nebulizers of the same model, with different outflows (NSA = 0.14 ml/min; NSB = 0.24 ml/min and NSC = 0.40 ml/min) showed different radioaerosol mass distribution, with MMD (NSC) > MMD (NSA). The ultrasonic nebulizer US-1000 from Narcosul, which is operated with an air flow of 2 l/min and frequency of 1.6 MHz, generated radioaerosol with MMD = 2.40 microns, higher than that obtained with most of the jet nebulizers evaluated (NSA = 1.50 microns; NSB1V = 1.40 microns; NSB2V = 1.20 microns and PITT#1 - 0.80 microns), and the ultrasonic nebulizer presented the highest outflow of the nebulized solution (1.15 ml/min). 3. Connecting one or two impactation reservoirs to the NSB jet nebulizer modified the mass distribution, which became significantly narrower for NSB2V when compared to the other two nebulizers. NSB2V presented a mass percentage with a diameter of 3 microns or less and a sufficient outflow for use in ventilation and pulmonary permeability studies. 4. Comparison of the mass collected in the cascade impactor and the total mass generated by the NSB, NSB1V and NSB2V nebulizers showed, on average, 4.5% efficiency in radioaerosol generation with a diameter of less than 16 microns and 3.2% efficiency for a diameter of 3 microns or less.

Aerosols↗

PubMed1998

[Isoproterenol continuous nebulization of childhood status asthmaticus. II. Efficacy and side effects of low-dose method comparing with high-dose method].

We investigated the efficacy and side effects of "low-dose isoproterenol continuous nebulization" for childhood status asthmaticus, and compared them with those of "high-dose method". "Low-dose" is defined as 10 ml or less of 0.5% dl-isoproterenol solution diluted in 500 ml of normal saline. Subjects were 23 children who were hospitalized and underwent the nebulization therapy. The period of continuous nebulization was 26.3 +/- 12.5 hours. The Wood's clinical score clearly decreased in 22 cases, the average score changing from 7.3 +/- 1.2 to 2.8 +/- 1.5. Heart rate was not elevated significantly during the nebulization period, and decreased gradually (142 +/- 22/min at the start of the nebulization, 145 +/- 22/min at 1 hour, and 134 +/- 23/min at 3 hours, and 103 +/- 13/min at the cessation of the nebulization). Serum GOT, LDH, CPK, and potassium were decreased after the nebulization compared with the values before the treatment, the changes of the last 2 items being statistically significant. Two subjects who had vomited before the nebulization therapy complained nausea during the procedure, and one experienced transient finger tremor. We conclude that "low-dose isoproterenol continuous nebulization" is an effective and safe method for childhood status asthmaticus. We expect that this method will be familiar to all clinicians.

Bronchodilator Agents↗

PubMed1984

Contaminated medication nebulizers in mechanical ventilator circuits. Source of bacterial aerosols.

The contamination rates of medication nebulizers inserted into mechanical ventilator circuits were studied. Semiquantitative techniques were used to sample the reservoir fluid from in-line nebulizers during the first 24 hours after a circuit change. In the initial survey, high levels of contamination (organism concentrations above 10(3)/ml) were present in 13 (68 percent) of the 19 nebulizer reservoirs, and bacterial aerosols were produced by 10 (71 percent) of 14 nebulizers. Gram-negative bacilli were the predominant organisms isolated. Nebulizer contamination originated primarily from reflux of contaminated condensate in the ventilator circuit. When nebulizers were cleaned after each treatment, a reduced rate of contamination was found. Small bacterial aerosols (less than 3 microns in size) were produced in vitro after inoculation of nebulizers with gram-negative bacilli in concentrations isolated from in-use nebulizers. Contaminated in-line medication nebulizers generate small-particle bacterial aerosols that may increase the risk of ventilator-associated pneumonia and therefore should be cleaned or disinfected after each treatment rather than every 24 hours.

Aerosols↗

PubMed1985

Efficiency of air compressor-driven nebulizers.

Five different volumes of test solutions (1 to 3 ml) containing 15 mg of metaproterenol were placed in each of five different nebulizers. The time to complete nebulization and the amount of drug delivered varied considerably, depending upon the initial volume of solution placed in the nebulizer. Small volumes (1 ml) were almost totally retained in the nebulizer, whereas larger volumes (3 ml) took an unacceptably long time for nebulization. With vigorous agitation, a maximum of 53 to 72 percent of the dose left the nebulizer, but even less (34 to 59 percent) was delivered under simulated clinical conditions. When nebulization was synchronized with breathing, only 0.33 to 0.54 ml of solution (2 to 3.2 mg of metaproterenol) was delivered with 90 deep inhalations. If nebulization was continuous instead of intermittent during the time to take 90 breaths, the majority of the drug was nebulized to the atmosphere.

Aerosols↗

PubMed1991

[Pentamidine aerosol in the preventive treatment of pneumocystosis in AIDS patients. Comparison of two salts and two nebulizers].

In a randomized trial conducted in AIDS patients requiring prophylaxis against pneumocystosis we compared two pentamidine salts, isethionate (I) and mesylate (M), and two nebulizers (a modified ultrasonic Ultraneb 99 Devilbiss nebulizer, and a disposable jet nebulizer). Patients were randomized to one or the other nebulizer and received alternatively, once every other week, the two pentamidine salts in the IMIM or MIMI order. Characteristics and the side effects of the two courses of each pentamidine salt, as well as drug delivery by each nebulizer during the first course, were studied in 48 patients. The ultrasonic nebulizer was more effective (nebulization time: 19.8 +/- 7.3 mn versus 30.7 +/- 11 mn) and produced less side-effects (FEV1 decrease: 186 +/- 677 versus 571 +/- 708 ml) than the jet nebulizer. The mesylate salt tended to produce more side-effects than the isethionate, but the difference was not significant (FEV1 decreases: 439 +/- 688 ml and 295 +/- 756 ml respectively). We concluded that the best therapeutic procedure is to use pentamidine isethionate delivered by the ultrasonic nebulizer.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Output of histamine chloride from 7 nebulizers.

The aim of the study was to assess the amount of aerosol delivered by seven different nebulizers. Six of the nebulizers were supplied by an airstream of 7.5 l/min and the seventh (Pari Inhalierboy) connected to a compressor supplying an airstream of 15 l/min. The nebulizer plus solution was weighed before and after one min of nebulization. In this way the amount of aerosol delivered was measured ten times for each nebulizer. Results are given as mean values +/- SD (gram/min): Hudson nebulizer model no. 2720: 0.2950 +/- 0.0154, Mefar Respi-Neb: 0.3574 +/- 0.0100, Sandoz: 0.4399 +/- 0.0201, VIx: 0.2824 +/- 0.0121, Acorn: 0.3619 +/- 0.0088, Pari Inhalierboy: 0.4865 +/- 0.0105, Raindrop: 0.2668 +/- 0.0082. Standard deviation calculated as per cent of the average were: Hudson nebulizer model no. 1720: 5.22%, Mefar Respi-Neb: 2.80%, Sandoz: 4.57% Vix: 4.28%, Acorn 2.43%, Pari Inhalierboy: 2.16%, Raindrop: 3.00%. Per cent variation between the products giving Hudson 100%: Mefar Respi-Neb: +18.77, Sandoz +46.19, Vix: -6.14, Acorn: +20.27, Pari Inhalierboy: +61.68, Raindrop: -9.56. The Hudson nebulizer was also tested with three different volumes of histamine chloride: 2 ml, 3 ml, and 4 ml. The mean values +/- SD (gram/min) for the aerosols were: 2 ml: 0.2986 +/- 0.0071, 3 ml: 0.2981 +/- 0.0080 and 4 ml: 0.2976 +/- 0.0056. The mean value of output from ten different Hudson nebulizers +/- SD was: 0.2767 +/- 0.0105 gram/min.

Aerosols↗

PubMed1982

Stability of some bronchodilator solutions during ultrasonic nebulization.

The effect of ultrasonic nebulization on the stability of isoetharine hydrochloride and isoproterenol hydrochloride solutions was studied. Commercially available solutions of isoetharine hydrochloride 1%, isoproterenol hydrochloride 1%, and isoproterenol hydrochloride 0.5% were diluted to 0.25%, 0.125%, and 0.125%, respectively. The solutions were nebulized for 10 or 15 minutes using three ultrasonic nebulizers at 0, 3, 6, 8, and 24 hours. Before and after nebulization, the solutions were assayed for intact drug by chemical assay and by thin-layer chromatography (TLC). The nebulized mist was also collected and assayed. The extent of drug degradation from ultrasonic nebulization was calculated as the apparent percent loss of active drug. Results of the chemical and TLC analyses for samples from two nebulizers showed no substantial chemical degradation of isoetharine hydrochloride or isoproterenol hydrochloride in any solution. Chemical assay was not performed for the third nebulizer, but results of TLC analysis showed no substantial degradation of either drug in any solution. Under the simulated-use conditions of this study, solutions of isoetharine hydrochloride and isoproterenol hydrochloride were stable when nebulized ultrasonically.

Aerosols↗

PubMed1996

Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia.

The best means for optimal delivery of drugs into lungs of infants with bronchopulmonary dysplasia (BPD) is uncertain. We aimed to measure radio-aerosol deposition of salbutamol by jet nebulizer and metered dose inhalers (MDI) in ventilated and non-ventilated BPD infants. In a randomized, crossover sequence, salbutamol lung deposition was measured using an MDI (2 puffs or 200 micrograms) or sidestream jet nebulizer (5 minutes of nebulization with 100 micrograms/kg) in 10 ventilated (mean birthweight, 1,101 g) and 13 non-ventilated (mean birthweight, 1,093 g) prematurely born infants. Non-ventilated infants inhaled aerosol through a face mask, connected to a nebulizer or an MDI and spacer (Aerochamber). Ventilated infants received aerosol from an MDI + MV15 Aerochamber or a nebulizer inserted in the ventilator circuit. Lung deposition by both methods was low: mean (SEM) from the MDI was 0.67 (0.17)% of the actuated dose, and from the nebulizer it was 1.74 (0.21)% and 0.28 (0.04)% of the nebulized and initial reservoir doses, respectively. Corresponding figures for the ventilated infants were 0.98 (0.19)% from the MDI and 0.95 (0.23)% and 0.22 (0.08)% from the nebulizer. In both groups, and for both methods of delivery, there was marked inter-subject variability in lung deposition and a tendency for the aerosol to be distributed to the central lung regions.

Aerosols↗

PubMed1997

Effects of salbutamol delivery from a metered dose inhaler versus jet nebulizer on dynamic lung mechanics in very preterm infants with chronic lung disease.

Treatment of chronic lung disease of prematurity requires effective aerosol delivery of different therapeutic agents. Aerosols can be generated by a metered dose inhaler (MDI) or a jet nebulizer. An MDI combined with a spacer device is easier to use and avoids undesirable effects noted in conjunction with jet nebulization. We compared the clinical effectiveness of 200 micrograms (2 puffs) salbutamol delivered from an MDI in conjunction with a valved spacer device (Aerochamber), and 600 micrograms given via jet nebulizer (PariBaby) on 2 consecutive days, the order being randomized. Thirteen spontaneously breathing very preterm infants [mean (SD) gestational age 27.2 (1.8) weeks; birth weight 0.90 (0.34) kg] were studied at a corrected age of 37 (2.3) weeks. Mean (SD) study weight was 1.83 (0.38) kg. Dynamic lung compliance and resistance were determined from measurements of flows, volumes, and transpulmonary pressures, using a pneumotachometer and a small esophageal microtransducer catheter before and 20 min after salbutamol application. Baseline values before salbutamol administration were similar on both occasions: the mean (SD) compliance was 7.7 (3.0) mL.kPa-1.kg-1 pre-MDI plus-spacer and 8.4 (3.1) pre-jet nebulizer; the resistance was 10.4 (4.0) kPa.L-1.s pre-MDI plus-spacer and 9.7 (3.4) pre-jet nebulizer. Following salbutamol, compliance did not change significantly with either MDI plus spacer or jet nebulizer. Resistance fall significantly with MDI plus spacer (mean -2.2; 99.9% CI -0.35, -4.35) and jet nebulizer (-2.4; 99% CI -0.39, -4.42). We conclude that even in small preterm infants 200 micrograms salbutamol via MDI plus spacer improves dynamic resistance as effectively as 600 micrograms via jet nebulizer and may therefore be a preferable mode of aarosol administration.

Administration, Inhalation↗

PubMed2001

Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis.

We enrolled 30 infants (median age 3 months, range 1-12 months), hospitalized for bronchiolitis in a randomized double-blind trial, to examine the efficacy and safety of nebulized epinephrine compared to salbutamol. Once admitted, patients were treated with either nebulized 0.5 mg of an 0.1% epinephrine solution (0.5 mL in 3.5 mL normal saline (NS)) or 2.5 mg nebulized salbutamol (0.5 mL in 3.5 mL NS). They were evaluated daily before and after nebulization until discharge. The outcome measures used were: baseline clinical score (based on respiratory rate, subcostal retraction, presence of wheezing, and O2 requirement), change in clinical O2 score after nebulization, duration of O2 therapy, and duration of hospitalization. A significant improvement in the clinical score was noted on the first day of hospitalization in subjects receiving epinephrine (P = 0.025); that change was not seen in those on salbutamol (P = 0.6). Nebulized epinephrine decreased the baseline clinical score faster than salbutamol (P = 0.02), though on the fourth study day there was no significant difference between the two scores. On the fourth and fifth days of study there were more patients hospitalized in the salbutamol group than in the epinephrine group (P = 0.03 vs. P = 0.025). No adverse effects were associated with nebulized therapy. We conclude that nebulized epinephrine is a more effective agent than salbutamol in the initial treatment of bronchiolitis and is equally safe.

Administration, Inhalation↗

PubMed1995

Assessment of the continued supervision and asthma management knowledge of patients possessing home nebulizers.

This paper describes the results of a questionnaire survey on some aspects of nebulizer use, nebulizer instruction, and features relating to the recognition and management of deteriorating asthma. The study population consisted of 90 children with home nebulizers attending a paediatric asthma clinic, and 200 asthmatic children and 200 asthmatic adults whose nebulizers had been purchased directly from a manufacturer in the U.K. The results suggest that follow-up supervision of the patients who bought their own nebulizers occurred in only approximately 25% of cases. Written information focusing on the management of symptoms was also lacking. Peak flow meters were being under-used. Although the majority (77-100%) of patients were aware of the '4 h rule' for repeat use of bronchodilator therapy at home, there was still some confusion about the acceptable time interval and action to be taken should the dose be required more frequently. Very few (32%) in the nationwide adult group had a crisis action plan should the nebulizer fail to produce relief. This paper recommends that a simple treatment and crisis plan should be included with the purchased nebulizer, highlighting the key areas to be discussed by the patients with the doctor or other medical professionals. Such a package may prevent the occasional disaster that can occur with unsupervised nebulized bronchodilator usage.

Acute Disease↗

PubMed2004

Perfluorocarbon species and nebulizer type influence aerosolization rate and particle size of perfluorocarbon aerosol.

PURPOSE: Aerosolization of perfluorocarbons (PFC) has been proven beneficial in vivo. The present in vitro study was performed to investigate, how PFC-aerosolization is affected by type of nebulizer and PFC properties. MATERIALS AND METHODS: Aerosolization rate was studied of 4 different PFC that were nebulized using 3 different jet nebulizers (operating at different flows: 4.1; 7.1; 13 l/min) and one ultrasonic nebulizer. Distribution of aerosol particle size was determined with a laser diffraction device. RESULTS: Between the studied nebulizers, considerable differences in the aerosolization rate were found. Aerosolization rate was significantly lower for PFOB (0.48-1.24 mL/min), when compared with PF 5080, RM 101 and FC 77 (1.33-4.75 mL/min). The ultrasonic nebulizer did not generate an aerosol but rather PFC vapor. Lowest mass median diameter (MMD) was found for PFOB and varied between the jet nebulizers from 2.2 and 3.7 microm, with a small range in particle size (maximum of 7.3 microm). FC 77 had highest MMD (3.5 to 9.2 microm) and greatest range of particle size of up to 13 microm. CONCLUSIONS: Our in vitro data show that aerosolization rate depends mainly on density of PFC and the flow of nebulizer. Particle size distribution is affected by PFC properties. Our result may explain controversial results of published in vivo studies.

Administration, Inhalation↗

PubMed2006

New ipratropium formulation to decrease nebulization time.

A new anticholinergic aerosol containing 0.5mg ipratropium bromide dissolved in 1mL of solution has been produced with the purpose of decreasing nebulization time for patients compared to the traditional formulation which is twice as voluminal (0.5mg/2mL, Boehringer-Ingelheim, France). The aim of this study was to compare aerosol characteristics (inhaled mass, particle size distribution and nebulization time) of these two formulations of ipratropium bromide, nebulized alone and with terbutaline (5mg/2mL, Astra Zeneca, Sweden), to determine whether the new formulation was equivalent to the old one. Four different jet nebulizers were used: PariLC+, Atomisor NL9M, Sidestream and Mistyneb. Statistical analysis of the results showed that for all types of nebulizer, the inhaled mass of ipratropium bromide 0.5mg/1mL was significantly lower than the inhaled mass of ipratropium bromide 0.5mg/2mL, and that there was no statistical difference between the inhaled mass of ipratropium bromide 0.5mg/1mL+terbutaline 5mg/2mL and the inhaled mass of ipratropium bromide 0.5mg/2mL+terbutaline 5mg/2mL. The study also showed that the new formulation of ipratropium bromide (0.5mg/1mL) mixed with terbutaline allowed a 26% decrease in nebulization time compared to the old formulation (0.5mg/2mL) mixed with terbutaline without changing aerosol characteristics (inhaled mass and particle size distribution). This leads to the conclusion that a 2mL minimum volume is required for nebulization, and that nebulization of ipratropium bromide 0.5mg/1mL alone must be avoided.

Aerosols↗

PubMed1994

Oral versus nebulized albuterol in the management of bronchiolitis in Egypt.

The efficacy of albuterol in the management of infants with first-time wheezing is controversial. This double-blind, placebo-controlled trial involved 128 Egyptian infants with first-time wheezing (mean age 5.9 months) who were randomly separated into four equivalent therapy groups: nebulized albuterol, nebulized saline solution, orally administered albuterol, and orally administered placebo. The nebulized therapy groups received two treatments 30 minutes apart; the oral therapy groups received one treatment. In addition, 41 infants with recurrent wheezing comprised an open-label control group who received two albuterol nebulizations. Chest radiographs, leukocyte counts, blood culture specimens, and nasal aspirate for viral antigen detection were obtained to confirm the clinical diagnosis of viral bronchiolitis. Respiratory and heart rates, clinical score, and oxygen saturation were recorded at baseline and 30 and 60 minutes after treatment. There was no difference among the four randomized groups in any of the outcomes except for an increase in heart rate of 10 beats/min in the nebulized albuterol group compared with a decrease in heart rate of 8 beats/min in the oral placebo group. No differences in the need for additional treatment were observed. Nebulized albuterol significantly improved the clinical score and reduced the respiratory rate of those with recurrent wheezing relative to those in the randomized groups. We conclude that nebulized albuterol is effective in the treatment of infants with recurrent wheezing, but there was no demonstrable efficacy of orally administered or nebulized albuterol in relieving the respiratory distress of infants with bronchiolitis in Egypt.

Administration, Oral↗