Delivery of salbutamol to nonventilated preterm infants by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer

Abstract

To identify the most efficient device for the delivery of bronchodilator aerosol to nonventilated preterm infants with chronic lung disease, we compared the metered dose inhaler (MDI) used in conjunction with a non-valved spacer, an ultrasonic nebulizer with a small medication cup, and two jet nebulizers. The subjects were enrolled in two double-blind randomized crossover studies. In study A (n=10), each infant was given a nominal dose of 200 microg of salbutamol by a MDI (Ventolin) at 4 h intervals, and in random sequence via an Aerochamber (Neonatal Aerochamber) with its one-way valve removed, an ultrasonic nebulizer with a small cone-shaped medication cup (Siemens Electronics), and a jet nebulizer (Side-stream). Their functional residual capacity (FRC) and static respiratory system mechanics were measured before, and at 15, 30, 60, and 120 min after aerosol delivery. Study B (n=10) was carried out in an identical manner, but with a different jet nebulizer (Hudson). In both studies, administration of salbutamol aerosol via the MDI Aerochamber or ultrasonic nebulizer resulted in a significantly greater reduction in respiratory system resistance than via jet nebulizers. Furthermore, the use of MDI Aerochamber or ultrasonic nebulizer was associated with a greater degree of post-treatment tachycardia and improvement in FRC. The bronchodilating effect of salbutamol delivered via the ultrasonic nebulizer appeared to be slightly greater than that via the MDI-Aerochamber, receiving significance only in Study B. We conclude that both the metered-dose inhaler used with a nonvalved Aerochamber and the ultrasonic nebulizer with a small medication cup are both more efficient than the jet nebulizers in preterm infants.

Albuterol Delivery by 4 Different Nebulizers Placed in 4 Different Positions in a Pediatric Ventilator In Vitro Model

“…6 Fok et al, in 2 in vivo studies (animal and neonatal), demonstrated a several-fold higher pulmonary deposition of ultrasonic nebulizers, compared to a jet nebulizer. 17,18 Our data are in agreement with their findings. Our data are also in partial agreement with results from Ari et al, who found in an adult mechanical ventilation model that the vibrating mesh outperformed the jet nebulizer but not the ultrasonic nebulizer when the devices were placed either at the Y-piece or 15 cm before the Y-piece.…”

“…[6][7][8]11,12,[16][17][18] However, there is paucity of data on the newly available technologies. In our study the vibrating mesh nebulizer outperformed 2 jet nebulizers in each position tested, and the ultrasonic nebulizer either at the ventilator or at the humidifier.…”

β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis

“…Of these, reviewers found that 25 papers were potentially eligible. Reasons for subsequent exclusion were studies on children >5 years old (n = 12) [11][12][13][14][15][16][26][27][28][29][30][31] ; studies on nonacute patients (n = 4) [32][33][34][35] ; and studies on hospitalized patients (n = 3). [36][37][38] Finally, 6 articles were selected for inclusion in the meta-analysis.…”

Challenges Associated with Route of Administration in Neonatal Drug Delivery

“…Lugo et al used a working neonatal ventilated lung model to show that MDIs with spacers provided more efficient delivery of albuterol than jet nebulizers [96]. Fok et al demonstrated a similar trend in vivo wherein an MDI was equally as effective as an ultrasonic nebulizer, and more effective than a jet nebulizer, at delivering salbutamol to the lower respiratory tract of ventilated preterm neonates [97]. Therefore, it is important to consider the method of aerosol generation when employing the intrapulmonary route for delivery to neonates.…”