Drug output from nebulizers is dependent on the method of measurement

Barry, PW; O’Callaghan, Chris

doi:10.1183/09031936.98.12020463

Cited by 24 publications

(13 citation statements)

References 13 publications

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“…The importance of using a simulated breathing pattern rather than continuous flow in the assessment of nebulizer performances was clearly shown with budesonide, even if that difference was less evident with a breath-enhanced nebulizer such as VentStream-Pro. 21 Nevertheless, the results for the corticosteroid output were similar to those from the literature using an adult breathing pattern. Nebulizing 2 mL of budesonide (0.25 mg/mL) with the Pari ProNeb Turbo/ LC Plus and the PortaNeb/VentStream, Barry and O'Callaghan found drug outputs of 22% and 10% of the initial amount, respectively.…”

Section: Discussionsupporting

confidence: 78%

Effects on Aerosol Performance of Mixing of Either Budesonide or Beclomethasone Dipropionate With Albuterol and Ipratropium Bromide

Melani

2011

Respir Care

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BACKGROUND: Mixing of nebulized drugs is common in real life, but its consequences on aerosol output and granulometry are poorly known. METHODS: In an in vitro study I evaluated the effects on aerosol output, drug output, and aerosol particle size characteristics of mixing either beclomethasone dipropionate or budesonide with albuterol and ipratropium bromide. I tested the SideStream and VentStream-Pro nebulizers, run with the AirClinic compressor. Using the same fill volume in all experiments, I nebulized and evaluated each studied drug alone, and 2 drug mixtures: beclomethasone plus albuterol plus ipratropium; and budesonide plus albuterol plus ipratropium. I measured aerosol output via gravimetrics. I measured drug delivery by collecting the aerosol on a filter in the inspiratory limb, and the residual solution in the reservoir and the circuit after nebulization, and assayed those liquids with chromatography. I measured particle size distribution via cascade impaction. RESULTS: Mixing tended to reduce drug output and to increase mass median aerodynamic diameter with the SideStream, but not always with the VentStream-Pro. However, the drug output always remained satisfactory and the mass median aerodynamic diameters were within the respirable range. When nebulized alone, the respirable mass of bronchodilators ranged from 18% to 40% of the nominal dose; when mixed, it ranged from 13% to 37%. When nebulized alone, the respirable mass of corticosteroids ranged from 10% to 24% of the nominal dose; when mixed, it ranged from 10% to 17%. CONCLU-SIONS: Both the SideStream and VentStream-Pro have good aerosol performance in nebulizing budesonide or beclomethasone dipropionate alone, and when mixed with albuterol and ipratropium bromide.

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Section: Discussionsupporting

confidence: 78%

Effects on Aerosol Performance of Mixing of Either Budesonide or Beclomethasone Dipropionate With Albuterol and Ipratropium Bromide

Melani

2011

Respir Care

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“…The NIV circuit consisted of a 187-cm length of disposable corrugated tubing (diameter of 25 mm) and a fixed leak expiration port. Spontaneous breathing was simulated to represent that of a typical adult and provided a tidal volume of 600 mL, breathing rate of 12 breaths/min and inspiratory phase of 40% (Barry & O'Callaghan 1998). The bi-level ventilator was set in spontaneous mode at an inspiratory pressure (IPAP) of 20 cmH 2 O and expiratory pressure (EPAP) of 5 cmH 2 O. Ventilator pressures were chosen as typical levels used for COPD patients when bi-level ventilation is initiated during acute exacerbations in clinical practice (British Thoracic Society Standards of Care Committee 2002).…”

Section: Study Onementioning

confidence: 99%

Enhanced delivery of nebulised salbutamol during non-invasive ventilation

Calvert

Jackson

White

et al. 2006

Journal of Pharmacy and Pharmacology

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Non-invasive ventilation (NIV) is used to treat acute respiratory failure. Nebulised drugs can be delivered concurrently with NIV or during breaks from ventilatory support. We hypothesised that the amount of nebulised salbutamol inhaled when delivered via bi-level ventilation would be no different to the amount available directly from the same nebuliser. A standard bi-level ventilation circuit was attached to a lung model simulating adult respiration. Drug delivery was compared when salbutamol (5 mg) was nebulised at different positions in the circuit and separately, with no ventilator. The amount of salbutamol contained in various particle size fractions was also determined. Nebuliser position within the NIV circuit was critically important for drug delivery. Optimal delivery of salbutamol occurred with the expiration port between the facemask and nebuliser (647+/-67 micro g). This was significantly better than nebulisation without the ventilator (424+/-61 micro g; P < 0.01). Delivery when the nebuliser was positioned between the facemask and expiration port was 544+/-85 micro g. The amount of salbutamol contained in particles < 5 micro m was significantly increased when the nebuliser was used in conjunction with bi-level ventilation (576+/-60 micro g vs 300+/-43 micro g, P < 0.001). We conclude that nebulised bronchodilator therapy, using a Cirrus jet nebuliser, during bi-level ventilation increases respirable particles likely to be inhaled when the nebuliser is optimally positioned within the circuit.

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“…3). 25 New filters (Pari Respiratory Equipment) were placed at the beginning of each experiment. The nebulizer was connected to the compressor and operated for 10 min and then reweighed to obtain the final weight.…”

Section: Breathing Simulationmentioning

confidence: 99%