In Vitro Evaluation of Positive Expiratory Pressure Devices Attached to Nebulizers

Self Cite

Patients receiving nebulized respiratory treatments and airway clearance therapies often combine the treatments to decrease treatment time, despite a lack of data supporting this practice. Moreover, manufacturers advertise simultaneous use in their marketing. The airway clearance devices that allow concomitant administration of aerosol can be classified as those that alter the pathway of the aerosol and those that do not.We all learn in algebra that the order of the factors does not affect a product. However, this might not be true in respiratory care practice. In this issue of RESPIRATORY CARE, Mesquita et al 1 report the findings of an in vivo study of the effect of different configurations of a high-frequency SEE THE ORIGINAL STUDY ON PAGE 328 oscillatory positive expiratory pressure (PEP) device (Acapella) and a jet nebulizer on pulmonary deposition of a radio-labeled aerosol in normal subjects. The Acapella alters the pathway of the aerosol. Mesquita et al found no difference in lung deposition between the nebulizer alone and the nebulizer interposed between the mouthpiece and the Acapella. However, when the nebulizer was connected to the back of the Acapella, as recommended by the manufacturer, there was a 70% decrease in pulmonary deposition. There was a non-significant trend toward more peripheral distribution of the aerosol. Mesquita et al also measured the effect of the nebulizer position on the pattern of aerosol deposition within the Acapella.One limitation of the study is that it was done in healthy subjects. Based on previously published data, one would expect that deposition would be greater in subjects with lung disease. 2 Moreover, aerosol distribution varies significantly with disease severity. 3 However, because the reduction in emitted aerosol occurs before inhalation, we would expect similar results in subjects with lung disease.Drug and device developers, manufacturers, researchers, and regulatory agencies struggle to find good in vivo/ in vitro correlation to aid development and approval processes of new drugs and devices. Our group recently reported the effect of concomitant use of nebulizer and PEP devices on drug output and aerosol characteristics. 4 We found that coupling the nebulizer with a PEP device that obstructs the aerosol pathway reduces the aerosol particle size and patient dose. The former finding was measured via cooled cascade impactor technique, and the latter finding was measured via breathing simulation technique. The mass median aerodynamic diameter decreased 70%, from 4.13 m with the nebulizer alone (equivalent to configuration C of Mesquita's report) to 1.24 m when coupled to the Acapella Choice (equivalent to configuration A of Mesquita's report). In addition, the amount of drug captured in the cascade impactor decreased by 65% when the nebulizer was coupled to the Acapella Choice. The device retained 75% of the drug that left the nebulizer. The patient dose also decreased 80 -90% when the nebulizer was coupled to the Acapella Choice. Good correlation was found be...

supporting

confidence: 76%

mentioning

confidence: 99%

The Order of the Factors Affects a Product!

Berlinski

2014

Self Cite

“…Berlinski 14 conducted a study to determine the impact of aerosol deposition in subjects with cystic fibrosis delivered with 2 types of nebulizer devices in combination with PEP and oscillatory PEP devices. Figure 1 shows the mass median aerodynamic diameters of aerosols from the nebulizers alone and connected to PEP devices.…”

Section: Patient Interfacesmentioning

confidence: 99%

Year in Review 2014: Aerosol Delivery Devices

Myers

2015

After centuries of discoveries and technological growth, aerosol therapy remains a cornerstone of care in the management of both acute and chronic respiratory conditions. Aerosol therapy embraces the concept that medicine is both an art and a science, where an explicit understanding of the science of aerosol therapy, the nuances of the different delivery devices, and the ability to provide accurate and reliable education to patients become increasingly important. The purpose of this article is to review recent literature regarding aerosol delivery devices in a style that readers of Respiratory Care may use as a key topic resource.

“…12 The degree to which the mass median aerodynamic diameter is altered is dependent upon type of PEP device, the presence of oscillations or vibrations, and the type of nebulizer. Although the convenience of delivering 2 therapies concurrently is tempting, the reality is that aerosol delivery may be far less effective than when delivered independent of the PEP device, again emphasizing the importance of understanding differences among devices.…”

Section: Pepmentioning

confidence: 99%

“…Although the convenience of delivering 2 therapies concurrently is tempting, the reality is that aerosol delivery may be far less effective than when delivered independent of the PEP device, again emphasizing the importance of understanding differences among devices. 12 The routine use of PEP for patients with COPD is not recommended but may be an option for those patients with COPD and symptomatic secretion retention. 1 Osadnik et al 13 conducted a randomized controlled trial to study the effect of PEP added to the usual care of hospitalized subjects with COPD exacerbations.…”

Section: Pepmentioning

confidence: 99%

Year in Review 2014: Airway Clearance

Strickland

2015

The respiratory therapist has had integrated adjuncts to improve mucus clearance for decades. However, there is a lack of literature describing the impact of these interventions on specific patient populations, resulting in an inability to make recommendations about the use of devices and techniques. The purpose of this article is to review recent literature regarding airway clearance therapies in a manner that is most likely to have interest to the readers of RESPIRATORY CARE.