Lung deposition from four nebulizers

Hardy, J. G.; Newman, S P; Knoch, M.

doi:10.1016/0954-6111(93)90074-a

Cited by 60 publications

(36 citation statements)

References 6 publications

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“…In this publication, we will refer to this device as Akita 2 . The Akita 2 deposits ,70% of the loaded dose in the lung [26], compared with 10-20% for conventional jet nebuliser systems [27][28][29][30]. Therefore, total lung dose of dornase alfa during this study was estimated to be 3-5 times higher than with standard jet nebulisers.…”

Section: Study Treatmentmentioning

confidence: 93%

Improved treatment response to dornase alfa in cystic fibrosis patients using controlled inhalation

Bakker¹,

Volpi²,

Salonini³

et al. 2011

Eur Respir J

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Better treatment of obstructed small airways is needed in cystic fibrosis. This study investigated whether efficient deposition of dornase alfa in the small airways improves small airway obstruction.In a multicentre, double-blind, randomised controlled clinical trial, cystic fibrosis patients on maintenance treatment with 2.5 mL dornase alfa once daily were switched to a smart nebuliser and randomised to small airway deposition (n524) or large airway deposition (n525) for 4 weeks. The primary outcome parameter was forced expiratory flow at 75% of forced vital capacity (FEF75%).FEF75% increased significantly by 0.7 SD (5.2% predicted) in the large airways group and 1.2 SD (8.8% pred) in the small airways group. Intention-to-treat analysis did not show a significant difference in treatment effect between groups. Per-protocol analysis, excluding patients not completing the trial or with adherence ,70%, showed a trend (p50.06) in FEF75% Z-score and a significant difference (p50.04) between groups in absolute FEF75% (L?s -1 ) favouring small airway deposition. Improved delivery of dornase alfa using a smart nebuliser that aids patients in correct inhalation technique resulted in significant improvement of FEF75% in children with stable cystic fibrosis. Adherent children showed a larger treatment response for small airway deposition.

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Section: Study Treatmentmentioning

confidence: 93%

Improved treatment response to dornase alfa in cystic fibrosis patients using controlled inhalation

Bakker¹,

Volpi²,

Salonini³

et al. 2011

Eur Respir J

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“…Delivery was only during inspiration, and an optimized surfactant concentration allowed the inhalation of the maximum amounts. However, intrapulmonary delivery was not directly assessed with a radiotracer, because this particular inhalation device has already been shown to result in about 19% intrapulmonary delivery in normal persons [28]. In adults with CF, a similar total pulmonary deposition is expected, the distribution, however, being uneven with a decreased aerosol entry to poorly ventilated regions [29].…”

Section: Discussionmentioning

confidence: 99%

Nebulization of a bovine surfactant in cystic fibrosis: a pilot study

Griese¹,

Bufler²,

Teller³

et al. 1997

Eur Respir J

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Cystic fibrosis (CF) is a lethal disorder which results in excessive airway secretions and in chronic inflammation of the airways. In vitro and in vivo studies have shown that a lack of surfactant results in the closure of the small airways. In this pilot study, we aimed to determine whether surfactant administered by aerosol might improve lung function on a short-term basis in patients with CF.In a randomized, crossover double-blind pilot study, 120 mg of a lipid-extracted bovine surfactant (Alveofact) or placebo was aerosolized to five young adult patients with CF over a period of 30 min for five consecutive days. The sample size had the power of 90% to detect an increase in forced expiratory volume in one second (FEV1) of 15% (p<0.05).Jet nebulization of surfactant produced particles of which more than 75% were the respirable range (<5 µm). The inhalations were well tolerated. No changes in serum antibody titres against the surfactant proteins-B and -C (SP-B/SP-C) were observed. No differences in FEV1 and forced vital capacity were found before, and 30 or 90 min after, the inhalation. This pilot study shows no acute or short-term benefits of surfactant inhalation in young adults with cystic fibrosis. However, a beneficial effect of exogenous surfactant cannot be excluded before other reasons for a lack of effect, such as insufficient quantity delivered, inhomogeneous distribution or inhibition of the surfactant in the lungs, have been completely ruled out.

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“…20 In some cases, residual loss can account for nearly 50 -75% of the drug placed in the nebulizer. 21,22 Moreover, there are differences in drug delivery related to nebulizer flow and gas composition and whether the device is being powered by a compressor or pressurized gas source.…”

Section: Aerosol Device Selectionmentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.

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Lung deposition from four nebulizers

Cited by 60 publications

References 6 publications

Improved treatment response to dornase alfa in cystic fibrosis patients using controlled inhalation

Improved treatment response to dornase alfa in cystic fibrosis patients using controlled inhalation

Nebulization of a bovine surfactant in cystic fibrosis: a pilot study

Clinical Controversies in Aerosol Therapy for Infants and Children

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