Performance of Large Spacer Versus Nebulizer T-Piece in Single-Limb Noninvasive Ventilation

Harb, Hadeer S.; Elberry, Ahmed A.; Rabea, Hoda; Fathy, Mona; Abdelrahim, Mohamed

doi:10.4187/respcare.05976

Cited by 48 publications

(34 citation statements)

References 44 publications

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“…Also, the fraction of salbutamol recovered from 24-h urine samples significantly increased with using HMP or HFM compared to HFNC (p<0.05), and therefore patients would be subjected to more systemic side effects of the drug. [12] Facial and ocular depositions were the main complaints previously reported with the use of facemask in addition to hindering eating and speech leading to interface displacement and less compliance. [13,14] The main problem noticed with HMP use was related to the inability of the patient to cooperate to maintain the interface in the mouth during the whole procedure.…”

Section: Discussionmentioning

confidence: 99%

Aerosol delivery aspects within a high-flow therapy system in COPD patients

et al. 2020

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There is a lack of information about the influence of patient interfaces like facemask or mouthpiece on the effective dose of aerosolized drugs while using high flow therapy in a clinical setting. These interfaces can improve pulmonary drug delivery over nasal cannula but patient preference and comfort should also be considered.The present work was to determine the effect of three different interfaces (nasal cannula, valved face mask, and mouthpiece) when combined with titrated oxygen flow on aerosol delivery in chronic obstructive pulmonary disease (COPD) patients hospitalised due to acute exacerbation.The variations between these interfaces were addressed in terms of change in lung function measurements pre-and post-inhalation, the delivered salbutamol dose, and patient tolerance to each interface.High flow nasal cannula was the most comfortable interface used. However, its pulmonary drug delivery was significantly lower than both the valved face mask and mouthpiece (p<0.05). Although drug delivery was different with the three tested interfaces, the lung function improvements were similar.

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Section: Discussionmentioning

confidence: 99%

Aerosol delivery aspects within a high-flow therapy system in COPD patients

et al. 2020

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“…Noninvasive ventilation respiratory support represents a standard strategy in the management of COPD patients and serves as a remarkable option in asthma management 4 . Over the past decades, attempts to combine aerosol delivery with noninvasive ventilation are largely appreciated to maximise patient benefits 3,5‐13 . One of the well‐studied systems for delivering noninvasive respiratory support is a high flow oxygen system that can deliver heated—humidified gas inflows up to 60 L/min but one can wonder whether the high flow is generally beneficial to patients in all cases 14,15 .…”

Section: Introductionmentioning

confidence: 99%

“…1 COPD is accompanied by a progressive decline in pulmonary function which increases over time besides the normal decrease with age. 2,3 Noninvasive ventilation respiratory support represents a standard strategy in the management of COPD patients and serves as a remarkable option in asthma management. 4 Over the past decades, attempts to combine aerosol delivery with noninvasive ventilation are largely appreciated to maximise patient benefits.…”

Section: Introductionmentioning

confidence: 99%

“…4 Over the past decades, attempts to combine aerosol delivery with noninvasive ventilation are largely appreciated to maximise patient benefits. 3,[5][6][7][8][9][10][11][12][13] One of the well-studied systems for delivering noninvasive respiratory support is a high flow oxygen system that can deliver heated-humidified gas inflows up to 60 L/min but one can wonder whether the high flow is generally beneficial to patients in all cases. 14,15 Uncontrolled oxygen therapy in acutely exacerbated COPD patients can result in an increased risk of severe respiratory acidosis and mortality.…”

Section: Introductionmentioning

confidence: 99%

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The impact of changing patient interfaces on delivering aerosol with titrated oxygen in the high flow system

et al. 2020

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Introduction Despite the widespread oxygen‐culture as more is better in prehospital and hospital settings, the use of titrated oxygen‐flow within a high‐flow system can be beneficial especially when combined with aerosol‐delivery and also save the patient from unnecessary‐hyperoxia. Methods Forty‐five COPD patients were included in this study where they allocated in three‐groups (nasal‐delivery, oral‐delivery, and oronasal‐delivery groups). All patients were received their inhaled‐salbutamol dose using Aerogen Solo nebuliser by one of the three interfaces, eg, nasal‐cannula, mouthpiece, and facemask in two conditions; with oxygen‐flow and without any oxygen‐flow. Pulmonary and systemic salbutamol deposition was estimated by collecting two urine‐samples from the patient; 30 min post‐inhalation and cumulatively 24 hr post‐inhalation. The quantity of salbutamol in these collected samples was measured by high‐performance liquid chromatography. Lung function measurement was performed pre‐bronchodilator inhalation and 30 min post‐bronchodilator to estimate the change in pulmonary functions post‐inhalation regarding all tested interfaces. Results COPD patients showed the highest salbutamol percentage excreted 30 min post‐inhalation of 5.7% (1.4) with mouthpiece interface when combined with oxygen at P < .002. While with the same condition using oxygen, valved‐facemask showed the highest salbutamol percentage excreted in 24 hr post inhalation samples but the difference is only significantly compared with nasal cannula (P < .006). Moreover, without oxygen delivery, mouthpiece and valved facemask showed approximately the same salbutamol percentage excreted in 30 min post‐inhalation samples, higher than that delivered by nasal cannula (P < .001). Of note, salbutamol delivery is significantly increased with oxygen flow for all interfaces (P < .05) except with nasal cannula. Conclusions The nasal cannula is a more comfortable and tolerable interface despite the lower fraction of the delivered drug compared with other tested interfaces. The use of oxygen‐flow with aerosol delivery within a high flow system positively affects the delivered drug fraction and the pulmonary deposition of the drug.

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“…The aerosol distribution in the COPD lungs follows a regular manner caused by the inflammation and bronchoconstriction. [11][12][13] It was supposed that COPD affects the aerosols deposition in the lungs as the aerosol lung deposition in COPD subjects was found to be less than that in the healthy lung. [14][15][16][17] However, no studies have been performed to assess the influence of smoking on lung deposition which consequently affects the response of the subject to aerosolized medication especially for the exacerbated COPD subject.…”

Section: Introductionmentioning

confidence: 99%

Lung deposition and systemic bioavailability of dose delivered to smoker compared with non‐smoker COPD subjects

Mohamed

Eldin

et al. 2020

Int J Clin Pract

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Introduction Inhaled drugs are the most commonly used class of medications for COPD subjects. No studies have been performed to assess the influence of smoking on lung deposition of aerosolized medication, especially for the exacerbated COPD subject. The present study aimed to assess the influence of smoking on the lung deposition of the aerosol delivered to exacerbated COPD subjects. Methods Twenty‐four exacerbated COPD subjects using automatic continuous positive airway pressure (Auto‐CPAP), 12 smokers (six females) and 12 non‐smokers (six females) were recruited in the study. The subjects participated in the study received four salbutamol study doses; 1200 µg (12 puffs 100 µg/puff) of salbutamol emitted from pMDI canister connected to AeroChamber MV spacer; 1200 µg of salbutamol emitted from pMDI canister connected to Combihaler spacer; 1 mL of salbutamol respirable solution (5000 µg/mL) nebulized by Aerogen Solo connected to its T‐piece; and 1 mL of salbutamol respirable solution nebulized by Aerogen Solo connected to Combihaler spacer with 2 puffs salbutamol MDI (200 µg salbutamol) before nebulisation. The subjects were randomised to receive the four selected dose‐adaptor combination in a sealed envelope design on days 1, 3, 5 and 7. A washout period of 24 hours was provided between each salbutamol dosing. Auto‐CPAP was adjusted at non‐invasive ventilation mode with the integrated heated humidifier, as a source of humidity. Urine samples were provided by subjects, 30 minutes and cumulatively 24 hours post inhalation, as an index of the relative and systemic bioavailability, respectively, and aliquots were retained for salbutamol analysis using solid‐phase extraction and high‐performance liquid chromatography (HPLC). On day 2 of the study, a collecting filter was placed between the aerosol generator and the subject's mask so that the subjects would not inhale the salbutamol delivered. The same study doses and/or adapters were delivered to each subject, with filters changed with each dose‐adapter combination. Salbutamol entrained on the filter was desorbed to be analysed by the HPLC. Results Significantly higher lung deposition (30 minutes urinary salbutamol) was detected with the non‐smoker compared with smokers (P < .05). Significantly higher systemic bioavailability (pooled 24‐hour urinary salbutamol) for smokers compared with non‐smokers was found with Aerogen Solo connected to its T‐piece and CombiHaler spacer with pMDI (P < .05) only. Significantly higher amount desorbed from the ex‐vivo filter were found from pMDI with both spacers in non‐smokers (P < .05) compared with the smokers. Conclusion The study demonstrated that smoking reduced the lung deposition of inhaled salbutamol delivered by nebulizer or pMDI. However, the smoking effect on cytochrome p450 was observed to increase systemic absorption of the ingested portion of the inhaled dose. The lower lung deposition and possible higher systemic absorption should be taken into consideration while prescribing inhaled medication to COPD smokers...

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Performance of Large Spacer Versus Nebulizer T-Piece in Single-Limb Noninvasive Ventilation

Cited by 48 publications

References 44 publications

Aerosol delivery aspects within a high-flow therapy system in COPD patients

Aerosol delivery aspects within a high-flow therapy system in COPD patients

The impact of changing patient interfaces on delivering aerosol with titrated oxygen in the high flow system

Lung deposition and systemic bioavailability of dose delivered to smoker compared with non‐smoker COPD subjects

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