Randomized Controlled Trial of a Breath-Activated Nebulizer in Patients with Exacerbation of COPD

Haynes, Jeffrey M

doi:10.4187/respcare.01609

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…A review of various meta-analyses and RCTs (involving 394 trials) comparing clinical outcomes of inhaled drugs (beta agonist, anticholinergic and corticosteroid) with nebulizers, pMDI, pMDI with spacer and DPI (dry powder inhalers) showed no difference between devices in efficacy outcomes in any patient group, including the ED [8]. Several other randomized, controlled trials have since been published comparing different aerosol delivery devices in the acute care setting [9][10][11][12]. In a randomized, controlled trial of 54 adults in the ED comparing bronchodilator administration via JN and breath-actuated nebulizer (BAN) (AeroEclipse, Monaghan Medical, Plattsburgh, New York), Parone, et al found no significant difference in clinical outcomes, in respect of the total number of treatments, respiratory rate, modified Borg Scale (MBS), and peak expiratory flow rate (PEFR) between groups [9].…”

Section: Discussionmentioning

confidence: 99%

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Dunne

Shortt

2018

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Dunne

Shortt

2018

The American Journal of Emergency Medicine

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“…The AeroEclipse is easy to use and is associated with a lower occurrence of adverse events (21). A recent clinical study reported that the breath-actuated nebulizer was more effective in reducing lung hyperinflation and respiratory frequency in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) (22). Also, patients and respiratory therapists had greater satisfaction with the BAN in adult patient populations, compared to the jet nebulizer with a corrugated tube (21).…”

Section: Breath-actuated Jet Nebulizersmentioning

confidence: 99%

Jet, Ultrasonic, and Mesh Nebulizers: An Evaluation of Nebulizers for Better Clinical Outcomes

Ari

2014

Eurasian J Pulmonol

148

110

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For over a century, nebulizers have been commonly used to deliver aerosolized medications in the treatment of patients with pulmonary diseases. They are the aerosol device of choice when patients can not coordinate inhalation and actuation needed for the use of the pressurized metered-dose inhalers (pMDIs) or are not able to provide the necessary inspiratory flow required by the dry powder inhaler (DPI) for effective aerosol drug delivery. Three types of nebulizers exist: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. The purpose of this paper is to explain the types of nebulizers available on the market and to evaluate their efficiencies in aerosol drug delivery while suggesting strategies for the optimal treatment of patients with pulmonary diseases. Keywords: Nebulizers, aerosols, inhalation therapyDelivery of aerosolized drugs was revolutionized in the 1950s with the development of nebulizers and pressurized metered-dose inhalers. Nebulizers transform liquid formulations and suspension into medical aerosol. In the past few years, there have been advances in the development of new nebulizers that hold the promise to improve aerosol drug delivery to patients with pulmonary diseases. Nebulizers are divided into three categories: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. While jet nebulizers are commonly used for the treatment of patients with pulmonary diseases, they are bulky and require a power source. Due to aerosolized droplets and solvent vapor that saturates the outgoing air, jet nebulizers cool the drug solution in the nebulizer and increase solute concentration in the residual volume. Although ultrasonic nebulizers are more efficient and compact than jet nebulizers, they can not be used to deliver proteins or suspensions. With the development of mesh nebulizers that use lower-frequency waves, heating issues that denature proteins during aerosol therapy are eliminated. Also, it has been shown that mesh nebulizers are suitable for delivery of suspensions, liposomes, and nucleic acids (1-5). Since there is a large number of nebulizers in each category that have been introduced to the market, the purpose of this paper is to explain the types of nebulizers available and to evaluate their efficiencies in aerosol drug delivery. In addition, strategies for optimal inhalation treatment of patients with pulmonary diseases will be investigated. JET NEBULIZERSTraditionally, jet nebulizers have been used for the treatment of pulmonary diseases. These nebulizers require 2 to 10 L/min of pressurized gas to draw medication up through a capillary tube from the nebulizer reservoir in order to generate a wide range of particle sizes that are blasted into one or more baffles, which take larger particles out of suspension and return them to the reservoir.Jet nebulizers are effective in delivering formulations that can not be delivered with pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). For instance, antibiotics, mucolytics, liposomal f...

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“…Contrast this to the option of nebulized generic albuterol/ipratropium (3 mg/0.5 mg), which can cost as little as $0.27/unit to an institution or $$1/day using equivalent QID dosing (86% lower). Patient-specific SVN tubing (standard or breath-activated) is generally less expensive than spacer devices and can also be used the length of the entire admission unless soiled (Table 1) 44,45 . Respiratory therapists should be involved in the drug delivery process regardless of which system is used (CC vs. SVN); so staffing costs are assumed to be similar, although that may be disputed.…”

Section: Potential Cost Of Cross-contamination Versus Alternative Metmentioning

confidence: 99%

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Larson

Gudavalli

Prater

et al. 2015

Current Medical Research and Opinion

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Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4-5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.

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Randomized Controlled Trial of a Breath-Activated Nebulizer in Patients with Exacerbation of COPD

Cited by 12 publications

References 20 publications

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Jet, Ultrasonic, and Mesh Nebulizers: An Evaluation of Nebulizers for Better Clinical Outcomes

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

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