2000 OPEN FORUM Abstracts
USE OF THE AEROECLIPSEtm BREATH ACTUATED NEBULIZER TO DELIVER AEROSOLIZED PENTAMIDINE
Bobby Terrell RRT, Mark Siobal BS RRT, Respiratory Care Services, San Francisco General Hospital, UCSF Department of Anesthesia
Introduction: The AeroEclipse? Breath Actuated Nebulizer, (Monaghan Medical Corp., Plattsburgh, NY) incorporates a unique design which allows the patient's respiratory effort to activate nebulization during inspiration only. This distinctive feature improves the efficiency of drug delivery by eliminating medication wastage during expiration. The following is a case report on the trial use of this device to administer aerosolized Pentamidine.
Case Summary: A 51 year old male with HIV disease received aerosolized Pentamidine 300 mg in 6 ml of sterile water every 4 weeks for Pneumocystis Carinii pneumonia prophylaxis. The patient had been treated on forty-four prior occasions using either the Respirgard II? (Vital Signs Inc., Totowa, NJ), or Iso Neb? (Hudson RCI, Temecula, CA) continuous flow medication delivery systems with filtered exhalation. The patient had no prior history of asthma or any chronic or acute respiratory illnesses. Following all previous treatments, the patient exhibited no adverse effects from inhaled Pentamidine (wheezing, bronchospasm, or cough). The AeroEclipse? was setup using a valved configuration that allowed activation of the nebulizer during inspiration and exhalation directed through an expiratory filter. Use of the AeroEclipse? doubled the usual treatment time to 40 minutes. At the end of the treatment the patient developed airway irritation to aerosolized Pentamidine, as evidenced by high pitched expiratory wheezing and cough. The patient required subsequent treatment with aerosolized Alupent to relieve symptoms.
Discussion: The AeroEclipse? delivers a high output small particle size aerosol (MMAD = 2.8 microns *) during inspiration only. This unique design improves the efficiency of aerosolized medication delivery when compared to continuous flow nebulization by eliminating medication waste during the expiratory phase. The high respirable fraction (particles < 4.8 microns = 80% *) and the reduction in drug wastage during expiration results in an increased aerosol mass deposited in the lung. The previously undetected irritant response to aerosolized Pentamidine in this patient was most likely due to this effect. Although the duration of the treatment was lengthened for this single trial, the improved drug delivery to the lungs using the AeroEclipse? should allow a reduction in the total dose administered, as well as the diluent volume used. This should allow an overall reduction in treatment time.
Conclusion: Further evaluation of the AeroEclipse? is needed to quantify the change in the ratio of Pentamidine delivered to the lungs to the total dose administered when compared to other nebulizer delivery systems. In addition, the potential savings in drug and labor costs, as well as changes in the environmental impact to health care workers, should be assessed.
(* Based on Monaghan Medical Corporation product testing.)