2001 OPEN FORUM Abstracts
PILOTCOMPARISON OF PEAK FLOW MEASUREMENTS: HANDHELD VERSUS A BREATH-ACTUATED NEBULIZER
Peter Wang BS, RRT,Wayne Wallace BA, RRT, Luis Moreta-Sainz MD; Kaiser Permanente Los Angeles MedicalCenter, Los Angeles, California
BACKGROUND: Patients sufferingfrom asthma or other reactive airways disease benefit from inhaling medicatedaerosols. Hand Held Nebulizers (HHN) deliver aerosol medications during inspiratoryand expiratory phases of a patient?s respiration. Recently, a Breath-ActuatedNebulizer (BAN) has been introduced that only delivers medicated aerosols onlyduring a patient?s inspiratory phase. The aim of the study was to investigatewhether using BAN?s efficient delivery of medicated aerosols improves peak flowsignificantly over current practice (using a HHN).
Methods: 40 patients diagnosedwith and acute episode of asthma or other reactive airways diseases were randomlyassigned to two groups. All patients were out-patients treated at the AllergyClinic or Emergency Department by RCPs or RNs. One group received medicatedaerosols (2.5 mg Albuterol or 2.5 mg Albuterol/.5 mg Ipratropium Bromide mixture)via HHN (Hudson RCI, MICRO MIST®, Temecula, CA). A 6-8 L/min of source gas drovethe HHN. The second group received their medicated aerosols, as described above,using a BAN (Monaghan Medical Corporation, AeroEclipse?, Plattsburgh, NY). A5-7 L/min of source gas drove the BAN in accordance with the manufacturer?sproduct recommendations. Peak Flows were measured, using standard instructions,by the (Dey Laboratories, Astech®, Napa, CA) or (Micro Direct Inc, Micro Plus,Lewiston, ME) at 0 and 10 min. Peak flows at 10 min. were subtracted from thepeak flows at 0 min. for both groups. A Student?s T-test (one-tailed) was calculatedon the resultant differences between groups. Results: 66 treatments were conductedon 40 patients using the research protocol. 19 patients were excluded from thestudy due to incomplete information. The following table summarizes the result(Mean and Standard Deviation reported in L/min.):
The individual statistics for theHHN were a mean flow at 0 min. of 222 L/min. and a mean flow of 259 at 10 min.(16.7% improvement). The individual statistics for the BAN were a mean flowat 0 min. of 193 L/min. and at 10 min. 238 L/min. (23.3% improvement).
EXPERIENCE: Caregivers seemto prefer BAN for sicker patients with lower initial peak flows.
Conclusions: BAN showed agreater percentage improvement in Peak Flows over HHN. However, the overalldifference in the peak flows between the devices was not significant. The resultsof the study may be limited by caregiver device selection bias, different aerosolmedication regimes, and cumulatitve effect of multiple treatments on a singlepatient. Furthermore, patients assigned to the two groups many not have hadthe same degree of responsiveness to aerosol medications.