The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

A BREATH-ACTUATED SMALL VOLUME NEBULIZER (BAN) OFFERS A RAPID ALTERNATIVE TREATMENT MODALITY FOR THE DELIVERY OF BRONCHODILATORS FOR ASTHMATIC PATIENTS IN A SEVERE EXACERBATION

Dominic P Coppolo RRT, Monaghan Medical Corp., Syracuse, NY, USA,
Jolyon P. Mitchell Ph.D, Kimberly J. Wiersema B.A., Cathy C. Doyle B.Sc and
Mark W. Nagel HB.Sc, Trudell Medical Aerosol Laboratory, London, Canada

Large volume continuous nebulizers (LVNs) are often used for the delivery of beta-2 adrenergic agonist bronchodilators in the emergency department to treat severe, reversible airways disease, in particular asthma 1. Treatment time, however, can be lengthy for delivery of the typical LVN fill volume from 20- to 120-ml. Quick delivery of a bronchodilator with an efficient nebulizer may help relive symptoms from bronchospasm in a shorter period of time. We report a study in which the delivery of diluted generic respirator solution albuterol by LVN (Hope, B&B Medical Technologies Inc., Loomis, CA) was compared with that from a small volume breath-actuated nebulizer (BAN) (AeroEclipse®, Monaghan Medical Corp., Plattsburgh, NY). The LVNs (n=5) were operated with 10 L/min air supplied at 50 psig with a 20-ml fill (albuterol concentration of 0.167 mg/ml).  A similar number of BANs were operated with 8.0 L/min air at 50 psi with a 3-ml fill (albuterol concentration of 0.833 mg/ml). The aerosol from the LVNs was sampled continuously until onset of sputtering at 12 L/min via a Dreschel filter/bottle where the albuterol was captured quantitatively. Aerosol from the BANs was sampled onto electret filters using a breathing simulator (600-ml tidal volume, inspiratory/expiratory ratio 1:2, rate 10 cycles/min) until onset of sputtering, so that operation of the breath actuation mechanism was effected. Assay for albuterol was undertaken by UV spectrophotometry. In a parallel study droplet size distributions were determined by laser diffractometry, so that the fine droplet fraction < 4.8 µm diameter likely to penetrate to the airways of the lungs could be determined. Fine droplet albuterol delivery rates were constant as a function of time for all nebulizers. After 15-min, the LVNs had supplied 127.3 ± 37.4 µg as fine droplets at a rate of 8.5 ± 2.5 µg/min. In contrast, the BANs delivered 810.0 ± 20.4 µg in a 10-min period, equivalent to a rate of 81.0 ± 2.0 µg/min. The significantly higher delivery rate from the BAN group (un-paired t-test, p < 0.001) offers an important clinical alternative to the LVN in the emergency department where rapid delivery of a bronchodilator is critical.

Reference:

McPeck M, Tandon R, Hughes K, Smaldone GC. Aerosol delivery during continuous nebulization. Chest. 1997;111:1200-1205.


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