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.