The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

COMPARISON OF BREATH-ACTUATED NEBULIZERS (BAN) AND ULTRASONIC NEBULIZERS IN SPUTUM INDUCTION

George M. Blaisdell1, John T. Dziodzio1, Christopher A. Hirsch1, Stephen A. Mette1



Background: Evaluation of a Breath-Actuated Nebulizer ("BAN") as a functional replacement for the older-technology ultrasonic nebulizer.

Methods: A convenience sample of 30 patients, referred to our lab for sputum induction, were randomized into two cohorts, one using the BAN, the other an ultrasonic nebulizer. The BAN was used in continuous flow mode. Four measures of the procedure were assessed: time-to-sample (minutes), specimen quality, quantity (ml), and patient response. The subjective scales were graded as a 0-3 range, with zero implying "n/a" or none, and the 1-3 scale representing poor, fair, and good. The procedure endpoint was defined as a maximum of 25 minutes, or on acquisition of an adequate sample. The mean, standard deviation (SD), and coefficient of variance (CV) were calculated for all variables.

Results: One BAN patient failed to achieve a specimen after 25 minutes, and was subsequently excluded from analysis. The two cohorts were analyzed separately, and a two-sample t-test was used to assess differences between the groups. The data here are expressed as mean ± one SD. The ultrasonic cohort mean time-to-sample was 11.3 ± 3.8 minutes, contrasted to the BAN at 11.6 ± 5.0 minutes, a 3.3% difference. Mean quantity measures were identical, with 4.0 ± 2.6 ml vs. BAN with 4.0 ± 2.0 ml. Quality was about 12% higher with the BAN, scoring 2.7 ± 0.5 compared to 2.4 ± 0.8. The means of the patient response measure differed by only about 7%, higher with the BAN. Small sample size and wide standard deviations conspire to make large CVs and small t-scores, limiting the ability to statistically discern subtle inter-group differences. It is however notable that the procedural variables of time and quantity compared favorably with differences of 3.3% and 0%; and that quality and patient response measures were increased for the BAN cohort.

Conclusion: No measured variables demonstrated any statistically or clinically significant difference and the calculated changes were all positive or enhanced within the BAN cohort. We see no evidence for excluding the use of the BAN device as a functional replacement for the ultrasonic nebulizer.

Clinical Implications: The BAN device provides a simpler option for nebulization than the ultrasonic; it is disposable, supports single patient use, easier to prepare and use, and essentially eliminates the problem of aerosol escaping during use.