The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

INHALED MEDICATIONS FOR NEONATES AND SMALL CHILDREN VIA A NOVEL AEROSOL CHAMBER: LABORATORY SIMULATION OF DELIVERY OPTIONS

Rob DiBlasi1, Dominic Copollo3, Jolyon Mitchell2, Cathy Doyle2, Valentina Avvakoumova2, Rubina Ali2, Mark Nagel2; 1Respiratory Care/Center for Developmental Therapeutics, Seattle Children’s Research Institute, Seattle, WA; 2Aerosol Research Laboratory, Trudell Medical, London, ON, Canada; 3Monaghan Medical, Syracuse, NY

Background: Delivery of bronchodilators to infants and small children by pressurized metered-dose inhalerholding aerosol chamber (pMDI-AC) is limited by airway narrowness, short respiratory cycle times, and low tidal volumes. There is a need for a versatile, efficient AC, given the variety of treatment modalities. Experiments with such an AC were undertaken to answer the question: ‘Are differences in the delivery of inhaled beta2-agonist medication associated with the simulated delivery options: (a) mechanical ventilation (MV) via endotracheal tube (ETT); (b) manual resuscitation (MR) via ETT; (c) spontaneous breathing (SB) via facemask? Methods: ACs with internal geometry optimized for aerosol delivery and capable of accepting GSK pMDI canisters with dose counter (AeroChamber Mini*, n=5 devices/test) were evaluated for the delivery of HFA-albuterol (90 μg/actuation). Tidal breathing of a premature neonate with tidal volume (6- mL), designated NEO-P; term neonate with tidal volume (20-mL), designated NEO-T; and a small child (~2 year) with tidal volume (60-mL), designated CH-S. were simulated. Aerosol collection was obtained by electret filter with quantitative assay for albuterol. Results: Total emitted mass albuterol/actuation (TEM) ex AC was marginally greater for the SB (12.1 ± 1.8 μg) than the MR (10.0 ± 1.1 μg) child model (p = 0.046). Albuterol delivery by MV, though measureable and comparable for each model (3.3 ± 1.2 μg NEOP; 3.8 ± 2.1 μg NEO-T; 4.2 ± 2.3 μg CH-S (p = 0.63)), was significantly lower than via the other simulated delivery options (p <0.001). Similar TEM was measured for the SB (6.0 ± 1.0 μg NEO-P; 10.5 ± 0.7 μg NEO-T), or MR (5.5 ± 0.3 μg NEO-P; 10.7 ± 0.9 μg NEO-T) neonate (1-way ANOVA, p ≥0.46). Conclusion: Reduced delivery of medication for MV was likely associated with the saturated atmosphere within the breathing circuit (T = 37∞C/>99%RH) compared with conditions (T = 22 ± 1∞C/44±7% RH) for the other modalities. The new AC may provide a versatile alternative to existing devices designed exclusively for each treatment modality. Sponsored Research - Trudell Medical provided devices, testing equipment, and assisted with data organization and statistics.

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