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: âAre 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 Î¼g/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 Â± 1.8 Î¼g) than the MR (10.0 Â± 1.1 Î¼g) child model (p = 0.046). Albuterol delivery by MV, though measureable and comparable for each model (3.3 Â± 1.2 Î¼g NEOP; 3.8 Â± 2.1 Î¼g NEO-T; 4.2 Â± 2.3 Î¼g 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 Â± 1.0 Î¼g NEO-P; 10.5 Â± 0.7 Î¼g NEO-T), or MR (5.5 Â± 0.3 Î¼g NEO-P; 10.7 Â± 0.9 Î¼g NEO-T) neonate (1-way ANOVA, p â¥0.46). Conclusion: Reduced delivery of medication for MV was likely associated with the saturated atmosphere within the breathing circuit (T = 37âC/>99%RH) compared with conditions (T = 22 Â± 1âC/44Â±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.