Conference Proceedings
December 2002 / Volume 47 / Number 12 / Page 1471
Liquid Nebulization: Emerging Technologies Conference Summary
IntroductionMost physicians and respiratory therapists are knowledgeable of the use of aerosolized drugs, but many are less familiar with the performance characteristics of the nebulizer. In fact, the general opinion is that the performance of the nebulizer is relatively unimportant. However, there is accumulating evidence that the nebulizer itself does make a difference. The decision to replace a good performing nebulizer with a poor performing nebulizer may decrease the delivered dose in half or more. Although this is less important for routine bronchodilator therapy, it may make a big difference with newer aerosolized drugs. Increasingly, the Food and Drug Administration is approving drugs to be used with a specific nebulizer brand and new nebulizer designs are becoming available for use with these drugs. There are several reasons why I think this conference was important. First, new aerosol drug formulations are becoming available and these will require better performing nebulizers. Second, we as clinicians need to be knowledgeable of the newer generations of nebulizers so that we can make informed purchase decisions. Third, and perhaps most important, we must gain an increased appreciation for aerosol therapy as a science. The proceedings of this conference do much to synthesize the current state-of-the art related to new nebulizer systems. This provides, in a complete and cogent manner, the scientific basis for which clinicians can improve their knowledge of the new generation of nebulizers.
Why a Conference on Nebulizers?
Background
New-Generation Nebulizer Designs
Standardization and the Future
A Few Final Thoughts
Introduction
The nebulizer is one of the devices most commonly used by respiratory therapists (RTs). Drugs used in nebulizers have undergone intensive scientific scrutiny, including studies of indications, hazards, complications, and treatment schedules. Many physicians and RTs are fluent in the mode of action and recommended dose of nebulizer drugs, but most are relatively ignorant of nebulizer performance characteristics. Terms such as mass median aerodynamic diameter, dead volume, and inhaled mass are just not part of the lexicon of most clinicians. Nebulizer selection is usually based on price, and the nebulizer brand may be selected by the purchasing department rather than the respiratory care department. Unfortunately, the general sentiment is that it does not matter. Contrary to the evidence, the general thinking is that the drug can be placed in any nebulizer, enough flow is added to generate an aerosol, and the patient simply breathes the aerosol for 10 minutes.
The evidence is now clear that the nebulizer does make a difference. I published a paper more than 5 years ago that illustrated that there are considerable differences in output among commercially available nebulizers. The decision to replace a good performing nebulizer with a poor performing nebulizer may decrease the delivered dose by more than half. Perhaps this does not matter for routine bronchodilator therapy, but it can make a difference with drugs that are now becoming available. In the case of tobramycin, for example, it could mean the difference between effective therapy and ineffective therapy resulting in pseudomonas infection, or the difference between effective therapy and aminoglycoside toxicity. Increasingly, the Food and Drug Administration is approving drugs for use with specific nebulizer brands, and new nebulizer designs are becoming available for use with these drugs.
