Comparison of breath-enhanced to breath-actuated nebulizers for rate, consistency, and efficiency.

OBJECTIVES To evaluate differences between three new-generation nebulizers-Pari LC Star (Pari Respiratory Equipment; Mississauga, ON, Canada), AeroEclipse (Trudell Medical International, London, ON, Canada), and Halolite (Medic-Aid Limited, West Sussex, UK)-in terms of rate and amount of expected deposition as well as the consistency of the doses delivered. METHODS The in vitro performance characteristics were determined and then coupled to the respiratory pattern of seven patients with cystic fibrosis (age range, 4 to 18 years) in order to calculate expected deposition. The Pari LC Star and AeroEclipse were characterized while being driven by the Pari ProNeb Ultra compressor (Pari Respiratory Equipment) for home use, and by a 50-psi medical air hospital source. The Halolite has its own self-contained compressor. Algorithms for the rate of output for the inspiratory flow were developed for each device. Patient flow patterns were divided into 5-ms epochs, and the expected deposition for each epoch was calculated from the algorithms. Summed over a breath, this allowed the calculation of the estimated deposition for each patient's particular pattern of breathing. RESULTS The rate of deposition was highest for the Pari LC Star and lowest for the Halolite. Rate of deposition was independent of respiratory pattern for the Pari LC Star and AeroEclipse, but proportional to respiratory rate for the Halolite. The differences between the Pari LC Star and AeroEclipse were less when driven by the 50-psi source. The AeroEclipse had the least amount of drug wastage. As designed, the Halolite delivered a predetermined amount of drug very accurately, whereas expected deposition when run to dryness of the other two devices had significant variations. CONCLUSIONS To minimize treatment time, the Pari LC Star would be best. To minimize drug wastage, the AeroEclipse would be best. To accurately deliver a specific drug dose, the Halolite would be best.

[1]  A. Morice,et al.  A widely available method for the assessment of aerosol delivery in cystic fibrosis. , 2002, Pulmonary pharmacology & therapeutics.

[2]  J. Abbott,et al.  Ways of coping with cystic fibrosis: implications for treatment adherence. , 2001, Disability and rehabilitation.

[3]  A. Coates,et al.  Effect of size and disease on estimated deposition of drugs administered using jet nebulization in children with cystic fibrosis. , 2001, Chest.

[4]  J. Wildhaber,et al.  Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. , 1999, The Journal of pediatrics.

[5]  A. Coates,et al.  Effect of dead volume on the efficiency and the cost to deliver medications in cystic fibrosis with four disposable nebulizers. , 1999, Canadian respiratory journal.

[6]  M S Pepe,et al.  Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. , 1999, The New England journal of medicine.

[7]  A. Coates,et al.  Drug administration by jet nebulization , 1998, Pediatric pulmonology.

[8]  J. Abbott,et al.  Contemporary psychosocial issues in cystic fibrosis: treatment adherence and quality of life. , 1998, Disability and rehabilitation.

[9]  A. Coates,et al.  A comparison of the availability of tobramycin for inhalation from vented vs unvented nebulizers. , 1998, Chest.

[10]  A. Coates,et al.  The choice of jet nebulizer, nebulizing flow, and addition of albuterol affects the output of tobramycin aerosols. , 1997, Chest.

[11]  J. Abbott,et al.  Health perceptions and treatment adherence in adults with cystic fibrosis. , 1996, Thorax.

[12]  A. Clark.  The use of laser diffraction for the evaluation of the aerosol clouds generated by medical nebulizers , 1995 .

[13]  B. Lipworth,et al.  Nebuliser performance, pharmacokinetics, airways and systemic effects of salbutamol given via a novel nebuliser delivery system ("Ventstream"). , 1994, Thorax.

[14]  B. Ramsey,et al.  Consensus conference: Practical applications of pulmozyme® september 22, 1993 , 1994, Pediatric pulmonology.

[15]  H. O'brodovich,et al.  Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. , 1993, The Journal of pediatrics.

[16]  S. Clarke,et al.  Evaluation of jet nebulisers for use with gentamicin solution. , 1985, Thorax.

[17]  D. Pavia,et al.  Factors influencing the size distribution of aerosols from jet nebulisers. , 1983, Thorax.

[18]  M. Rosenfeld,et al.  Efficiency of pulmonary administration of tobramycin solution for inhalation in cystic fibrosis using an improved drug delivery system. , 2003, Chest.

[19]  A. Coates,et al.  Evaluation of four breath-enhanced nebulizers for home use. , 2001, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[20]  A. Coates,et al.  Nebulizer choice for inhaled colistin treatment in cystic fibrosis. , 2001, Chest.

[21]  A. Coates,et al.  Comparison of nebulized particle size distribution with Malvern laser diffraction analyzer versus Andersen cascade impactor and low-flow Marple personal cascade impactor. , 2000, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[22]  A. Coates,et al.  Accounting for radioactivity before and after nebulization of tobramycin to insure accuracy of quantification of lung deposition. , 2000, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[23]  A. Coates,et al.  The Use of Osmometry as a Means of Determining Changes in Drug Concentration During Jet Nebulization , 1998 .

[24]  R. Gibson,et al.  Efficacy and safety of short-term administration of aerosolized recombinant human deoxyribonuclease in patients with cystic fibrosis. , 1993, The American review of respiratory disease.