Barry P W, O'Callaghan C
Department of Child Health, University of Leicester, Leicester, United Kingdom.
J Allergy Clin Immunol. 1999 Dec;104(6):1168-73. doi: 10.1016/s0091-6749(99)70009-6.
Inhaled corticosteroids are increasingly used in the treatment of asthma, and many different nebulizers are available to aerosolize steroid medications. There are few comparative data on their ability to do so.
Our purpose was to determine the particle size and mass output of budesonide nebulizer suspension from different nebulizers.
In vitro measurement of drug particle size and total drug output from 3 nebulizers (the Pari LC Plus, the Pari LC Star, and the Medicaid Ventstream) was performed under simulated breathing conditions. Nebulizers were charged with 2 mL (500 microg) of budesonide suspension. A sinus pump was used to draw aerosol from the nebulizers onto a filter during simulated inspiration at tidal volumes of 150 and 600 mL, mimicking pediatric and adult use. Aerosol particle size was determined separately by inertial impaction.
The LC Plus nebulizer had the highest initial output rate and delivered the most budesonide at both breathing patterns. The maximal output rates of the Ventstream and LC Star nebulizers was half that of the LC Plus, but the LC Star nebulizer continued nebulization for longer and delivered twice as much budesonide as the Ventstream did. However, the Ventstream produced the smallest particles, mass median diameter 3.1 microm compared with 3.8 microm for the LC Star and 4.1 microm for the LC Plus.
This study has identified differences among the nebulizers that would not have been apparent with current standards for nebulizer assessment. Incorporation of breathing simulation in the study imitates patient use and allows effective nebulization times to be predicted. The results suggest that the nebulizers studied would deliver different masses of budesonide to the lungs and to the upper airway. This may have important consequences in determining the efficacy and side effect profile of budesonide.
吸入性糖皮质激素在哮喘治疗中的应用日益广泛，有多种不同的雾化器可用于雾化类固醇药物。关于它们雾化能力的比较数据较少。
我们的目的是确定不同雾化器中布地奈德雾化混悬液的粒径和质量输出量。
在模拟呼吸条件下，对3种雾化器（帕里LC Plus、帕里LC Star和医疗补助通气雾化器）的药物粒径和总药物输出量进行体外测量。向雾化器中装入2 mL（500微克）布地奈德混悬液。在模拟吸气过程中，使用正弦泵将雾化器产生的气溶胶在潮气量为150和600 mL时抽吸到滤器上，分别模拟儿童和成人使用情况。通过惯性撞击法分别测定气溶胶粒径。
LC Plus雾化器的初始输出速率最高，在两种呼吸模式下输送的布地奈德最多。通气雾化器和LC Star雾化器的最大输出速率是LC Plus的一半，但LC Star雾化器持续雾化时间更长，输送的布地奈德是通气雾化器的两倍。然而，通气雾化器产生的颗粒最小，质量中值直径为3.1微米，而LC Star为3.8微米，LC Plus为4.1微米。
本研究发现了雾化器之间的差异，这些差异在当前的雾化器评估标准中并不明显。在研究中纳入呼吸模拟可模仿患者使用情况，并能预测有效雾化时间。结果表明，所研究的雾化器向肺部和上呼吸道输送的布地奈德质量不同。这可能对确定布地奈德的疗效和副作用情况具有重要影响。
