Pulmonology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, and with the Pediatric Aerosol Research Laboratory, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
Respir Care. 2014 Feb;59(2):216-22. doi: 10.4187/respcare.02698. Epub 2013 Aug 6.
Patients with cystic fibrosis perform airway clearance techniques and receive nebulized medications on a regular basis. Some positive expiratory pressure (PEP) devices allow concomitant administration of aerosol. I hypothesized that this practice alters the aerosol characteristics and patient dose. I compared the aerosol characteristics and patient dose of nebulized albuterol from 2 types of nebulizer, alone and when connected to different PEP and vibratory PEP devices.
Three units of a continuous-output nebulizer (Up-Draft II Opti-Neb) and 3 units of a breath-enhanced nebulizer (LC Plus) were tested alone and connected to PEP devices (Acapella Choice, Acapella Duet, and EzPAP for Up-Draft II Opti-Neb, and Pari PEP at 2 different settings, and Pari PEP S system with the LC Plus). Aerosol characteristics were evaluated with a cooled cascade impaction technique. The nebulizers were loaded with 2.5 mg/3 mL albuterol solution and operated for 4 min at 6 L/min (wall air). Patient dose was evaluated with simulated breathing patterns for a child, small adult, and large adult. Albuterol was assayed via spectrophotometry.
Connecting the LC Plus to the PEP devices did not change the aerosol characteristics or patient dose. Connecting the Up-Draft II Opti-Neb to the PEP devices significantly reduced the mass median aerodynamic diameter, from 4.13 μm to 3.72 μm with EzPAP (P = .02), 1.24 μm with Acapella Choice (P < .001), and 1.22 μm with Acapella Duet (P < .001). The total amount of albuterol captured by the impactor decreased when connected to either Acapella Choice (65%) or Acapella Duet (69%), with 17-25% retained in the PEP devices. Patient dose decreased by 76% and 84% when connected to Acapella Choice and Acapella Duet, respectively.
Concomitant use of nebulizer and PEP or vibratory PEP devices that obstruct the aerosol pathway significantly decrease the aerosol particle size and the patient dose.
囊性纤维化患者经常进行气道清除技术并接受雾化药物治疗。一些正压呼气（PEP）设备允许同时给药气溶胶。我假设这种做法会改变气溶胶特性和患者剂量。我比较了单独使用和连接到不同的 PEP 和振动 PEP 设备时两种雾化器（Up-Draft II Opti-Neb 连续输出雾化器和 Breath-Enhanced LC Plus 雾化器）的气溶胶特性和患者剂量。
测试了三个连续输出雾化器（Up-Draft II Opti-Neb）和三个呼吸增强雾化器（LC Plus）单元，分别单独使用和连接到 PEP 设备（Acapella Choice、Acapella Duet 和 EzPAP 用于 Up-Draft II Opti-Neb，以及 Pari PEP 的两种不同设置，和 LC Plus 的 Pari PEP S 系统）。使用冷却级联撞击技术评估气溶胶特性。雾化器用 2.5 毫克/3 毫升沙丁胺醇溶液加载，以 6 升/分钟（壁气）运行 4 分钟。通过模拟儿童、小成人和大成人的呼吸模式评估患者剂量。通过分光光度法测定沙丁胺醇含量。
将 LC Plus 连接到 PEP 设备不会改变气溶胶特性或患者剂量。将 Up-Draft II Opti-Neb 连接到 PEP 设备会显著降低质量中值空气动力学直径，从 EzPAP 时的 4.13μm 降至 3.72μm（P=0.02），从 Acapella Choice 时的 1.24μm 降至 0.001（P<0.001），从 Acapella Duet 时的 1.22μm 降至 0.001（P<0.001）。当连接到 Acapella Choice（65%）或 Acapella Duet（69%）时，撞击器捕获的沙丁胺醇总量减少，而 17-25%的沙丁胺醇保留在 PEP 设备中。当连接到 Acapella Choice 和 Acapella Duet 时，患者剂量分别下降 76%和 84%。
同时使用阻塞气溶胶通路的雾化器和 PEP 或振动 PEP 设备会显著降低气溶胶颗粒大小和患者剂量。
