Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
Department of Chest Diseases, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
Int J Clin Pract. 2021 Apr;75(4):e13898. doi: 10.1111/ijcp.13898. Epub 2020 Dec 19.
Despite the widespread oxygen-culture as more is better in prehospital and hospital settings, the use of titrated oxygen-flow within a high-flow system can be beneficial especially when combined with aerosol-delivery and also save the patient from unnecessary-hyperoxia.
Forty-five COPD patients were included in this study where they allocated in three-groups (nasal-delivery, oral-delivery, and oronasal-delivery groups). All patients were received their inhaled-salbutamol dose using Aerogen Solo nebuliser by one of the three interfaces, eg, nasal-cannula, mouthpiece, and facemask in two conditions; with oxygen-flow and without any oxygen-flow. Pulmonary and systemic salbutamol deposition was estimated by collecting two urine-samples from the patient; 30 min post-inhalation and cumulatively 24 hr post-inhalation. The quantity of salbutamol in these collected samples was measured by high-performance liquid chromatography. Lung function measurement was performed pre-bronchodilator inhalation and 30 min post-bronchodilator to estimate the change in pulmonary functions post-inhalation regarding all tested interfaces.
COPD patients showed the highest salbutamol percentage excreted 30 min post-inhalation of 5.7% (1.4) with mouthpiece interface when combined with oxygen at P < .002. While with the same condition using oxygen, valved-facemask showed the highest salbutamol percentage excreted in 24 hr post inhalation samples but the difference is only significantly compared with nasal cannula (P < .006). Moreover, without oxygen delivery, mouthpiece and valved facemask showed approximately the same salbutamol percentage excreted in 30 min post-inhalation samples, higher than that delivered by nasal cannula (P < .001). Of note, salbutamol delivery is significantly increased with oxygen flow for all interfaces (P < .05) except with nasal cannula.
The nasal cannula is a more comfortable and tolerable interface despite the lower fraction of the delivered drug compared with other tested interfaces. The use of oxygen-flow with aerosol delivery within a high flow system positively affects the delivered drug fraction and the pulmonary deposition of the drug.
尽管在院前和医院环境中广泛采用吸氧-培养策略，即吸氧越多越好，但在高流量系统中滴定给氧流量可能有益，尤其是与气溶胶输送联合使用时，还可以避免患者发生不必要的高氧血症。
本研究纳入 45 例 COPD 患者，将其分为 3 组（鼻输送组、口输送组和口鼻输送组）。所有患者均使用 Aerogen Solo 雾化器通过 3 种接口（鼻导管、接口器和面罩）中的 1 种吸入沙丁胺醇，在有或没有氧气输送 2 种条件下吸入沙丁胺醇。通过收集患者 2 份尿液样本来估计肺内和全身沙丁胺醇沉积量；分别为吸入后 30min 和 24h。使用高效液相色谱法测量这些收集样本中的沙丁胺醇含量。在支气管扩张剂吸入前和吸入后 30min 进行肺功能测量，以评估所有测试接口吸入后肺功能的变化。
COPD 患者在吸入沙丁胺醇后 30min 时，当与氧气联合使用时，以接口器组的 5.7%（1.4）的沙丁胺醇排泄率最高（P<0.002）。而在相同条件下使用氧气时，带阀面罩在 24h 后吸入样本中显示出最高的沙丁胺醇排泄率，但与鼻导管相比差异仅具有统计学意义（P<0.006）。此外，在不输送氧气的情况下，接口器和带阀面罩在 30min 后吸入样本中的沙丁胺醇排泄率大致相同，高于鼻导管（P<0.001）。值得注意的是，除了鼻导管外，所有接口的沙丁胺醇输送量均随氧气流量的增加而增加（P<0.05）。
尽管与其他测试接口相比，输送的药物比例较低，但鼻导管是一种更舒适和耐受的接口。在高流量系统中使用氧气输送联合气溶胶输送，可积极影响输送药物的比例和药物在肺部的沉积。
