A mesh nebulizer is more effective than jet nebulizer to nebulize bronchodilators during non-invasive ventilation of subjects with COPD: A randomized controlled trial with radiolabeled aerosols

Abstract

Background: Beneficial effects from non-invasive ventilation (NIV) in acute COPD are well-established, but the impact of nebulization during NIV has not been well described. Aim: To compare pulmonary deposition and distribution across regions of interest with administration of radiolabeled aerosols generated by vibrating mesh nebulizers (VMN) and jet nebulizer (JN) during NIV. Methods: A crossover single dose study involving 9 stable subjects with moderate to severe COPD randomly allocated to receive aerosol administration by the VMN Aerogen and the MistyNeb jet nebulizer operating with oxygen at 8 lpm during NIV. Radiolabeled bronchodilators (fill volume of 3 mL: 0.5 mL salbutamol 2.5 mg + 0.125 mL ipratropium 0.25 mg and physiologic saline up to 3 mL) were delivered until sputtering during NIV (pressures of 12 cmH2O and 5 cmH2O -inspiratory and expiratory, respectively) using an oro-nasal facemask. Radioactivity counts were performed using a gamma camera and regions of interest (ROIs) were delimited. Aerosol mass balance based on counts from the lungs, upper airways, stomach, nebulizer, circuit, inspiratory and expiratory filters, and mask were determined and expressed as a percentage of the total. Results: Both inhaled and lung doses were greater with VMN (22.78 ± 3.38% and 12.05 ± 2.96%, respectively) than JN (12.51 ± 6.31% and 3.14 ± 1.71%; p = 0.008). Residual drug volume was lower in VMN than in JN (3.08 ± 1.3% versus 46.44 ± 5.83%, p = 0.001). Peripheral deposition of radioaerosol was significantly lower with JN than VMN. Conclusions: VMN deposited > 3 fold more radioaerosol into the lungs of moderate to severe COPD patients than JN during NIV.

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

“…In this study, there were only small differences between NIV and IMV with respect to the delivered aerosol dose (19.02% versus 22.64% respectively). Again, these figures are in line with previous published reports [ 51 , 52 ].…”

Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models

“…More recently, G alindo- F ilho et al [ 32 ], comparing the delivery of radiolabelled aerosol during NIV with jet and mesh nebulisers in moderate-to-severe COPD, patient-reported lung doses of 3.14% with a jet nebuliser versus 12.05% with a mesh nebuliser. Their lower reported lung dose than our in vitro reports is probably due to our use of collecting filters that are known to overestimate inhaled dose, and filters do not allow for exhalation of aerosol that occurs in vivo .…”

Future Trends in Nebulized Therapies for Pulmonary Disease

“…The combination of LAMA with LABA therapies has proven effective in COPD treatment, several studies showed their efficacy with inhalers [190,193] so delivery by nebulizer may soon be standard. There are also several clinical trials comparing JN versus VMN in COPD patients with some publications already pointing to preference for VMN [194]. Interestingly, the need for improved patient-orientated personalized care [195], and better adherence to prescription guidelines for asthma patients is also noted.…”