Extreme Variability in Aerosol Output of the DeVilbiss 646 Jet Nebulizer*

Hollie, Michael C.; Malone, Randolph A.; Skufca, Roberta M.; Nelson, Harold S.

doi:10.1378/chest.100.5.1339

Cited by 29 publications

(8 citation statements)

References 2 publications

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“…Furthermore, marked variability in solution output for different NEBs of the same model may exist [15]. Zainudin et al [20]reported that equivalent bronchodilation was achieved by an NEB (Acorn) as compared with an MDI or a DPI (Rotahaler) with the identical drug dose, but other studies have noted that the MDI and DPI produced the same effect with less than half the dose used in an NEB [5, 6, 8, 26].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

Ikeda

Nishimura²,

Koyama³

et al. 1999

Respiration

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The aim of this study was to compare the bronchodilator effects of salbutamol delivered via three different devices: a dry-powder inhaler (DPI), a metered-dose inhaler (MDI) with a large-volume spacer and a jet nebulizer (NEB) in patients with stable chronic obstructive pulmonary disease (COPD). Ten male patients with stable COPD [age: 67.2 ± 3.8 years, forced expiratory volume in 1 s (FEV₁): 1.56 ± 0.32 liters] were studied in a randomized, double-blind and crossover manner. Each patient received 200 or 1,000 µg salbutamol via an MDI with an InspirEase^TM spacer, a Rotahaler^TM, or a DeVilbiss 646^TM nebulizer (NEB), or matching placebo on 7 separate days. Spirometry was performed before and 15, 30, 60, 90, 120, and 240 min after inhalation. With the 200-µg dose, only DPI produced a small but greater response in maximum FEV₁ and in area under the time-response curve (AUC-FEV₁) compared with placebo. With the 1,000-µg dose, DPI and MDI produced equally greater improvements in both maximum FEV₁ and AUC–FEV₁ than NEB. An equal bronchodilating effect can be obtained using either DPI or MDI with a spacer device, whereas the NEB was less effective when the same dose was administered.

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Section: Discussionmentioning

confidence: 99%

“…The inhalers investigated were an MDI with a large-volume (750 ml) spacer, InspirEase TM , which is commonly used in our department; Rotahaler, a DPI, which has low resistance against airflow [14], and DeVilbiss TM 646, a jet nebulizer which is widely used in the United States [15]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

Ikeda

Nishimura²,

Koyama³

et al. 1999

Respiration

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“…Other nebulizers with equivalent characteristics and output are acceptable. Because the DeVilbiss 646 model has high between-unit output variability (106,107), each nebulizer must be adjusted and its output checked before it is put into service. The extra vent on the DeVilbiss 646 nebulizer must be closed during methacholine challenge testing, as the nebulizer output increases and is variable when air can be entrained into the nebulizer (108).…”

Section: H Nebulizers and Dosimetersmentioning

confidence: 99%

Guidelines for Methacholine and Exercise Challenge Testing—1999

Ro¹,

Casaburi²,

Al³

et al. 2000

Am J Respir Crit Care Med

2,093

455

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This statement provides practical guidelines and suggestions for methacholine and exercise challenging testing. Specifically, it reviews indications for these challenges, details factors that influence the results, presents brief step-by-step protocols, outlines safety measures, describes proper patient preparation and procedures, provides an algorithm for calculating results, and offers guidelines for clinical interpretation of results. The details are important because methacholine and exercise challenge tests are, in effect, dose-response tests and delivery of the dose and measurement of the response must be accurate if a valid test is to be obtained. These guidelines are geared to patients who can perform good-quality spirometry tests; they are not appropriate for infants or preschool children. They are not intended to limit the use of alternative protocols or procedures that have been established as acceptable methods. We do not discuss the general topic of bronchial hyperresponsiveness (BHR). 100 mg 100 mg 6.25 ml A: 16 mg/ml 3 ml of dilution A 9 ml B: 4 mg/ml 3 ml of dilution B 9 ml C: 1 mg/ml 3 ml of dilution C 9 ml D: 0.25 mg/ml 3 ml of dilution D 9 ml E: 0.0625 mg/ml * Schedule obtained from Methapharm (Brantford, ON, Canada). * This list is provided to simplify access to some sources of equipment. It is not a complete list of all possible sources of acceptable equipment.

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“…For methacholine provocation tests, the DeVilbiss 646 is the nebuliser of recommendation [16]. This nebuliser can yield variable particle sizes depending mainly on its output flow rate [17] and at a flow rate of 12 L?min -1 , methacholine is aerosolised to particles of 3.7 mm [18]. Particles of 5-7 mm in mass mean aerodynamic diameter (MMAD), as produced by an ultrasonic nebuliser, do not reach the lower airways, in contrast to particles of 2-3 mm MMAD produced by a jet nebuliser [19].…”

mentioning

confidence: 99%

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Cohen¹,

Postma²,

Douma³

et al. 2010

European Respiratory Journal

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Small airways are an important site of inflammation and obstruction in asthma, which contributes to the severity of airway hyperresponsiveness (AHR) that is usually measured by nebulisation of large-particle stimuli. We investigated whether small and large particle sizes of aerosolised adenosine monophospate (AMP) provoke similar severity of AHR. Additionally, effects of the small-particle inhaled corticosteroid (ICS) ciclesonide and large-particle ICS fluticasone on AHR to large-and small-particle size AMP were assessed.After a 4-week run-in period using open-label fluticasone (100 mg b.i.d.), 37 mild-to-moderate asthmatics underwent provocations with standard-size (3.7 mm), large-particle (9.9 mm) and smallparticle (1.06 mm) AMP. Subjects received 4-week ciclesonide (160 mg s.i.d.) or fluticasone (100 mg b.i.d.) treatment (double-blind and double-dummy) followed by large-and small-particle AMP provocation.Small-particle AMP induced a 20% decrease in forced expiratory volume in 1 s (FEV1) at a significantly higher dose than large-particle AMP. Ciclesonide and fluticasone had comparable effects on AMP provocations. Not all subjects reached the provocative concentration causing a 20% fall in FEV1 (PC20) at the highest AMP dose. In those who did, ciclesonide improved smallparticle AMP PC20 by 1.74 doubling doses (DD) (p50.03), whereas fluticasone did not. Conversely, fluticasone improved large-particle AMP PC20 significantly (1.32 DD; p50.03), whereas ciclesonide did not.Small-particle AMP provocation appears to be a promising tool to assess changes in small airway inflammation. Future adjustments are necessary taking into account the very small particle size used, with large exhaled fractions. In asthmatics reaching a PC20 with small-and largeparticle AMP provocations, ciclesonide improves hyperresponsiveness to small particle size AMP, and fluticasone to large particle size. This warrants further research to target provocations and treatment to specific airway sizes.

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Extreme Variability in Aerosol Output of the DeVilbiss 646 Jet Nebulizer*

Cited by 29 publications

References 2 publications

Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

Guidelines for Methacholine and Exercise Challenge Testing—1999

Particle size matters: diagnostics and treatment of small airways involvement in asthma

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