Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations

Abstract

BACKGROUND:The Acapella device produces high-frequency oscillations and positive expiratory pressure to promote bronchial secretion clearance. Its performance during aerosol delivery has not been described. We evaluated the effect of nebulizer and Acapella configuration on pulmonary deposition of radio-tagged aerosol in healthy subjects. METHODS: Ten healthy male subjects (mean age 24.4 ؎ 2.2 y) participated in a crossover study that compared pulmonary delivery of 4 mL of technetium-99m-labeled diethylene triamine penta-acetic acid (25 mCi) and 0.9% saline solution via jet nebulizer. We tested 3 configurations: nebulizer attached to the distal end of the Acapella; nebulizer placed between the mouthpiece and the Acapella; and nebulizer alone (control). With scintigraphy we measured radio-aerosol deposition in 6 lung regions: upper, middle, lower, central, intermediate, and peripheral. RESULTS: Deposition was similar between the right and left lungs, with no significant differences between device configurations. Lung deposition was less with the nebulizer attached to the Acapella than with nebulizer between the mouthpiece and the Acapella (P ‫؍‬ .001, for both lungs) or without the Acapella (P ‫؍‬ .003 and P ‫؍‬ .001 for the right and left lungs, respectively). There was no significant difference between the setup without Acapella and the setup with the nebulizer between the mouthpiece and the Acapella (P ‫؍‬ .001, for both lungs). On the vertical axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (upper region P < .001, middle region P ‫؍‬ .001, lower region P ‫؍‬ .003), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (upper and middle region both P ‫؍‬ .001, lower region P ‫؍‬ .002), with up to a 3-fold difference in the middle and lower regions. On the centralperipheral axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (central region P < .001, peripheral region P < .001), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (central and peripheral regions both P ‫؍‬ .002), with differences of 3-4-fold between the central and peripheral regions. CONCLUSIONS: Placing the nebulizer distal to the Acapella, as recommended by the manufacturer, decreased intrapulmonary deposition, compared to placing the nebulizer between the Acapella and the patient airway, or delivering aerosol without the Acapella in the circuit. (ClinicalTrials.gov NCT01102166)

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

“…Berlinski also noted that this finding is consistent with the outcome from another laboratory study by Mitchell et al [112], who observed that OPEP devices that avoid restriction of the aerosol pathway (in their case, within the Aerobika* device) do not significantly alter the dose available for inhalation. Looking at evidence from direct measures of drug deposition in the lungs of patients, the large losses of medication in the Acapella*-Up-Draft II Opti-Neb nebulizer arm of the Berlinski study [111] are consistent with the findings from a scintigraphic study with healthy volunteer adults, undertaken by Mesquita et al [110]. This group found that placing a jet nebulizer (ST3, NS, Sa ˜o Paulo, Brazil) distal to an Acapella* Choice OPEP device, as recommended by the manufacturer at that time, substantially decreased intrapulmonary deposition.…”

“…However, it is self-evident that airway patency is a necessary precondition before such medications can reach the receptors to provide therapeutic benefits. The combination of inhaled medication delivery with PEP has been established for some time [109,110]. However, recently, with the increased variety of OPEP devices becoming available, there has been increasing interest in exploring the potential for combining OPEP with inhaled medication therapy, delivered principally by a nebulizer [19,110,111].…”

Aerosolised micro and nanoparticle: formulation and delivery method for lung imaging

“…As seen in Table 3, nebulised 99m Tc-DTPA is mainly used to investigate the effect of particular pulmonary delivery equipment, e.g. positive expiratory pressure device, on the aerosol performance of lung deposition [97,[100][101][102][103][104][105]. Other studies with 99m Tc-DTPA focus on distinguishing different lung diseases [74,106,107], understanding the physiology of lung disease [108], and investigating the new application of ventilation scintigraphy [109].…”

Year in Review 2014: Aerosol Delivery Devices

“…Mesquita et al 15 conducted a study to assess lung deposition provided by a variety of nebulizers in combination with the Acapella (Smiths Medical, Watford, United Kingdom) in healthy subjects. The authors hypothesized that placement of the nebulizer distal to the Acapella, as recommended by the manufacturer, would reduce aerosol lung delivery compared with more proximal placement (between the device and mouthpiece) or compared with the nebulizer alone (Fig.…”