Inhalation therapy remains the cornerstone of treatment for many pediatric pulmonary diseases. Nebulizer therapy is widely prescribed by pediatricians particularly for younger patients. Since many patients receive these treatments in a supine position, thus tilting the nebulizer cup to an approximate 45 degree angle, we speculated that delivery angle might influence nebulizer solution output. In the present study we aim to evaluate the effects of nebulizer cup angle on bronchodilator solution output at different fill volumes, drug concentrations, and running times.
We tested 4 continuous jet nebulizer brands: MICRO MIST® & T UP-DRAFT® (Hudson RCI); Airlife™ Misty-Neb™ (Allegiance Healthcare Corp.); and Aeromist B&F Medical (Allied, Inc.). Nebulizers were operated at 10 LPM (compressed air at 50 PSI) and solution output was determined by gravimetric analysis at with delivery angles of 90 and 45 degrees (N=6, for each determination). Operating conditions (OC) were as follows: (A) albuterol nebulizer solution (2.5 mg/3ml) run for 5 minutes; (B) albuterol nebulizer solution (1.25 mg/3ml) run for 5 minutes; (C) operating condition (A) + ipratropium bromide nebulizer solution (0.5 mg/2.5ml) (fill volume 5.5 ml); and (D) operating condition (C) run for 9.2 minutes. Statistical analysis done by ANOVA for repeated measures.
Please refer to the tableNebulizerMicro Mist®T Up-DRAFTMisty-Neb™Aeromist B&FOC90°45°90°45°90°45°90°45°A1.481.34*0.89*0.631.571.37*1.29*0.56B1.321.34*0.88*0.541.471.43*1.10*0.41C1.231.400.730.721.261.261.321.31D2.682.80*2.11*1.49*3.05*2.69*2.57*1.81
(expressed as ml) are shown below (★P<0.05):.
Aerosolized bronchodilator therapy in the supine position (thus tilting the nebulizer cup to a 45 degree angle), significantly decreases solution output for 2 of the 4 nebulizers tested. Increasing fill volume, but not bronchodilator concentration or run time, buffers this detrimental effect.
Effects of treatment position on drug delivery and therapeutic outcomes should be considered when prescribing nebulized bronchodilators.
A. Berlinski, None.