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PEDIATRICS CME
Clinical Considerations
assessed various nebulizer/compressor combi- Jet Nebulizer Types. Jet nebulizers vary wide- nations in models simulating pediatric inspira- ly in their design, ability to be reused and drug tory and expiratory flows, budesonide inhala- delivery profiles. Table 3 provides an overview tion suspension was nebulized in amounts sim- of the three primary jet nebulizer types avail- ilar to those of other common drugs in solu- able. The breath-actuated jet nebulizers allow tion.19 Inhaled mass for the 27 nebulizer/com- intermittent nebulization during inspiration pressor combinations tested varied consider- alone, which reduces expiratory losses, aerosol ably, from 2% to 18% of the nebulizer charge.
However, 13 of the most efficient systems deliv- ment.16,18 Nebulizers are designed for single ered the drug amount in a relatively narrow use (discarded after one use) or repeated use range (see Table 4), suggesting that similar drug (also referred to by insurers as “durable” for potency can be obtained with various devices.
reimbursement purposes). For patients using a Facemask vs. Mouthpiece. The use of a face- long-term maintenance medication, it is impor- mask with a nebulizer effectively delivers the tant to use a nebulizer designed for repeated use. Too often, patients given single-use nebu- mouthpiece, typically those younger than 2 lizers (e.g., while in the hospital) use them on years, or those with visual, physical or mental a long-term basis. Not all nebulizers have been disabilities.16 Although there are several con- studied under repeated-use conditions. One cerns with facemasks (e.g., some of the drug study assessed repeated clinical use of a will land on the face, an inadequate seal may reusable jet nebulizer and compressor combi- lead to leakage of the drug), one study showed Conventional Jet
nation (PARI LC Jet Plus/PARI Master by PARI no differences in the response of asthmatic Nebulizer Design
Respiratory Equipment Inc.) with budesonide children to nebulized albuterol treatment using inhalation suspension.19 Following a protocol mouthpieces or facemasks.20 Most recently, Air from the compressor passes through asmall hole (venturi). Rapid expansion of air to simulate one month of twice-daily therapy two retrospective studies demonstrated that causes a negative pressure, which sucks fluid up with budesonide, no significant changes in the nebulization of budesonide inhalation suspen- the feeding tube system, where it is atomized.
inhaled mass of drug were observed over time.
sion is similarly effective and safe whether Larger particles impact on baffles and walls of Lung Dose. With nebulized therapy depend- administered by facemask or mouthpiece in the chamber and are returned for renebuliza- ent on multiple variables, clinicians may not feel tion. Small aerosol particles are released con-tinuously from the nebulizer chamber.
confident that a device will deliver a therapeu- Patient or Caregiver Adherence. As with any tic drug dose. Thus, it is important that ade- chronic disease, patient or caregiver adherence Source: O’Callaghan C, Barry PW.The science of nebulised quate testing of drug delivery be performed is an important determinant of therapeutic suc- drug delivery. Thorax. 1997;52 suppl 2:S31-S44. before clinical use. In an in vitro study that cess in asthma.23 Adherence to medication reg- Table 2:Anti-Asthma Medications Available for
Nebulized Drug Delivery in the United States
Available Products
(Distributor)
Indication
Available
Preparation
Ventolin Nebules Inhalation Solution, 0.083% Anti-inflammatory Intal Nebulizer Solution 0.63 mg/3 mL unit-dose vials1.25 mg/3 mL unit-dose vials * The appropriate volume should be diluted in sterile normal saline before administration via nebulization.
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