168 Combining inhalation by a breath-actuated nebulizer (BAN) and exhalation with oscillating positive expiratory pressure device (OPEP) offers potential for simultaneous therapy: A laboratory study

Abstract

Objectives Mobilization of secretions by OPEP is often given separately to aerosol delivery. Combining a nebulizer [AeroEclipse®-II, Trudell Medical International (TMI)] with OPEP (Aerobika*, TMI), both therapies can be delivered concurrently. We investigated if the BAN output is affected by use with the Aerobika* device, or by substituting another OPEP product (acapella® duet, Smiths Medical). Methods A Next Generation Cascade Impactor operated at 15 L/min was used in accordance with United States Pharmacopeia (USP) ‘Products for Nebulization' to make droplet size measurements of the BAN-aerosol (3×3 replicates/device) operated by compressed air at 50 psig. The BAN was filled with 4 mL ipratropium bromide anticholinergic solution (0.5 mg/ml, TEVA), and connected directly to the USP induction port. Measurements were made (a) with the Aerobika* OPEP device inserted between the BAN and induction port, and (b) substituting the acapella® duet OPEP device. The BAN was run to sputter, and the therapeutically beneficial fine particle mass FMipr ) determined. Results FMipr (mean±SD) via the BAN alone, with the BAN-Aerobika*, and the BAN-acapella® duet OPEP devices were 452±28, 426±27 and 308±23 mg respectively. The BAN-Aerobika* combination marginally reduced delivery (paired t-test, p=0.043), whereas the BAN-acapella® duet configuration resulted in substantial losses (p Conclusion An AeroEclipse®-II BAN-Aerobika* OPEP combination offers combined aerosol/OPEP therapy with minimal medication loss. Substitution with the acapella® duet OPEP results in substantial reduction in BAN-output that may have adverse clinical implications.