Jet Nebulizer Research Articles

Controlled inhalation improves central and peripheral deposition in cystic fibrosis patients with moderate lung disease.

AimWith progressive impairment of lung function, deposition of inhaled drug in the lungs becomes progressively more central, limiting its effectiveness. This pilot study explored the possibility that long slow inhalations might improve delivery of aerosol to the lung periphery in cystic fibrosis patients with moderate lung disease.MethodsFive subjects aged 12–18 years (mean FEV1 72%; range 63–80%) inhaled a radiolabelled aerosol from a jet nebuliser on two occasions. Two inhalation techniques were compared: breathing tidally from a standard continuous output nebuliser and using long slow inhalations from the AKITA® JET system.ResultsLong slow breaths resulted in much lower oropharyngeal deposition with higher lung doses. Importantly, the peripheral lung increased proportionately. The increased lung dose is attributable to more of the larger inhaled droplets passing into the lower airways. This would be expected to increase the central deposition unless significantly more of the smaller droplets were able to penetrate deeper into the lungs. The data support improved delivery of drug to the distal lung when compared with tidal breathing.ConclusionThese pilot data suggest that this approach may prove to be clinically relevant in improving the efficacy of inhaled medication in those with moderate‐severe lung disease.

Assessment of High-Power Electronic Nicotine Delivery System as an Alternative Aerosol Device for Terbutaline Delivery.

The performance of new-generation high-power electronic nicotine delivery system (ENDS) for the administration of inhaled terbutaline was assessed. The formulation of e-liquid was carried out using terbutaline in combination with 1, 3- propanediol. Several terbutaline concentrations (from 0.3125 to 2.500mg / mL) and power levels (from 15 to 35W) were assessed using a box type ENDS. The respirable drug dose was determined using a Glass Twin Impinger and quantified by liquid chromatography coupled with a UV-detector. The Next Generation Impactor and the Dekati Low Pressure Impactor were used to measure the aerosol particle size distribution in drug mass. The results were compared with a jet nebulizer (Cirrus TM 2) similar to the usual clinical conditions (2mL at [terbutaline] of 2.5mg / mL). The optimal conditions to maximize terbutaline delivery using ENDS are a drug concentration at 1mg/mL, and a power level at 30W, to reach a respirable dose of 8.73 ± 0.90µg/puff. By contrast, during a 5min nebulization, the respirable dose of terbutaline was 1040 ± 33µg whatever the cascade impactors and the aerosol devices used. The mass median aerodynamic diameter (MMAD) remains similar for jet nebulizer and ENDS in the 1.74-2.07µm range. Compared to the jet nebulizer, a same respirable dose of terbutaline at the same range of aerosol size distribution was delivered by ENDS if 120 puffs were performed. The ENDS can be considered as an alternative aerosol device for terbutaline delivery.

Hypertonic saline jet nebulization breathing treatments produce a predictable quantity of aerosolized sodium chloride for inhalation.

PurposeThe amount of sodium chloride (NaCl) that escapes a nebulizer cup, intended for patient inhalation, during a 5-min hypertonic saline jet nebulization (HSJN) breathing treatment is apparently unknown in the pure and applied scientific literature. This study aimed to address this void by focusing on NaCl mass changes prior to and after a typical HSJN breathing treatment using an ordinary household, medical-grade air compressor.Research methodsSaline solutions of varying concentrations were nebulized to room air for 5 min. Pre- and post-nebulization NaCl concentrations were determined from measured conductivities via calibration curve. The resulting data were used to quantify NaCl mass changed from the beginning and end of a typical HSJN breathing treatment.Main findingsConductivity was a reliable metric in NaCl concentrations ranging from 2.10 × 10-1 to 8.16 × 10-3 M. Pre- and post-nebulization NaCl mass differences of 19–114 mg linearly correlated with saline concentration (wt%). The resulting trendline data reasonably predict how much NaCl is available for patient inhalation during a typical HSJN breathing treatment. Linearity in the data suggests that factors such as colligative properties (e.g., osmolarity) have a minimal influence on the amount of NaCl that escapes the nebulizer cup.ConclusionsThese results are the first to quantify how much NaCl escapes a nebulizer cup during a typical HSJN breathing treatment. Furthermore, the results represent a key starting point upon which future studies can be built to explore additional airflow rates, kinetics, and temperature effects. Collectively, these findings will play a critical role in ascertaining the mechanism of action in hypertonic saline breathing treatments.

Preliminary bronchodilator dose effect on aerosol-delivery through different nebulizers in noninvasively ventilated COPD patients

Objectives: This study aimed to evaluate the effect of a preliminary bronchodilator dose on the aerosol-d elivery by different nebulizers in noninvasively ventilated chronic obstructive pulmonary disease (COPD) patients. Method: COPD patients were randomized to receive study doses of 800 µg beclomethasone dipropionate (BPD) nebulized by either a vibrating mesh nebulizer (VMN) or a jet nebulizer (JN) connected to MinimHal spacer device. On a different day, the nebulized dose of beclomethasone was given to each patient by the same aerosol generator with and without preceded two puffs (100 µg each) of salbutamol delivered by a pressurized-metered dose inhaler. Urinary BPD and its metabolites in 30 min post-inhalation samples and pooled up to 24 h post-inhalation were measured. On day 2, ex-vivo studies were performed with BPD collected on filters before reaching patients which were eluted from filters and analyzed to estimate the total emitted dose. Results: The highest urinary excretion amounts of BPD and its metabolites 30 min and 24 h post-inhalation were identified with pMDI + VMN compared with other regimens(p < 0.001). The amounts of BPD and its metabolites excreted 30 min post inhalation had approximately doubled with pMDI + JN compared with JN delivery (p < 0.05). No significant effect was found in the ex-vivo study results except between VMN and JN with a significant superiority of the VMN (p < 0.001). Conclusion: Using a preliminary bronchodilator dose before drug nebulization significantly increased the effective lung dose of the nebulized drug with both VMNs and JNs. However, adding a preliminary bronchodilator dose increased the 24 hr cumulative urinary amount of the drug representing higher systemic delivery of the drug, which in turn could result in higher systemic side effects.

Effect of IFN-α and other commonly used nebulization drugs in different nebulization methods on the resistance of breathing circuit filters under invasive mechanical ventilation.

BackgroundInterferon (IFN) is widely used in clinical practice and nebulization inhalation is one of the commonly used routes of administration. However, nebulization drugs such as interferon-α (IFN-α) with large molecular weights may deposit in the membrane of the breathing filters, causing its resistance to gradually increase. Thus, our study explores the effect of IFN-α and other nebulization drugs on the resistance of breathing circuit filters under invasive mechanical ventilation.MethodsWe divided 96 breathing filters into eight groups. The baseline group was not treated while the blank group was installed but were not nebulized. The remaining groups received jet nebulized or vibrating nebulized with either normal saline, Combivent, Amphotericin B, or IFN-α at a frequency of once every 12 hours separately and were removed from the breathing circuit after 24 hours. The resistance of the filter of each group was then measured and statistical comparisons were made.ResultsFilter resistance of the IFN-α jet nebulization group was greater than that of the other groups, and there were statistical differences except for the Amphotericin B jet nebulization group. Comparison of the resistance [cmH2O/(L·s)] of the IFN-α jet nebulization group vs. the baseline group showed 2.56 (2.40, 2.68) vs. 2.26 (2.03, 2.40), P=0.037; of the IFN-α jet nebulization group vs. the blank group showed 2.56 (2.40, 2.68) vs. 2.11 (1.98, 2.27), P=0.003; of the IFN-α jet nebulization group vs. the normal saline group: 2.56 (2.40, 2.68) vs. 2.16 (2.08, 2.32), P=0.023; of the IFN-α jet nebulization group vs. the Combivent jet nebulization group: 2.56 (2.40, 2.68) vs. 2.18 (2.14, 2.27), P=0.018; and of the IFN-α jet nebulization group vs. the Amphotericin B jet nebulization group: 2.56 (2.40, 2.68) vs. 2.33 (2.05, 2.45), P=0.221. The effect of jet nebulization and vibrating mesh nebulization on the resistance of breathing filters showed no significant statistical difference.ConclusionsJet nebulization with IFN-α significantly increased the resistance of the breathing filter within 24 hours and there was no significant difference in filter resistance between jet nebulization and vibrating mesh nebulization of IFN-α or Amphotericin B.

Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care

To determine whether the combination of systemic corticosteroids and nebulized epinephrine, compared with standard care, reduces the duration of positive pressure support in children with bronchiolitis admitted to intensive care. We performed a pragmatic, multicenter, open-label, randomized trial between July 2013 and November 2019 in children younger than 18months old with a clinical diagnosis of bronchiolitis. The intervention group received the equivalent of 13mg/kg prednisolone over 3days, then 1mg/kg daily for 3days, plus 0.05mL/kg of nebulized 1% epinephrine made up to 6ml with 0.9% saline via jet nebulizer and mask using oxygen at 12l/min every 30minutes for 5 doses, then 1-4 hourly for 3days, then as required for 3days. The primary outcome was clinician-managed duration of positive pressure support in intensive care defined as high-flow nasal-prong oxygen, nasopharyngeal continuous positive airway pressure, or mechanical ventilation. In total, 210 children received positive pressure support. In the corticosteroid-epinephrine group, 107 children received positive pressure support for a geometric mean of 26 (95% CI, 22-32) hours compared with 40 (95% CI 34-47) hours in 103 controls, adjusted ratio 0.66 (95% CI 0.51-0.84), P=.001. In the intervention group, 41 (38%) children experienced at least 1 adverse event, compared with 39 (38%) in the control group. In children with severe bronchiolitis, the duration of clinician-managed pressure support was reduced by regular treatment with systemic corticosteroids and inhaled epinephrine compared with standard care. Australian Clinical Trials Research Network: ACTRN12613000316707.

Impact of Substrate Temperature on Structural, Electric and Optical Characteristics of CuO Thin Films Grown by JNS Pyrolysis Technique

The jet nebulizer spray (JNS) pyrolysis method has been successfully employed to grow CuO thin films at various substrate temperatures, ranging from 300 to 600˚C. The XRD analyses revealed the monoclinic phased polycrystalline growth of the samples and exhibited the strong influence of substrate temperature (ST) on the crystallite sizes. Optical transmission and bandgap studies also showed that sample bandgaps clearly rely upon the growth temperatures. The SEM micrographs displayed the agglomerated growth of particles having golf ball-like structures. The occurrence of Cu and O in the samples were confirmed through EDS analyses. The studies on DC electrical conductivities (I-V curves) also show strong dependency on the ST. A p-CuO/n-Si diode was fabricated at the ST of 600˚C and the diode parameters like barrier height (\({\varphi }_{b}\)) and ideality factor (n) were determined under light and dark conditions.

Fabrication of Cu/Y-MoO3/p-Si type Schottky barrier diodes by facile spray pyrolysis technique for photodetection application

The metal-semiconductor interface is a regular multitudinous photoelectric device like Schottky barrier diodes (SBDs) applications. Here we have designed a metal-insulator-semiconductor (MIS) photo detector primarily based on Y-MoO3 film fabricated on p-type Si substrate. The Y-MoO3 film is coated with different Y (5, 10 and 15 wt%) concentrations using the jet nebuliser spray paralysis (JNSP) technique with a glass substrate of a target at 500 °C. XRD pattern of Y-MoO3 film with 15 wt% revealed monoclinic structure with good crystalline nature and improved grain size. FE-SEM photographs of the higher concentrated film exhibited agglomerate nanoplate structures, and the EDAX spectrum confirmed the stoichiometric ratio of O, Mo and Y elements. The UV absorption spectrum displayed comprehensive bandgap energy for a higher concentration of Y (15 wt%). The conductivity (σ) decreased for higher concentration Y-MoO3 thin films elevated values of corresponding activation energy and resistivity. The fabricated Cu/Y-MoO3/p-Si type SBDs have good rectification behaviour of all the diodes, specifically for 15 wt% of Y. The photodiode behaviours of various parameters such as (n) with corresponding (ΦB), (PS), (R), (QE) and (D*) were calculated for light intensities based on the I-V characteristic.

Bronchodilator response after two methods of salbutamol nebulization in asthmatic children.

Salbutamol is used in bronchodilator response testing (BDRT), which is an important diagnostic tool in bronchial obstructive diseases. Most available studies compare the bronchodilator response of salbutamol administered with a pressurized metered-dose inhaler and salbutamol in a nebulization solution. The spirometric evaluation of the bronchodilator response of two methods of salbutamol nebulization in asthmatic children. A randomized, open, comparative study was conducted in which 132 children with partially controlled asthma and current bronchial obstruction determined by spirometry were enrolled. BDRT was conducted using salbutamol solution administered with either a continuous jet nebulizer (CON) or a breath-actuated jet nebulizer (BAN). The BAN group received half the dose of the drug compared to the CON group, i.e. 2.5 mg. Changes in FEV1 and FEF25-75 after drug administration were calculated in relation to the baseline values. The change in FEV1 after salbutamol administration was 16.9 ±9.7% in the BAN group and was statistically significantly higher than in the CON group (12.6 ±8.8%) (p = 0.026). The change in FEF25-75 was 37.7 ±23.2% in the BAN group and 32.7 ±25.5% in the CON group (p = 0.061). There were no statistically significant differences in the frequency of adverse events between the compared groups. Salbutamol inhaled from BAN results in a better bronchodilator response than twice the nominal dose of this drug inhaled from CON, which is due to the absence of drug loss during the expiratory phase and therefore greater pulmonary deposition.

Contamination of Aerosol with Pseudomonas Aeruginosa Introduced via Mouthpiece in Different Nebulizer Designs

Background: Nebulizers have been associated with bacterial and viral contamination likely from drooling or expulson of oral secretions into the nebulizer mouthpiece. We hypothesized that simulated “drooling” could result in contamination of the nebulizer medication resulting in aerosolization of potential pathogens. Method: We evaluated four nebulizers: Continuous jet nebulizer (CJN: MistyMax, Allegiance, USA), breath enhanced (BEN:LC Sprint; Pari, Germany), breath actuated (BAN; AeroEclipse Monaghan/Trudell, Canada) and vibrating mesh nebulizer (VMN; Aerogen with Ultra, Aerogen Ltd, Galway, Ireland) operated per manufacturer recommendations with 3 mL of NSS. Pseudomonas aeruginosa broth (2 mL) was pipetted into the mouthpiece of each nebulizer in an upright postion simulating a patient drooling into the device. Aerosol was produced for 30-60 seconds and collected on Triptic Soy Agar (TSA) plate, prior, immeadiately, and 4-5 hours post instillation. Colony counts were done post incubation (3-5 days). Results: P. aeruginosa colony counts prior, immediately, and four hours after instillation; BAN (0, 110, and 122 CFU/m); and BEN (0, Too Numerous To Count (TNC), and TNC), VMN: (0, 0, and 0 CFU/mL) and CJN (0, 0, and 0 CFU/mL), respectively. Conclusions: Nebulizer type and design influence impact of pathogen containing fluids passing through the mouthpiece contaminating the aerosol generated.

Lung deposition of inhaled once-daily long-acting muscarinic antagonists via standard jet nebulizer or dry powder inhaler, measured using functional respiratory imaging, in patients with chronic obstructive pulmonary disease.

Background:Data for bronchodilator deposition via nebulizers and dry powder inhalers (DPIs) in the respiratory tract of patients with chronic obstructive pulmonary disease (COPD) are limited. We used functional respiratory imaging (FRI) to determine deposition patterns for revefenacin solution via a PARI LC® Sprint® nebulizer and tiotropium powder via HandiHaler® DPI.Methods:Ten patients with COPD, of whom 9 had severe airflow obstruction, were selected from FLUIDDA’s database. The study did not enroll patients. Drug deposition in the extrathoracic and intrathoracic regions, including the central and peripheral airways was simulated by FRI. The percentage of delivered dose and central-to-peripheral (C/P) deposition ratio for nebulizer and DPI were evaluated.Results:Mean ± standard deviation (SD) age was 64.7 ± 7.1 years, height was 168.8 ± 8.5 cm, and percent predicted forced expiratory volume in 1 s was 40.8 ± 12.3%; 50% of patients were men. At optimal inhalation flow, intrathoracic and peripheral deposition was three-fold higher for revefenacin via nebulizer than tiotropium via HandiHaler (mean ± SD 34.6 ± 8.53% versus 10.9 ± 5.67% and 18.2 ± 4.30% versus 5.8 ± 2.73% of delivered dose, respectively). Similar results were observed for suboptimal flow (mean ± SD percentage of revefenacin versus tiotropium: intrathoracic, 32.1 ± 8.3% versus 15.1 ± 5.9%; peripheral; 16.6 ± 4.1% versus 8.4 ± 2.9%). The C/P deposition ratio for nebulizer was similar to DPI (mean ± SD 0.915 ± 0.241 versus 0.812 ± 0.249 at optimal; 0.947 ± 0.253 versus 0.784 ± 0.219 at suboptimal flow), even though the mass median aerodynamic diameter of revefenacin was higher than tiotropium. C/P deposition ratio for revefenacin decreased after bronchodilation (0.915 ± 0.241 pre-bronchodilation versus 0.799 ± 0.192 post-bronchodilation), suggesting progressively better deposition in the peripheral region, assuming bronchodilation occurred during the nebulization process.Conclusions:These results demonstrate more efficient intrathoracic and peripheral deposition for revefenacin via standard jet nebulizer than tiotropium via HandiHaler, with similar C/P deposition ratio in patients with COPD. Nebulizers are an efficient alternative to DPIs for bronchodilator administration in patients with COPD.

EFFECT OF COBALT DOPING AND ANNEALING ON PROPERTIES OF MANGANESE OXIDE THIN FILMS PREPARED USING JET NEBULIZER SPRAY PYROLYSIS TECHNIQUE

The controlled deposition and post-deposition treatments are fundamental steps in the synthesis of thin films in the range of nanometer to several micrometers in thickness for various applications. Because the uniform coating of nano-particles of doped metal oxide modifies the properties of metal oxide, thin films of cobalt-doped manganese oxide are prepared using the Jet nebulizer spray pyrolysis procedure at a temperature of 300°C in this study. The thin films are annealed in an air environment for two hours at various temperatures, including 350°C, 450°C, and 550°C. Cobalt thin films were produced and annealed for two hours at 550 °C in the air before being tested. The effect of annealing temperature and atomic percentage content of dopant cobalt in manganese oxide thin film on their properties were characterized by XRD, photoluminescence spectroscopy, UV-vis spectroscopic technique, scanning electron microscopy, and EDX. The characterization of the thin film reveals that these thin films are made up of uniformly coated doped metal oxide particles with (002) plan as a preferential orientation of crystal growth and band gap energy in the span of 2.5 -1.65 eV. The sensing property of the thin films towards ethanol was also characterized.

Effect on Airflow of a Vibrating Mesh Nebulizer Compared to a Jet Nebulizer for Delivery of Bronchodilator Therapy to Acute Severe Asthma Patients in an Emergency Department

Effect on Airflow of a Vibrating Mesh Nebulizer Compared to a Jet Nebulizer for Delivery of Bronchodilator Therapy to Acute Severe Asthma Patients in an Emergency Department

Nebulization of a polyelectrolyte-drug system for systemic hypertension treatment

Hypertension is a chronic pathology where blood pressure levels are continuously high, causing cardiac, renal, cerebral, and vascular damage leading to early morbi-mortality. This illness is the main risk factor for cardiovascular diseases and the main cause of atrial fibrillation. Atenolol (AT) is a β-1 blocker drug useful for antihypertension and antiarrhythmic treatments. However, this drug possesses low oral bioavailability associated to its low permeability and extensive hepatic first-pass metabolism. To solve the conventional AT-administration problems, oral controlled-release and transdermal delivery have been reported. In this work, an alternative AT inhalatory system administered by nebulization is presented. This system is based on an ionic complex between acidic groups of alginic acid and cationic groups of AT (AA-AT), which was obtained by spray-drying. Pharmaceutical and biopharmaceutical properties for AA-AT inhalatory administration using a jet nebulizer were investigated. The aerodynamic performance (assayed at different cup-nebulizer loadings) of the nebulized system demonstrated that around 40% of the formulation would deposit in the respiratory membrane, with mass median aerodynamic diameters of 3.4–3.6 µm. The AT carried in the AA-AT system was released adequately by ionic exchange in saline solution by permeation through a cellulose membrane. The presence of AA as polyelectrolyte conferred mucoadhesive properties to the ionic complex. Even at high relative AA-AT concentrations, no cytotoxic effect was detected in A-549 cell line. Finally, the preliminary pharmacokinetic assay in the in vivo model confirmed that AT was absorbed from the lung to the systemic circulation, with a greater plasmatic AUC compared to the pure drug (around 50% higher). Then, the system and the nebulization administration demonstrated potential for drug cardiac targeting.

Airway nerve block versus nebulization by lignocaine during diagnostic flexible bronchoscopy under moderate sedation: A randomized controlled trial

ABSTRACT Background Flexible bronchoscopy is an important procedure for the diagnosis and management of patients with respiratory diseases. This study aimed to assess safety and effectiveness of local anesthetic nebulization versus airway nerve block for upper airway anesthesia during diagnostic fiberoptic bronchoscopy under moderate sedation. Methods This randomized, controlled trial enrolled 120 patients scheduled for diagnostic fiberoptic procedures. The patients received 5 ml of 10% lignocaine by air-driven jet nebulizer for 20 minutes (Group A, n = 60) or bilateral superior laryngeal nerve block and trans-tracheal instillation of 4 ml of 2% lignocaine along with viscous lignocaine gargles twice (Group B, n = 60). In the postoperative period, the patient tolerance was assessed. Results Both groups were comparable in all baseline characteristics. The pain score was significantly lower in the nerve block group. Cough and requiring lignocaine were significantly more frequent in the nebulization group. No significant differences between the studied groups regarding intraoperative and postoperative PaO2, PaCO2, heart rate and mean blood pressure except heart rate; were significantly higher in the nebulized group. PaO2 reductions at intraoperative and postoperative (compared with induction) were non-significantly higher in the nebulized group. PaCO2, heart rate and mean blood pressure elevations in intraoperative and postoperative (compared with induction) were higher in the nebulized group, and the differences were non-significant in heart rate only. Conclusion Airway nerve block was associated with reduced consumption of lignocaine and less cough episodes during the procedure compared to nebulized lignocaine.

Comparison of efficacies of full and abbreviated cascade impactors in aerosol characterization of nebulized salbutamol sulfate produced by a jet nebulizer

The properties of aerosols generated from salbutamol sulfate solution (1 mg/mL) using an air-jet nebulizer were evaluated using Next Generation Impactor (NGI), a full cascade impactor, and Fast Screening Impactor (FSI), an abbreviated impactor measurement (AIM). Both impactors were operated under the same experimental conditions. The samples were recovered and assayed using validated high performance liquid chromatography (HPLC). The study investigated AIM-Human Respiratory Tract (HRT) concept by comparing key parameters of aerosolization i.e. fine particle dose (FPD) and fine particle fraction (FPF) measured using FSI, with NGI as baseline. The results showed that FSI yielded different but comparable values for FPD and FPF, indicating that it is alternative impactor to NGI. Despite the fact that FSI could not replace NGI, it may be used as an alternative impactor for simple and rapid aerosol characterization of formulations in some pharmaceutical development and quality control processes.

Survey of nebulizer therapy for nasal inflammatory diseases in Japan before and during the COVID-19 pandemic

Objective: Nebulizer therapy is an effective and safe topical treatment for rhinosinusitis and is frequently used by otolaryngologists in Japan. However, treatment methods used vary among regions and according to doctors’ preferences. In this study, we aimed to investigate the use of nebulizer therapy for rhinosinusitis. Administration of nebulizer therapy has been affected by the coronavirus disease 2019 (COVID-19) pandemic. Thus, we also investigated the difference in the prevalence of nebulizer use before and during the pandemic.Methods: Between February and September 2016 and in January 2021, we administered questionnaire surveys on nebulizer treatment for rhinosinusitis to otorhinolaryngologists, who were members of the Oto-Rhino-Laryngological Society of Japan, in Aomori, Saitama, Mie, Fukui, Shiga, Okayama, and Kagoshima prefectures.Results: More than 90% of the otorhinolaryngologists performed nebulizer treatment for rhinosinusitis in 2016. In April 2020 (the first wave of the COVID-19 pandemic), the use rate decreased to 20%, but in January 2021, the use rate increased to 60%. Jet nebulizers were the most frequently used type. One-third of the otolaryngologists enlarged the natural opening of the paranasal sinuses in more than half of their patients by using vasoconstrictors. Cefmenoxime and betamethasone were the most commonly used antibiotics and steroids, respectively.Conclusion: Because it is important to perform nasal pretreatment and strict disinfection of nebulizer equipment, it is clear that education of otorhinolaryngologists as well as paramedical personnel is required to ensure safe and effective use of nebulizer therapy in Japan.

Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis

Objective Conventional inhaler devices have a low efficacy in targeting small airways. Smart nebulizers can be used to increase deposition to small airways by adjusting the flow and depth of each inhalation based on patients ‘individual inspiratory capacity. We investigated whether targeting of high dose inhaled corticosteroids (ICS) to small airways with a smart nebulizer could reduce exacerbation rate in children with severe asthma (SA). Methods We conducted a retrospective study in children with SA using a smart nebulizer (Akita® Jet nebulizer) for the administration of high dose ICS in our outpatient clinic at the Erasmus MC — Sophia Children’s Hospital. Clinical data before and after start of treatment were collected. The primary outcome was exacerbation rate, defined as: number of asthma exacerbations for which oral corticosteroid courses (OCS) were prescribed. The exacerbation rate 1 year before treatment was compared with the exacerbation rate 1 year after start of treatment. Secondary outcomes were changes in spirometry parameters, hospital admissions and medication use. Results Data on OCS use was available for 28/31 patients. Median number of asthma exacerbations requiring OCS courses 1 year before decreased from 2 (interquartile range(IQR) 2) to 0.5 (IQR 3) 1 year after treatment (p = 0.021). Hospital admission decreased from 1 (IQR 3) to 0 (IQR 1)(p = 0.028). FEV1, FEF25-75 and FEF75 were not significantly improved after one year of treatment with the smart nebulizer (p = 0.191; p = 0.248; p = 0.572). Conclusion Targeting small airways with high dose ICS using a smart nebulizer resulted in a significant reduction in exacerbations requiring OCS after one year of treatment.

Safety and efficacy of autologous non-hematopoietic enriched stem cell nebulization in COVID-19 patients: a randomized clinical trial, Abu Dhabi 2020

BackgroundThe novel SARS-CoV-2 has caused the coronavirus disease 2019 (COVID-19) pandemic. Currently, with insufficient worldwide vaccination rates, identifying treatment solutions to reduce the impact of the virus is urgently needed.MethodAn adaptive, multicentric, open-label, and randomized controlled phase I/II clinical trial entitled the “SENTAD-COVID Study” was conducted by the Abu Dhabi Stem Cells Center under exceptional conditional approval by the Emirates Institutional Review Board (IRB) for COVID-19 Research Committee from April 4th to July 31st, 2020, using an autologous peripheral blood non-hematopoietic enriched stem cell cocktail (PB-NHESC-C) administered by compressor (jet) nebulization as a complement to standard care therapy. The primary endpoints include safety and efficacy assessments, adverse events, the mortality rate within 28 days, and the time to clinical improvement as measured by a 2-point reduction on a seven-category ordinal scale or discharge from the hospital whichever occurred first.ResultsThe study included a total of 139 randomized COVID-19 patients, with 69 in the experimental group and 70 in the control group (standard care). Overall survival was 94.20% for the cocktail-treated group vs. 90.27% for the control group. Adverse events were reported in 50 (72.46%) patients receiving PB-NHESC-C and 51 (72.85%) in the control group (p = 0.9590), with signs and symptoms commonly found in COVID-19. After the first 9 days of the intervention, 67.3% of cocktail-treated patients recovered and were released from hospitals compared to 53.1% (RR = 0.84; 95% CI, 0.56–1.28) in the control group. Improvement, i.e., at least a 2-point reduction in the severity scale, was more frequently observed in cocktail-treated patients (42.0%) than in controls (17.0%) (RR = 0.69; 95% CI, 0.56–0.88).ConclusionsCocktail treatment improved clinical outcomes without increasing adverse events. Thus, the nebulization of PB-NHESC-C was safe and effective for treatment in most of these patients.Trial registrationClinicalTrials.gov. NCT04473170. It was retrospectively registered on July 16th, 2020.

Performance of different add-on devices in dual limb non-invasive mechanically ventilated circuit

Aerosol delivery is thought to be improved by giving one or two pMDI puffs before the prescribed nebulizer dose during non-invasive ventilation (NIV). The aim of the present study was to in-vitro evaluate the efficiency of aerosol delivery using newly developed spacers versus standard T-piece in dual limb NIV circuit.Three add-on devices were evaluated: Combihaler, Minimhal, and standard T-piece which were connected to a vibrating mesh nebulizer (VMN), jet nebulizer (JN), or pMDI within NIV circuit. Three experimental setts were evaluated. Firstly, two pMDI puffs were actuated before nebulization of 1 ml of salbutamol respirable solution by VMN using Combihaler, and Minimhal; the second was the actuation of 10 pMDI puffs only without nebulization.; and the third was the nebulization of 1 ml respirable solution by either VMN or JN without the preliminary pMDI puffs. The amount of aerosol deposited on the inhalation filter was quantified by high-performance liquid chromatography.The Combihaler + VMN delivered the highest TID. Aerosol delivery by Combihaler + pMD and Minimhal + pMDI was significantly higher than that of T-piece + pMDI (p = 0.009 and 0.025, respectively). No significant difference was found between the TID of Minimhal + JN and T-piece + JN. No significant effect was found upon using 2 puffs before the nebulized dose with both Minimhal and Combihaler.Combihaler delivered higher aerosol from VMN and pMDI compared to Minimhal, and standard T-piece. Minimhal delivered higher aerosol from pMDI compared to standard T-piece. Introducing two puffs of pMDI before nebulization with both Minimhal and Combihaler insignificantly affected aerosol delivery.