Previous studies have demonstrated that salbutamol administration via metered-dose inhaler with spacer (MDI-S) is as effective as using a jet nebulizer (NEB) for treating children experiencing asthma exacerbation. However, a paucity of research focuses on the direct medical costs associated with each mode of salbutamol administration for asthma exacerbation. This study aims to compare the effectiveness and direct medical costs of salbutamol administration via MDI-S versus NEB. A retrospective cohort study was conducted on the medical records of children under 18 years old presenting with mild to moderate asthma exacerbation. Clinical responses to salbutamol administration were assessed using the Ramathibodi Pediatrics Asthma Scores. The costs and clinical outcomes (i.e., Asthma score and hospitalization averted) were compared using the Incremental Cost-Effectiveness Ratio (ICER) from a hospital perspective. The study included 95 medical records from 72 children, with 33 records of MDI-S and 62 records of NEB. Both the MDI-S and NEB groups showed significant reductions in asthma scores post-treatment. Children with moderate asthma exacerbation treated with MDI-S had a lower hospitalization rate than those treated with NEB (20% vs 57.5%, p = 0.034). The cost-effectiveness analysis indicated that the MDI-S group incurred lower costs and was considered cost-saving compared to the NEB group, with an ICER of -4.60 US dollars per one-point improvement in asthma score and -20.07 US dollars per hospitalization averted. Salbutamol administration via MDI-S offers clinical effectiveness comparable to NEB and is more cost-effective.

To date, no studies have assessed the outcomes of different inhalation methods for procaterol, a short-acting β2-agonist frequently used in Japan to treat acute asthma exacerbations in children. The present study compared the efficacy and safety of procaterol using a nebulizer (NEB) and a metered-dose inhaler (MDI) with a spacer. The present before-and-after study targeted patients aged 4-16 years with moderate to severe acute asthma exacerbations who visited the pediatric emergency department (PED). The primary outcome was a reduction in the Modified Pulmonary Index Score (MPIS), and the secondary outcomes were the hospitalization rate, length of stay (LOS), and incidence of adverse events. Propensity score matching and multiple regression analysis were conducted to adjust for confounding factors. Forty-nine patients were selected from 70 and 77 patients in the NEB and MDI group, respectively, using propensity score matching. No statistically significant difference in MPIS reduction (3.7 vs. 4.3; p = 0.13) or the hospitalization rate (26.5% vs. 20.4%; p = 0.48) was found between the groups. The LOS (94 vs. 61 min; p < 0.001) was significantly shorter in the MDI group. Only one patient (2.0%) using an MDI experienced vomiting. An MDI with a spacer was comparable to an NEB in effectiveness and was associated with a shorter LOS and lower incidence of adverse events. An MDI with a spacer may serve as an alternative to an NEB for administering inhaled procaterol in patients with acute asthma exacerbation in the PED.

Introduction: Acute paediatric asthma can pose an emergency challenge requiring medical preparedness. Hence, it is prudent to identify the best drug delivery option for managing acute asthma exacerbations. The objective of the study was to compare the effectiveness of metered dose inhaler with spacer (MDI-S) versus nebulizer (NEB) in delivering levosalbutamol for acute exacerbation of asthma in children. Methods: This randomized clinical trial enrolled 58 children aged five to 15 years with mild-moderate asthma and randomly divided them into two treatment groups – Group MDI-S (N = 29) and Group NEB (N = 29). Pulmonary Index Score (PIS) along with signs and symptoms of asthma were compared between the groups before and one hour after levosalbutamol treatment. Chi square test was used to compare continuous variables and the level of significancewas set at P &lt; 0.05. Results: The two groups showed no significant differences in median age, age of wheezing onset, prior hospitalizations, and PIS before treatment (p &gt; 0.05). Even one hour after treatment, they did not differ significantly in PIS and hospital admissions (P &gt; 0.05). All children showed improvement in their asthmatic status after the therapy and none showed any worsening of their condition. Conclusions: Metered dose inhaler with spacer is an effective and efficient alternate to the routinely used nebulizer for managing acute asthmatic episodes in children.

Aedes aegypti is the dominant vector of several arboviruses that threaten urban populations in tropical and subtropical countries. Because of the climate changes and the spread of the disease worldwide, the population at risk of acquiring the disease is increasing. This study investigated the impact of the larval habitats control (CC), nebulization (NEB), and both methods (CC + NEB) using the distribution of Ae. aegypti eggs collected in urban area of Santa Bárbara d'Oeste, São Paulo State, Brazil. A total of 142,469 eggs were collected from 2014 to 2017. To verify the effects of control interventions, a spatial trend, and a predictive machine learning modeling analytical approaches were adopted. The spatial analysis revealed sites with the highest probability of Ae. aegypti occurrence and the machine learning generated an asymmetric histogram for predicting the presence of the mosquito. Results of analyses showed that CC, NEB, and CC + NEB control methods had a negative impact on the number of eggs collected in ovitraps, with effects on the distribution of eggs in the three weeks following the treatments, according to the predictive machine learning modeling. The vector control interventions are essential to decrease both occurrence of the mosquito vectors and urban arboviruses. The inference processes proposed in this study revealed the relative causal impact of distinct mosquito control interventions. The spatio-temporal and the machine learning analysis are relevant and Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation robust analytical approach to be employed in surveillance and monitoring the results of public health programs focused on combating urban arboviruses.

Noninvasive mechanical ventilation (NIV) and high-flow nasal cannula (HFNC) are increasingly used in patients with exacerbated acute and chronic respiratory failure. Some patients receiving these therapies may also benefit from inhaled drug delivery. It is therefore attractive to combine treatment with aerosols and noninvasive respiratory support (NIRS). Aerosol therapy devices that can be adapted in line with NIRS are pressurized metered-dose inhalers (pMDIs) and nebulizers. In the subgroup of nebulizers are three types: jet nebulizers (NJ), ultrasonic nebulizers (NUs) and vibrating mesh nebulizers (VMN). The administration of aerosol therapy in line with HFNC seems a novel combination and of great applicability in selected patients. Based on the available evidence, the combination of providing NIV and aerosol therapy in patients with airflow obstruction without interrupting respiratory treatment seems appropriate. The aim of this article is to review the available literature on aerosol therapy during NIRS. In addition, to provide recommendations based on the available evidence.

PCR29 Improved Patient Reported Satisfaction and Outcomes in the Pulmonary Arterial Hypertension (PAH) BREEZE Clinical Trial

Intravenous (i.v.) morphine is a safe, robust, and recommended treatment for severe pain using the titration principle. Despite its high efficacy, it is impacted by organizational constraints related to venous access. Nebulized (NEB) morphine may represent an alternative for titration but pharmacokinetic (PK) properties of short nebulization using routine devices need evaluation. Twenty‐seven healthy volunteers were included to receive NEB or i.v. morphine administration using increasing amounts according to Dixon’s reference method. Plasma morphine, morphine‐3‐glucuronide (M3G), and morphine‐6‐glucuronide (M6G) were quantified. PK modeling and simulations were performed using Monolix. Dixon’s method exhibited a significantly higher morphine dose regimen in the NEB group versus the i.v. group (6.2 [5.3–7.1] vs. 3.0 [2.0–4.0] mg, p < 0.001). Morphine, M3G, and M6G dose‐normalized exposure were significantly lower in the NEB group versus the i.v. group: morphine (19 [13–23] vs. 1044 [702–1266] µg min/L, p < 0.001), M3G (245 [162–287] vs. 3752 [2487–5165] µg min/L, p < 0.001) and M6G (28 [21–43] vs. 466 [370–723] µg min/L, p < 0.001). The model that best fitted the data consisted in a transit compartment for morphine absorption, three compartments for morphine distribution followed by multiple transit compartments (8.2 and 57.5‐min transit time for M3G and M6G, respectively) and a first order elimination for M3G and M6G. Morphine bioavailability in the NEB group was 3.5% using the i.v. group as reference. Administration route and sex significantly influenced morphine and metabolite PKs. This work aimed to evaluate the PKs of NEB morphine compared with the i.v. route. Despite a bioavailability to improve, NEB morphine administration using a routine device is suitable to plan morphine titration.

Background: Asthma is a common chronic respiratory disorder in children and adults worldwide. Inhalers are vital medications that are prescribed to control the disease and reduce its mortality and morbidity. Objectives: This study aimed to assess the knowledge and skills of Medical Students (MSs) and pediatric residents (PRs) in using different inhaler devices (IDs). Methods: This cross-sectional study included 243 MSs and PRs at Shiraz University of Medical Sciences, Iran, from March 2018 to March 2019. The MSs were divided into the senior medical students (SMSs) and junior medical students (JMSs). Data regarding participants’ knowledge on metered dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers (NBs) were gathered using questionnaires and a face-to-face interview. Results: Of the 243 participants in the study, 113 (46.5%) were SMSs, 87 (35.8%) were JMSs, and 43 (17.7%) were PRs. The mean age of the participants was 26/20 ± 4/25 years. There was no significant difference between studied groups regarding recognition of MDI device (P = 0.072). PRs were more familiar with the DPIs than MSs (P &lt; 0.001). They also could recognize the NBs better than the MSs (P &lt; 0.001). In terms of using DPIs correctly, PRs executed all the steps better than MSs (P &lt; 0.001) except for the third step which all the participants had the same knowledge (P = 0.13). Regarding correct use of NBs, PRs had better performance compared to MSs (P &lt; 0.001). Conclusions: According to our results, there was an educational vacancy in training MSs regarding using IDs correctly, which can lead to poor compliance in asthmatic patients and deteriorating their lifestyle. The current research supports the need to redesign the educational curriculum of MSs and PRs in Iran to teach them sufficient knowledge and skills about how to use different types of inhalers properly.

Consensus of Chinese experts on the clinical application of nebulized expectorants

Objective: This study assessed the efficacy of nebulization (NEB), also known as fogging, to expose gilts to Mycoplasma hyopneumoniae under field conditions as a potential acclimation strategy. Materials and methods: Phase I consisted of 448 M hyopneumoniae-free gilts from four different batches of a gilt development unit (GDU). On study day 0, batches 1 and 2 were exposed to M hyopneumoniae-positive lung homogenate via intratracheal (IT) route and were used as reference for batches 3 and 4, which were exposed using a mechanical fogger. Tracheobronchial swabs (TBS) were collected at 2 and 4 weeks post exposure (D14 and D28, respectively) and infection success was assessed by real-time polymerase chain reaction of pooled samples. In phase II, 1160 gilts from the same GDU belonging to three different batches (5 to 7) were exposed to M hyopneumoniae via NEB, and TBS were collected at D14. Results: In phase I, no statistically significant differences were observed between IT and NEB exposure in proportion of positives and mean cycle threshold values of TBS pooled samples at any time point (D14 and D28). In phase II, TBS pooled samples from all batches were positive for M hyopneumoniae at D14. Implications: Nebulization of lung homogenate positive for M hyopneumoniae resulted in infection of commercial gilts with this pathogen. Therefore, the use of NEB may be a reliable M hyopneumoniae exposure method under field conditions. The information generated in this investigation broadens the understanding of this technology as an acclimation strategy.

IntroductionRecommended methods of administering bronchodilator drugs in children with asthma exacerbations in a hospital include the pressurized metered-dose inhaler (pMDI) and nebulization (NEB). These methods differ in clinical effectiveness, safety and, as some studies indicate, the cost of their use in a child.AimTo calculate the direct costs of hospital therapy conducted with the use of short-acting β2-agonist (SABA) or its combination with short-acting muscarinic antagonist (SAMA) administered via pMDI with valved holding chamber (VHC) versus the same drugs in NEB in children with asthma exacerbation.Material and methodsA retrospective analysis of the costs of SABA (salbutamol) and SABA + SAMA (fenoterol + ipratropium bromide) inhalation therapy was performed. Based on the data obtained from the financial department, the pharmacy, and the sterilization department of the university hospital, the direct unit cost of the inhalation therapy in the child was calculated.ResultsThe results of the analysis indicate that in a hospital setting the cost of one-time SABA or SABA + SAMA administration via pMDI+VHC is 1.5–2.4 times lower compared to NEB. The payer incurred the lowest costs during anti-obstructive treatment using SABA with pMDI + VHC (PLN 9.39 for one inhalation procedure). The working time of medical staff during the inhalation treatment is the component generating the highest cost for the hospital (up to 40% of direct costs).ConclusionsIn hospital conditions, the supply of SABA or SABA + SAMA with the use of pMDI + VHC in a child with asthma exacerbation is more beneficial financially than the supply of the same drugs in NEB.

"Nebulizer Breathing Treatments at Home." American Journal of Respiratory and Critical Care Medicine, 202(3), pp. P7–P8

Nebulizer Breathing Treatments at Home.

Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1 700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1)Standard prevention and protection, and patient isolation; (2)Patient wearing mask during HFNC treatment; (3)Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4)Placing filter between resuscitator and mask or artificial airway; (5)For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6)Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O(1 cmH(2)O=0.098 kPa); (7)In-line suction catheter is recommended and it can be used for one week; (8)Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9)For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10)PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11)Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.

Assessment of the efficacy of nebulized local anesthesia using continuous positive airway pressure during fibroptic bronchoscopy

Background: The management of asthma currently focuses on the Global Initiative for Asthma (GINA) guideline. This randomized clinical trial aimed to find whether the addition of nebulized budesonide to basic treatment would further improve the peak expiratory flow (PEF) rates and decrease the hospitalization days in patients through asthma exacerbation. Methods: Eligible patients with a definitive diagnosis of asthma exacerbation in the emergency department of Masih Daneshvari hospital were entered into this study. Patients were divided into the intervention and the control groups based on random numbers. To follow the GINA guidelines, both the groups received hydrocortisone (3 mg/kg slow IV stat) at the arrival, oxygen and nebulizer containing salbutamol and ipratropium bromide three times every 30 min and then every 8 h during the first 24 h. Nebulized budesonide (0.5 mg/2 ml) was added to the regimen of the intervention group and nebulized saline as the placebo in the control group. PEF of all eligible cases was measured on arrival and then at 1, 6, and 24 h after the ending of the first session of inhalation. Results: Hospitalization days decreased significantly in the intervention group (P ≤ 0.001). There was no median ± standard deviation of PEF in the intervention group after 1 h (P = 0.019) and stayed higher than the control group on 6 and 24 h, respectively (P = 0.015 and P = 0.050). Conclusion: Adding nebulized budesonide to the main treatment regimen of an acute asthma attack helps the patients gaining better respiratory flow and reduces the hospitalization time.

Akut Bronşiolitli Çocuklarda Epinefrin İnhalasyon Tedavisinde Jet Nebülizatör ile Mesh Nebülizatörün Etkinliğinin Karşılaştırılması

Purpose: To investigate the effectiveness of nebulized magnesium sulfate as an adjunct treatment in pediatric patients with severe asthma exacerbation as compared with the standard treatment, salbutamol plus ipratropium, in the emergency room. Methods: A double-blind randomized controlled trial was conducted in a tertiary hospital in Baguio City. Pediatric patients age 6 to 17 years old in severe asthma exacerbation …

Nebulized Lidocaine to Prevent Cough at Emergence From Anesthesia

Objective To investigate the clinical efficacy of atomization inhalation combined with montelukast in the treatment of children with post infectious cough. Methods From January 2016 to January 2018, 100 children with post-infection cough were selected and randomly divided into two groups according to the digital table, with 50 cases in each group.The observation group was treated with oral budesonide atomization inhalation.The control group was not given drugs.The clinical efficacy, symptom score, pulmonary function index, inflammatory factor index and adverse reaction were compared between the two groups. Results The total effective rate in the observation group was higher than that in the control group[96%(48/50) vs.80%(40/50), P 0.05]. Conclusion The combination of oral montelukast and budesonide atomization inhalation can effectively treat children with cough after infection, relieve their symptoms, improve the lung function, suppress the inflammatory reaction of respiratory tract, and it is safe and reliable. Key words: Cough after infantile infection; Monteiro; Budesonide; Nebulizers and vaporizers; Respiratory function tests; Child