Use Of Nebulizer Research Articles

Toll-like receptor 2 signalling and inflammation

<h3>Background and aim</h3> How patients use their nebulisers at home is vital to ensure effective treatment and optimal health outcomes for patients with chronic obstructive pulmonary disease (COPD). The aim...

Impact of a Criteria‐Based Reimbursement Policy on the Use of Respiratory Drugs Delivered by Nebulizer and Health Care Services Utilization in Nova Scotia, Canada

In February 2000, the Nova Scotia Seniors' Pharmacare Program announced a change in the reimbursement of respiratory drugs that added specific reimbursement criteria for wet nebulization therapy. Policy implementation coincided with multifaceted interventions to assist patients and providers with the change. To assess the impact of the new policy and associated interventions on the use of wet nebulization and portable inhaler delivery systems of respiratory drugs and on the utilization of health services. The administrative claims database identified all beneficiaries (age > or = 65 yrs) who received at least one respiratory drug prescription in the 12 months before the study. These patients were then grouped into the wet nebulization cohort or the control cohort receiving a metered-dose or a dry-powder inhaler. The study period was from April 1998-February 2002. Use of respiratory drugs, physician visits, and hospitalizations were compared between study cohorts using an interrupted time-series design. A sharp decrease was noted in use of wet nebulization after the policy announcement, along with an increase in use of short-acting beta2-agonists and anticholinergic agents delivered by metered-dose or drypowder inhaler. From December 1999 to December 2001, in the heavy wet nebulization cohort (a subset of the wet nebulization cohort), wet nebulization use dropped from 100% to 35%; in the wet nebulization cohort, wet nebulization use decreased from 67% to 20%. Rates of spacer device use were 42%, 31%, and 17% in the heavy wet nebulization, wet nebulization, and control cohorts, respectively, in December 2001. Rates of general practitioner visits and hospitalizations for respiratory conditions did not increase in the intervention cohorts after the policy announcement. In fact, relative to the control cohort, health services use in response to the policy and interventions in the wet nebulization cohort decreased. The reimbursement policy resulted in decreased use of respiratory drugs delivered by wet nebulization without a negative impact on general practitioner visits and hospitalizations for respiratory conditions.

How do patients use their nebuliser in the community?

Nebulised therapy is commonly used in the management of patients with asthma and chronic obstructive pulmonary disease (COPD). There are guidelines setting out standards for maintenance of the compressor and replacement and care of consumables. This study surveys patients using nebulisers to ascertain the reported use and maintenance of the nebulisers and any side effects related to therapy. An anonymous postal questionnaire, requesting information on nebuliser use and maintenance, and side effects was sent to 200 patients who had been maintained on nebuliser therapy and had been in contact with the nebuliser service at Glasgow Royal Infirmary within the last year. One hundred and seventeen (58.5%) questionnaires were returned completed or partially completed for analysis. The majority of patients who replied were female (median age of 69 years). The most commonly reported diagnosis was COPD (87/117); 92/117 (79%) were smokers or ex-smokers. The most commonly reported side effects associated with treatment are dry mouth, tremor and chest tightness. The responses to questions on servicing, maintenance and replacement of consumables indicate that patients comply poorly with these activities. Additionally compliance with the prescribed drug regimen occurs in less than 50% of the patient cohort. The results of this study indicate that compliance with instructions given on the care and maintenance of home nebulisers may be suboptimal. Additionally patients reported poorer compliance than was predicted. These areas may be improved with the introduction of a new patient information leaflet.

Monitoring nebulizer use in children: comparison of electronic and asthma diary data

Measurement of nebulizer medication adherence that relies on self-report of medication use is subject to recall bias and increased patient burden. Electronic monitoring of nebulizer medication use is relatively new technology and provides an objective measure of nebulizer use. To examine levels of agreement for nebulizer use between self-report on diary cards and electronic monitor data in young inner-city children with asthma. Of 221 enrolled children with persistent asthma, 157 (71%) provided 12 weeks of diary card and nebulizer monitor recordings that were matched by date across days and by patient. Concordance, sensitivity, specificity, and kappa coefficients were calculated between self-report and electronic data. The children were predominantly African American (89%) and male (66%), with a mean age of 4.6 years. Their persistent asthma was categorized as mild (61%) or moderate to severe (35%). Concordance between diary and electronic data was 85%, with overreporting on diary cards noted on 15% of the total days. Sensitivity of the diary data relative to the electronic data ranged from 0.80 to 0.91 during the 12-week study. Diary return rates decreased from 75% during the initial 3 weeks to 44% at 12 weeks. Electronic monitoring of nebulizer use provides a more precise measure of long-term medication use than does self-report on diary cards, and it is feasible for use in high-risk populations. However, diary cards seem to be a valid alternative for short-term monitoring of nebulizer use, resulting in only a slight overestimation of medication use.

Computational and experimental study of JP-8, a surrogate, and its components in counterflow diffusion flames

Non-sooting counterflow diffusion flames have been studied both computationally and experimentally, using either JP-8, or a six-component JP-8 surrogate mixture, or its individual components. The computational study employs a counterflow diffusion flame model, the solution of which is coupled with arc length continuation to examine a wide variety of inlet conditions and to calculate extinction limits. The surrogate model includes a semi-detailed kinetic mechanism composed of 221 gaseous species participating in 5032 reactions. Experimentally, counterflow diffusion flames are established, in which multicomponent fuel vaporization is achieved through the use of an ultrasonic nebulizer that introduces small fuel droplets into a heated nitrogen stream, fostering complete vaporization without fractional distillation. Temperature profiles and extinction limits are measured in all flames and compared with predictions using the semi-detailed mechanism. These measurements show good agreement with predictions in single-component n-dodecane, methylcyclohexane, and iso-octane flames. Good agreement also exists between predicted and measured variables in flames of the surrogate, and the agreement is even better between the experimental JP-8 flames and the surrogate predictions.

Improved precision and accuracy for high‐performance liquid chromatography/Fourier transform ion cyclotron resonance mass spectrometric exact mass measurement of small molecules from the simultaneous and controlled introduction of internal calibrants via a second electrospray nebuliser

The use of a second electrospray nebuliser has proved to be highly successful for exact mass measurement during high-performance liquid chromatography/Fourier transform ion cyclotron resonance mass spectrometry (HPLC/FTICRMS). Much improved accuracy and precision of mass measurement were afforded by the introduction of the internal calibration solution, thus overcoming space charge issues due to the lack of control over relative ion abundances of the species eluting from the HPLC column. Further, issues of suppression of ionisation, observed when using a T-piece method, are addressed and this simple system has significant benefits over other more elaborate approaches providing data that compares very favourably with these other approaches. The technique is robust, flexible and transferable and can be used in conjunction with HPLC, infusion or flow injection analysis (FIA) to provide constant internal calibration signals to allow routine, accurate and precise mass measurements to be recorded.

Omissions and errors during oxygen therapy of hospitalized patients in a large city of Greece

Omissions and errors are commonly found concerning hospital oxygen use and the use of nebulizers. The aim of the study was to record oxygen use in seven hospitals located in a large district city of Greece. Another aim was to record the use of nebulizers in the same hospitals. We included 105 head nurses (HNs) working in seven hospitals of a large city district of Greece. Data were collected after interviewing each HN using a questionnaire and completing an anonymous data form. Data are expressed as percentages and analyzed using the chi-square test. We found that 41% of HN believed O(2) is a gas that improves patient's dyspnea. The majority of the nurses (88.6%) stated that there was no protocol for O(2) therapy in the departments in which they worked. We found that O(2) therapy was commonly started, modified, discontinued by nurses in the absence of a medical order. Oxygen therapy was commonly not guided by arterial blood gas (ABG) analysis. We also found that there are no guidelines to prevent O(2) therapy interruption during intra-hospital transportation, and that few measures were taken to prevent O(2) explosion. In 95.2% of the departments the nebulizers were filled with tap water and were not changed on a daily basis (81.2%). Our results indicate that educational programmes, nursing protocols and guidelines are becoming mandatory in our country in order to ensure the proper use of O(2) therapy and nebulizers.

Use of a parallel path nebulizer for capillary-based microseparation techniques coupled with an inductively coupled plasma mass spectrometer for speciation measurements

A low flow, parallel path Mira Mist CE nebulizer designed for capillary electrophoresis (CE) was evaluated as a function of make-up solution flow rate, composition, and concentration, as well as the nebulizer gas flow rate. This research was conducted in support of a project related to the separation and quantification of cobalamin (vitamin B-12) species using microseparation techniques combined with inductively coupled plasma mass spectrometry (ICP-MS) detection. As such, Co signals were monitored during the nebulizer characterization process. Transient effects in the ICP were studied to evaluate the suitability of using gradients for microseparations and the benefit of using methanol for the make-up solution was demonstrated. Co signal response changed significantly as a function of changing methanol concentrations of the make-up solution and maximum signal enhancement was seen at 20% methanol with a 15 μl/min flow rate. Evaluation of the effect of changing the nebulizer gas flow rates showed that argon flows from 0.8 to 1.2 l/min were equally effective. The Mira Mist CE parallel path nebulizer was then evaluated for interfacing capillary microseparation techniques including capillary electrophoresis (CE) and micro high performance liquid chromatography (μHPLC) to inductively coupled plasma mass spectrometry (ICP-MS). A mixture of four cobalamin species standards (cyanocobalamin, hydroxocobalamin, methylcobalamin, and 5′ deoxyadenosylcobalamin) and the corrinoid analogue cobinamide dicyanide were successfully separated using both CE-ICP-MS and μHPLC-ICP-MS using the parallel path nebulizer with a make-up solution containing 20% methanol with a flow rate of 15 μl/min.

Contamination of nebulizer equipment with cockroach allergen: there's a bug in the system!

Physicians often have anecdotal reports of patients describing increased asthma symptoms after the use of nebulizers; however, there are few published reports of nebulizer-associated exacerbations. To present 2 cases of asthmatic children who experienced a life-threatening exacerbation of their symptoms after nebulizer use. Case 2's nebulizer was tested for cockroach allergen by washing the medication reservoir with 2 mL of sterile filtered 1% phosphate-buffered saline, 0.05% bovine serum albumin, and Tween 20 overnight with rotation. The patient's sealed albuterol nebulizer medication was used as a control. The control albuterol and test solutions were analyzed for Blattella germanica 1 and 2 allergens using a monoclonal antibody-based immunoenzymetric assay. The reservoir from case 2 was found to have measurable levels of both Bla g 1 and Bla g 2. The control albuterol solution had no measurable cockroach allergen. An insect found in the nebulizer box of case 2 was identified as an infantile German cockroach. Nebulizer use provides an opportunity for antigen exposure directly to small airways, which may lead to severe allergic reactions in patients using contaminated equipment.

Contamination of nebulizers with environmental allergens

Rationale A previous report described detectable cockroach allergen in the nebulizer reservoir of a cockroach sensitive asthmatic patient who experienced an acute life-threatening exacerbation after use of his nebulizer. In this study, we examined whether common indoor allergens could be measured in nebulizer reservoirs from the homes of children with asthma. Methods As part of a large study examining nebulizer use in inner city children with asthma, visiting nurses replaced nebulizer delivery equipment in subjects' homes as part of an intervention. Twenty reservoirs were randomly selected from the study group. The nebulizer sets were not linked to any clinical or environmental data from the subject's home. The nebulizer reservoirs were extracted with 2 ml of PBS-1%, BSA-0.05% Tween 20, after overnight rotation. Extraction buffer and unused albuterol nebulizer medication were used as negative controls. The solutions were tested for cockroach-(Bla g-1 and 2), cat-(Fel d-1), dog-(Can f-1) and mouse-(Mus m-1) allergens using a standard ELISA (Indoor Biotechnologies). Results Of the 17 reservoirs where adequate specimen was available for allergen detection, 29.4% had measurable allergen levels for at least one of the 5 allergen specificities tested. One had measurable Can f 1 (7.3 ng/ml), 2 had Bla g 1 and 2 (range 0.15-0.99 U/ml), 3 had Mus m 1 (range 0.45-2.6 ng/ml) and none had measurable Fel d 1. Conclusions Measurable levels of common indoor allergens can be found in nebulizer equipment of children with asthma with the potential for adverse consequences.

The impact of asthma action plans on quality of life and other asthma outcomes

Rationale Asthma action plans (AAPs) are recommended for asthma self-management. Our purpose was to determine if the use of AAP impacts on asthma outcome measures. Methods This study is part of an investigation of nebulizer use in inner city, minority children ages (2-8 yrs). Data were collected from primary caregivers interviews about their use of AAC as well as PO steroids, hospitalizations, ED visits and controller medication use. Caregiver quality of life (QOL) was assessed using Juniper scale. Caregivers of 221 asthmatic children were recruited from sub-specialty clinics, emergency department, inpatient floors and community care sites. Results There were no differences in age or asthma severity among subjects with AAP (n=85) and without AAP (n=136). Subjects with AAPs reported more courses of PO steroids within the last year (3.54, range, 0-33) compared to those without AAP (mean 2.39, range 0-12, p=0.02) and fewer hospitalizations (0.19, range 0-3) than those without AAP (0.49, range 0-5, p=0.002). ED visits for subjects with AAPs averaged 1.75 visits within last 6 months (range 0-20) compared to 2.08 for those with no AAP (range 0-20, p=0.39). Controller medication use was reported in 84.7% of subjects with AAP and 76.4% of subjects without AAP (p=0.14). Subjects with AAPs had higher Mean QOL of scores (5.25, range 2.0-7.0) compared to those without AAP (4.59, range 1.31-7.0, p=0.001). Conclusions Caregivers of subjects with AAPs report improved QOL scores, more PO steroid use and fewer admissions than those without AAPs. AAP use did not impact significantly on ED visits or controller medication use.

The study of nebulizer (accessory instrument) using problems in asthma children

Rationale Inhalational therapy is mow one of the major method in managing asthma. Nebulizer is widely used at home nowadays, but there has been not many survey on the usage methods of home nebulizer in Korea yet. This study was performed using questionnaires to evaluate that how the patients use the personal nebulizer properly as a treatment tool for asthma and culture of nebulizer accessory instruments (chamber, mouthpiece, mask, line, et al). Methods The questionnaire survey was performed to sixty asthmatic children who used nebulizer at home. Personal history, purpose of personal nebulizer, understanding of the instruction to use were analyzed using questionnaires. At the same time we collected nebulizer and there accessory instruments. The mouthpiece, mask, chamber, and line were cultured with a sterile swab. All samples were plated on agar plates. The plates were incubated at 35°C for 24 hours. Results A questionnaire survey showed that where the patients gets information about using and cleaning nebulizer was form nurse (55%), there doctors (35%), neighborhood (5%) and sellers(5%). The survey showed that 62.5% were not cleaning the nebulizer and accessory instruments. The most common cleaning methods were using boiling water and other way was put in vinegar. From the mouthpiece α-hemolytic streptococcus had been cultured. And from the line gram negative bacilli, coagulase negative staphylococcus were cultured. Conclusions Many problems on the use and cleaning of personal home nebulizer in asthmatic children were revealed by this study. Education of patient parents on how to use and clear nebulizers is necessary when prescribe or sell the nebulizers.

Organic and inorganic arsenic speciation through ion exchange chromatography with particle beam-glow discharge mass spectrometry detection

A mixture of organic and inorganic arsenic compounds has been separated using ion exchange liquid chromatography and detected using a particle beam glow discharge mass spectrometer (PB-GDMS). The particle beam interface makes use of nebulization and momentum separation to deliver a stream of dry analyte particles to the glow discharge source from the LC output. In the glow discharge, the analyte particles are vaporized and ionized at or near the cathode surface. The ions are analyzed by a quadrupole mass spectrometer collecting data in either single ion monitoring (SIM) or total ion counting (TIC) modes. The separation of arsenobetaine (2-(trimethylarsonio)acetate), arsenic(III) chloride and dimethylarsenic acid was performed on a universal cation-exchange column using an isocratic mobile phase, with a total elution time of less than four minutes. The mass spectrum for each of these compounds contains a strong elemental arsenic signal as well as the molecular fragments that allow for the identification of the specific species responsible for the chromatographic peak. The limits of detection (LOD) for organic arsenic (dimethylarsenic acid) were found to be 2 ppm (90 ng DMA molecular ion) in the TIC mode and 15 ppb (0.8 ng As from DMA) in the SIM mode. Inorganic arsenic(III) chloride has an LOD of 11 ppb or 0.55 ng As absolute. This work suggests that the PB-GDMS has high potential as a comprehensive (inorganic/organic) detector for both biological and environmental speciation work.

Selenium speciation analysis of selenium-enriched supplements by HPLC with ultrasonic nebulisation ICP-MS and electrospray MS/MS detection

Size-exclusion, anion-exchange and reversed-phase ion-pair (RP-IP) HPLC were used in combination with ICP-(Q)MS for selenium (Se)-specific detection and quantitation of Se-compounds in extracts of Se-yeast and Se-methylselenocysteine (SeMC) based supplements. On-line electrospray ionisation (ESI)-MS/MS combined with RP-IP HPLC allowed characterisation of such materials in terms of species identification. Accelerated solvent extraction (ASE) was evaluated for extraction of the Se-compounds from the complex matrices in water. Alternatively, digestion with proteolytic enzymes was used for yeast protein hydrolysis. The use of ultrasonic nebulisation in combination with HPLC-ICP-(Q)MS for Se speciation led to detection limits up to six-fold lower (as low as ng l−1 levels) than those obtained with pneumatic nebulisation. Such enhancement of the ICP-MS capabilities for Se detection, combined with an improved separation using the newly developed RP-IP-HPLC method, allowed quantification of minor Se species such as SeMC in yeast extracts. Identification of the main compounds in yeast and SeleniumMC™ tablet hydrolysates as SeMet and SeMC, respectively, was accomplished by on-line RP-IP HPLC with ESI-MS/MS. Identification of SeMC in yeast digests, on the basis of retention time, molecular mass determination for the [M + H]+ 80Se ions (m/z 184) and detection of its product ions, is reported here for the first time. The mass spectral confirmation for SeMC in yeast is of interest, as this species is believed to be metabolised in animals and humans to methylselenol (CH3SeH), an anti-carcinogenic Se-metabolite.

Carrier gas flow optimization for an end-on type of electrothermal vaporizer used for sample introduction in plasma source spectrometry

In case of end-on type of graphite tube electrothermal vaporizers (ETVs) the vaporization product is streamed towards the plasma through one of the ends of the graphite tube, which is represented in the present work by the commercial unit of Perkin–Elmer HGA-600MS. The properties of this ETV unit are compared under two sets of gas-flow conditions: (A) using a high flow rate of carrier gas within the graphite tube and a low flow rate of make-up gas that is introduced into the interface close to the outlet end of the graphite tube, and (B) using a decreased carrier gas flow and a relatively high flow rate of make-up gas, while the total transport gas flow rate was kept constant. The ETV unit was coupled to a multi-channel optical emission spectrometer and time integrated line intensities for 26 elements were measured under (A) and (B) conditions and also with the use of pneumatic nebulization of the same multi-element standard solution. A relatively low heating rate was applied to the ETV to minimize plasma loading and also for a better estimation of the appearance temperatures (volatility) of the elements. The intensity ratios with low and high flow rate of the carrier gas (B/A) were between 1.2 and 0.8 for 20 elements. Significantly higher ratios (B/A) were found for volatile elements (Cd and Zn), while the ratios were significantly lower for heavy volatile elements (V, Ti, B). This means that apart from the latter group of elements, the use of a relatively low flow rate of the carrier gas does not result in an essential decrease of analytical sensitivity. This finding can be utilized, e.g. to the direct analysis of finely powdered samples which is handicapped under high carrier gas flow conditions, due to possible sample loss. Comparing the sensitivities with ETV(A) conditions and pneumatic nebulization sample introduction methods there was an unfavorable tendency for the ETV(A) method with decreasing volatility of the analytes. This observation suggests an increased vapor condensation of low volatile elements close to the graphite tube end that is characteristic for this type of ETV units.

Detection of trace elements in liquids by laser-induced breakdown spectroscopy with a Meinhard nebulizer.

The laser-induced breakdown spectroscopy of magnesium, manganese, and chromium atoms by use of a commercial Meinhard nebulizer originally designed for inductively coupled plasma measurements is described. This is the first time, to our knowledge, that this nebulizer has been used for laser-induced breakdown spectroscopy measurements. The limit of detection is slightly lower when the nebulizer rather than a liquid jet is used in single-pulse laser excitation. In addition we present the response characteristics of the nebulizer, such as effects of variations in purge gas and liquid flow rate, that are different from normal operating specifications. The effects of gate delay, gate width, and laser power variations were also studied. The objective of the present research has been to consider a new operating mode and conditions in which a better limit of detection of trace elements in water can be obtained.

Clinical Pathology for Athletic Trainers: Recognizing Systemic Disease

Written specifically for athletic trainers, by athletic trainers, the updated Third Edition of Clinical Pathology for Athletic Trainers emphasizes practical knowledge; development of clinical skills, including evaluation and treatment; and development of clinical decision-making abilities. The Third Edition incorporates full-color photos and images to enhance readers' understanding of the common non-orthopedic pathology that may occur in athletes and physically active people. Chapters are organized by body systems and emphasize the clinical presentation, diagnosis, acute care, long-term management, and return to participation criteria for systemic illnesses and injuries. Dr. Daniel P. O'Connor and Dr. A. Louise Fincher have incorporated the competencies from the Athletic Training Education Competencies (5th Edition) that are associated with the non-orthopedic conditions discussed in this unique text. Competencies that are addressed throughout the text are still conveniently listed at the beginning of each chapter in which they are referenced. What's New in the Third Edition : Full-color photos and graphics throughout. Updated head injury screening, evaluation, and return to participation criteria to be consistent with current recommendations. Integration of up-to-date NATA Position Statements and Consensus Statements throughout. Online lab manual for the development of the psychomotor skills required to evaluate the described medical conditions. Instructors in educational settings can visit www.efacultylounge.com for additional materials to be used for teaching in the classroom. New Lab Activities: Use of nebulizer in the treatment of asthma. Administration of therapeutic oxygen. Use of pulse oximeter for measuring oxygen saturation. With expanded discussions and case studies, a new online lab manual, and an emphasis on the development of clinical skills, the Third Edition of Clinical Pathology for Athletic Trainers: Recognizing Systemic Disease is a must-have for today's athletic training students and clinicians as well as allied health professionals working with athletic or physically active populations.

Inhaled therapy for acute adult asthma.

To evaluate recent developments on emergency department inhalotherapy in non-intubated acute adult asthma patients. There is evidence that high-flow oxygen can be associated with hypercarbia, and that full humidification of the inspired gases should be recommended. On the contrary, there is a lack of evidence to support the role of heliox in the initial treatment of acute asthma. Specific short-acting inhaled beta(2)-agonists are the drugs of choice. A more rapid and profound bronchodilatation with fewer side effects and less time of treatment can be achieved when sufficient doses are given using pressurized meter dose inhalers and large-volume valved-spacers, particularly in patients with the most severe obstruction. Findings argue against the routine use of continuous nebulization. High and repetitive doses of ipratropium bromide in combination with beta(2)-agonists are indicated as first line treatment of severe acute asthma. There is insufficient evidence that inhaled corticosteroids alone are as effective as systemic corticosteroids. Finally, the combination of nebulized magnesium and albuterol provides no benefit in addition to that provided by therapy with albuterol in patients with mild-to-moderate asthma exacerbations. According to the latest evidence, the goals of treatment may be summarized as follows: maintenance of adequate arterial oxygen saturation with supplemental oxygen, relief of airflow obstruction by administration of inhaled beta-agonists and anticholinergics, and reduction of airway inflammation and prevention of future relapses by using early administration of systemic corticosteroids.

Chromium determination in foods by quadrupole inductively coupled plasma–mass spectrometry with ultrasonic nebulization

The analytical issues connected with chromium determination in foodstuffs by quadrupole inductively coupled plasma–mass spectrometry (Q-ICP-MS) were addressed, including signal stability, spectral interferences and the use of mathematical correction equations. The analytical performance was compared to that of electrothermal atomisation–atomic absorption spectrometry (ETA-AAS), selected as reference method. Five food certified reference materials (CRMs), including two meat-based CRMs not previously characterized for their Cr content, were included in the study. The use of ultrasonic nebulization (UN) and the adoption of 53Cr as analytical mass allowed precise and accurate results to be obtained by Q-ICP-MS, with lower detection limits than ETA-AAS.

Comparison of the bioavailability and systemic effects of beclometasone dipropionate suspension for nebulization and beclometasone dipropionate via a metered-dose inhaler after single-dose administration in healty male volunteers

Pharmacokinetic properties of a drug, and selection and correct usage of an appropriate delivery device, are factors that can affect the outcome of inhaled therapy. The use of nebulization on can overcome problems that are associated with other delivery systems used for inhalation therapy. The objective of this open, randomized, single-dose study was to compare the systemic exposure and safety of beclometasone cipropionate (BDP) suspension for nebulization with BDP via metered-dose inhaler (MDI) in healthy subjects. Following a run-in period to assess basal 24-h serum cortisol levels and cortisol urinary excretion, 12 healthy males were administered BDP 1600 μg given via MDI and were then randomized to receive a single dose of either 1600 μg ( n=6) or 3200 μg BDP ( n=6) suspension for nebulization given via a nebulizer. Results with respect to systemic exposure to beclometasone-17-monopropionate (B17MP) (the active metabolite of BDP) and systemic effects on the hypothalamic-pituitary-adrenal (HPA) axis were determined by evaluation of a number of pharmacokinetic parameters for plasma B17MP and serum and urinary coritsol, respectively. A statistically significantly greater peak plasma concentration (C max) of B17MP was reported with BDP via MDI (1587 pg ml −1) compared with BDP 1600 μg (455 pg ml −1) and BDP 3200 μg suspensions for nebulization (758 pg ml −1), and was achieved more rapidly (T max) (1 · 3 h, 3 h, and 2 · 5 h, respectively). In addition, elimination half-life (t 1 2 el) was statistically significantly shorter with BDP via MDI (4·6 h) than with both dosages of BDP suspensions for nebulization (7·4 h and 6·3 h with 1600 μg and 3200 μg, respectively), as was mean residence time (MRT) (5·4 h, 11·1 h, and 10·0 h, respectively). Total systemci exposure to B17MP (as determined by the area under the concentration-time curve: AUC ∞) was comparable for BDP via MDI (6883 pg ml −1h −1) and BDP 3200 μg suspension for nebulization (8201 pg ml −1h −1), but significantly greater than with BDP 1600 μg suspension for nebulization (4870 pg ml −1; P<0·05 vs BDP via MDI). All treatments were well tolerated, and no significant differences were found between them with respect to the serum or urinary cortisol pharmacokinetic parameters assessed. In conclusion, the results of this study demonstrate that BDP suspension for nebulization 3200 μg given via a nebulizer and BDP 1600 μg given via an MDI are equivalent in terms of systemic exposure to B17MP and systemic effects on the HPA axis, with BDP suspension for nebulization having a potentially more prolonged activity. It confirms that use of a double dose of BDP suspension for nebulization administered by nebulizer compared with BDP given via metered-dose inhalation is justified and poses no risk with regard to safety.