Effect of Holding Chamber as an Add-on Device on Aerosol Delivery and Fugitive Aerosol from Different Jet Nebulizers
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A new Circulaire II (holding chamber) was designed to be used with VixOne nebulizer to increase the inhalable doses reaching the patient. The aim of this study was to evaluate the efficacy of this holding chamber with VixOne nebulizer and determine its usability with other nebulizers.
The aerodynamic characteristics of emitted dose of 2 ml salbutamol solution, 5000 μg/ml, were evaluated using cooled Andersen cascade impactor at inhalation flow 15 L/min. The respirable solutions were nebulized using 3JN (VixOne, NebuTech, and En full Kit) with both holding chamber and T-piece. To evaluate the pulmonary and systemic bioavailability, 12 non-smoking health subjects (6 females), > 18 years, with an average(SD) FEV1 > 90% of predicted, inhaled nebulized aerosol of 1 ml respirable solution (5000 μg salbutamol), diluted to 2 ml total volume using normal saline through the same nebulizer setting described above using normal tidal breathing. Subjects provided urine samples 30 min post-dosing (USAL0.5) as an index of pulmonary bioavailability and cumulatively collected their urine for 24 h (USAL24) as an index of systemic bioavailability. To determine the amount that would reach the patients (aerosol-emitted), subjects again inhaled 1 ml salbutamol-diluted respirable solution through the same nebulizer setting described above but with filters to capture salbutamol-emitted.
Amount of salbutamol deposited in the holding chamber was significantly higher than in T-piece among all nebulizers (p < 0.001). The fine particle fraction (FPF), < 3 μm, of VixOne with holding chamber, was significantly higher (p < 0.001) and the mass median aerodynamic diameter (MMAD) was significantly lower (p = 0.022) than that with T-piece. The NebuTech and Kit had lower FPF and higher MMAD with holding chamber compared to T-piece (p < 0.05). There was no significant difference in the USAL24 and the emitted aerosol between the 3JNs with holding chamber or T-piece.
Holding chamber did not significantly increase the emitted aerosol or USAL24 responsible for the side effect but improved the FPF < 3 μm and MMAD, responsible for lung deposition, with VixOne-JN only. Holding chamber, or similar add-on device, can be used with other nebulizers other than the VixOne, not to increase the inhaled dose but as a fugitive aerosol saver.
KeywordsHolding chamber T-piece Jet nebulizers Andersen cascade impactor
Mona Ahmed: Experiment, data entry, statistics, and writing.
Raghda R.S. Hussein: Experiment and study design.
Ahmed A. Elberry: Concept and study design.
Mohamed E. Abdelrahim: Concept, planning of study design, statistics, and writing.
Compliance with Ethical Standards
This study was conducted in accordance with the amended Declaration of Helsinki. Local institutional review boards and independent ethics committees approved the protocol and written informed consent was obtained from all volunteers.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Dean RH. Nebulizers: principles and performance. Respir Care. 2000;45(6):609.Google Scholar
- 2.Pisut F. Comparison of medication delivery by T-nebulizer with inspiratory and expiratory reservoir. Respir Care. 1989;34(11):985–8.Google Scholar
- 3.Nwakaego CO. Cost-benefit analysis of a dosimetric nebulizer using Circulaire and aTraditional Vixone nebulizer. The College of Health and Human Science: Georgia State University; 2011.Google Scholar
- 8.Gardenhire DS, editor. Improved aerosol delivery with a conserver-type nebulizer system powered by 6 common home air compressors. Submitted to the American Association for Respiratory Care for the AARC Open Forum to be held November; 2013.Google Scholar
- 9.Gardenhire DS, editor. An in vitro comparison of two dosimetric nebulizers. American journal of respiratory and critical care medicine; 2011. Am Thoracic Soc.Google Scholar
- 25.Mohsen M, Elberry AE, Salah Eldin A, Hussein RR, Abdelrahim EM. Effects of heat and humidification on aerosol delivery during auto-CPAP noninvasive ventilation. Arch Pulmonol Respir Care. 2017;3(1):11–5.Google Scholar
- 27.Saeed H, Ali AMA, Elberry AA, Eldin AS, Rabea H, Abdelrahim MEA. Modeling and optimization of nebulizers’ performance in non-invasive ventilation using different fill volumes: comparative study between vibrating mesh and jet nebulizers. Pulm Pharmacol Ther. 2018 2018/06/01/;50:62–71.CrossRefGoogle Scholar
- 32.Hussein RR, MA Ali A, Salem HF, Abdelrahman MM, Said AS, Abdelrahim ME. In vitro/in vivo correlation and modeling of emitted dose and lung deposition of inhaled salbutamol from metered dose inhalers with different types of spacers in noninvasively ventilated patients. Pharm Dev Technol. 2017;22(7):871–80.CrossRefGoogle Scholar
- 33.Madney YM, Fathy M, Elberry AA, Rabea H, Abdelrahim MEA. Aerosol delivery through adult nasal-cannula via HFNC circuit at a low-oxygen flow. Respir Care. 2018. (In press).Google Scholar
- 38.Carnathan B, Martin B, Colice G. Second hand (S)-albuterol: RT exposure risk following racemic albuterol. Respir Care. 2001;46(10):1084.Google Scholar
- 45.Mason JW, Miller WC. Comparison of aerosol delivery via circulaire nebulizer system versus a disposable nebulizer in COPD patients. Respir Care. 1996;41(11):1006–8.Google Scholar
- 46.Mason JW, Miller WC, Small S. Comparison of aerosol delivery via Circulaire system vs conventional small volume nebulizer. Respir Care. 1994;39(12):1157–61.Google Scholar
- 47.Hoffman L, Smithline H. Comparison of Circulaire to conventional small volume nebulizer for the treatment of bronchospasm in the emergency department. Respir Care. 1997;42(12):1170–4.Google Scholar
- 48.Raabe O, Howard R, Cross C. Aerosol considerations in asthma. Bronchial asthma, principles of diagnosis and treatment. 2nd ed. Orlando: Grune & Stratton; 1986. p. 495–514.Google Scholar
- 50.Ari A, Fink JB, Pilbeam S. Secondhand aerosol exposure during mechanical ventilation with and without expiratory filters: an in-vitro study. Indian J Respir Care. 2016;5(1):677.Google Scholar
- 51.Mitchell J. Inhalation and nasal formulations. In: Developing drug products in an aging society. Springer; 2016. p. 331–82.Google Scholar