assessed various nebulizer/compressor combi-
Jet Nebulizer Types.
Jet nebulizers vary wide-
nations in models simulating pediatric inspira-
ly in their design, ability to be reused and drug
tory and expiratory flows, budesonide inhala-
delivery profiles. Table 3 provides an overview
tion suspension was nebulized in amounts sim-
of the three primary jet nebulizer types avail-
ilar to those of other common drugs in solu-
able. The breath-actuated jet nebulizers allow
tion.19 Inhaled mass for the 27 nebulizer/com-
intermittent nebulization during inspiration
pressor combinations tested varied consider-
alone, which reduces expiratory losses, aerosol
ably, from 2% to 18% of the nebulizer charge.
However, 13 of the most efficient systems deliv-
ment.16,18 Nebulizers are designed for single
ered the drug amount in a relatively narrow
use (discarded after one use) or repeated use
range (see Table 4), suggesting that similar drug
(also referred to by insurers as “durable” for
potency can be obtained with various devices.
reimbursement purposes). For patients using a
Facemask vs. Mouthpiece.
The use of a face-
long-term maintenance medication, it is impor-
mask with a nebulizer effectively delivers the
tant to use a nebulizer designed for repeated
use. Too often, patients given single-use nebu-
mouthpiece, typically those younger than 2
lizers (e.g., while in the hospital) use them on
years, or those with visual, physical or mental
a long-term basis. Not all nebulizers have been
disabilities.16 Although there are several con-
studied under repeated-use conditions. One
cerns with facemasks (e.g., some of the drug
study assessed repeated clinical use of a
will land on the face, an inadequate seal may
reusable jet nebulizer and compressor combi-
lead to leakage of the drug), one study showed
nation (PARI LC Jet Plus/PARI Master by PARI
no differences in the response of asthmatic
Respiratory Equipment Inc.) with budesonide
children to nebulized albuterol treatment using
inhalation suspension.19 Following a protocol
mouthpieces or facemasks.20 Most recently,
Air from the compressor passes through asmall hole (venturi). Rapid expansion of air
to simulate one month of twice-daily therapy
two retrospective studies demonstrated that
causes a negative pressure, which sucks fluid up
with budesonide, no significant changes in the
nebulization of budesonide inhalation suspen-
the feeding tube system, where it is atomized.
inhaled mass of drug were observed over time.
sion is similarly effective and safe whether
Larger particles impact on baffles and walls of
With nebulized therapy depend-
administered by facemask or mouthpiece in
the chamber and are returned for renebuliza-
ent on multiple variables, clinicians may not feel
tion. Small aerosol particles are released con-tinuously from the nebulizer chamber.
confident that a device will deliver a therapeu-
Patient or Caregiver Adherence.
As with any
tic drug dose. Thus, it is important that ade-
chronic disease, patient or caregiver adherence
Source: O’Callaghan C, Barry PW.The science of nebulised
quate testing of drug delivery be performed
is an important determinant of therapeutic suc-
Thorax. 1997;52 suppl 2:S31-S44.
before clinical use. In an in vitro study that
cess in asthma.23 Adherence to medication reg-
Table 2:Anti-Asthma Medications Available for
Nebulized Drug Delivery in the United States
Ventolin Nebules Inhalation Solution, 0.083%
Anti-inflammatory Intal Nebulizer Solution
0.63 mg/3 mL unit-dose vials1.25 mg/3 mL unit-dose vials
* The appropriate volume should be diluted in sterile normal saline before administration via nebulization.
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N ove m b e r- D e c e m b e r 2 0 0 2 55
Jason M. Newell Assistant Professor of Social Work B.A., Auburn University M.S.W., University of Alabama Ph. D., University of Alabama Jeter Building, Basement Room A (205) 665-6184 Office firstname.lastname@example.org Research Interests : Professional self-care; prevention of professional burnout and compassion fatigue; clinical social work practice in mental health care (adult, ado
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