The use of metered-dose inhaler versus nebulization for the delivery of salbutamol in pediatric severe asthma exacerbations: A systematic review

BACKGROUND@#Recent guidelines for the management of asthma have advocated the use of a pressurized metered-dose inhaler (MDI) and spacer in the delivery of salbutamol. However, there is a dearth of research in children with severe exacerbation.@*OBJECTIVES@#To compare the effectiveness of MDI with spacers versus nebulizers in drug delivery of salbutamol for the management of pediatric severe asthma exacerbations. @*METHODOLOGY@#A systematic search of the Pubmed, Cochrane library, Herdin, WPRIM, ClinicalTrials and reference review databases was conducted for studies containing “severe asthma” using MDI and spacer as an intervention with nebulization as a comparator.@*RESULTS@#Of 220 articles, 4 met the criteria. In the subgroup analysis, children who received salbutamol through MDI showed no significant difference in hospital admission, pulmonary score, heart and respiratory rate, oxygen saturation, and lung function.@*CONCLUSION@#In severe asthma exacerbations, there is evidence to support that MDI compared with nebulizer is statistically equal in terms of hospital admission, pulmonary scores, clinical improvement, and side effects@*RECOMMENDATIONS@#Further randomized controlled trials are suggested to explore the intricacies of drug delivery in management of severe asthma. A meta-analysis may be made possible in the future with more evidence.

Observational, Concurrent Study to Assess Safety and Efficacy of Glycopyrronium and Arformoterol Home Nebulization in High-risk, Symptomatic Acute Exacerbation of Chronic Obstructive Pulmonary Disease Cases: SYMPTOM Study

Background: Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for hospitalizationworldwide with high 30-day readmission rates. Although the prognostic significance of early readmission is not fully understood,they are often associated with poor outcomes including high mortality rates of 4%–19% at 30 and 365 days, respectively.Similarly, in acute exacerbations of COPD (AECOPD) cases receiving emergency department care, current status on lungfunction and cardiovascular comorbidities are considered as best predictors for both 30- and 90-day COPD readmission rates.Dual bronchodilator strategy with long-acting muscarinic antagonist (LAMA)/long-acting beta-agonists (LABA) is thereforerecommended by GOLD (2019) in the postdischarge phase following an acute exacerbation.Aim: To further assess the clinical impact of dual bronchodilators including glycopyrronium and arformoterol as home nebulizationin the post-discharge phase of AECOPD, the current postapproval, observational study was conducted.Materials and Methods: An observational, concurrent, and non-inferiority study with glycopyrronium and arformoterol homenebulizing solutions on patients with moderate and severe COPD was conducted at two centers in India. An estimated samplesize of 40 patients involving moderate and severe COPD cases was factored for per-protocol analyses with P < 0.05 consideredas statistically significant. A concurrent study analysis for the follow-up visit was conducted as per the principles of InternationalConference of Harmonization for Good clinical practice and Declaration of Helsinki while ensuring confidentiality during accessof patient support registration sheets.Results: Per protocol analyses for consecutive 46 cases from two centers receiving Nebulized glycopyrronium (25 mcg) andarformoterol (15 mcg), as separate formulations are given as admixed solution with follow-up visit for at least 4 weeks wascarried out. Baseline demographics for the overall group showed exacerbation history (46, 100%), hospitalization for AECOPD(21, 45.6%); ED visit (25, 54.3%), forced expiratory volume in one second (FEV1) 1.2 ± 0.6 L/min; FEV1/FVC64.8% ± 10.6;reversibility 8.4% ± 11.8; CAT 34.6 ± 2.3; and vibrating mesh nebulizer (46, 100%). The mean predose FEV1 (∆) at the end of 4weeks for overall, moderate and severe COPD cases were observed as of 9.6±3.1%, 11.8% ± 3.1, and 8.4% ± 1.6, respectively(P < 0.0001). Similarly, the mean CAT(∆) score at the end of 4 weeks was observed as of 18.1 ± 0.69, 20.6 ± 0.69, and 18.26 ±0.6 for overall, moderate and severe COPD cases, respectively (P < 0.0001). The intergroup differences for rescue medicationuse for a lone case with severe COPD (1, 2.04%) complied with the suggested non-inferiority margin between the groups.There were no other treatment-emergent adverse events or serious adverse events that warranted treatment modification orwithdrawals in both groups.

In Vitro Comparative Assessment and Characterization of Vibrating Mesh Nebulizers with Glycopyrronium Nebulizing Solution: New Generation Impactor Study

Background: Inhalation therapy involving nebulization remains important modality of therapy for severe or high-risk obstructive airwaydiseases including bronchial asthma. The likely incremental factors for the translational impact of this delivery strategy includes fine particledose (FPD), fine particle fraction (FPF), mass median aerodynamic diameter (MMAD), and respirable fraction (RF) of the pharmaceuticalaerosols playing a key role in site-specific delivery to the lungs. The new generation active vibrating mesh nebulizers (VMNs) offer aconvenient, portable strategy in above clinical cases without compromising the delivery efficiency for improved therapeutic outcomes.Aim: This in vitro study was conducted to validate the improved efficiency and aerodynamic effect of glycopyrronium solutionnebulization with novel patented active and passive VMN devices.Materials and Methods: A in vitro lung deposition study was conducted using drug samples of glycopyrronium bromide(25 mcg/2 ml and 1 ml) using new generation cascade impactor at a flow rate of 15 L/min at Glenmark R&D Center, Sinnar, India.Results: Three samples of glycopyrronium nebulizing solution were analyzed using next generation impactor at a flow rate of15 L/min for aerodynamic aerosol parameters (FPF and RF) and total/active substance delivered (FPD and delivered dose) whenloaded with active (NEBZMART*, 2 ml) and passive (E-flow*, 1 ml) VMN. The results demonstrated comparable aerodynamicaerosol, particle size, and total delivered dose as FPF (64.9% vs. 72.8%), FPD (16.4 vs. 14.2 mcg), MMAD (3.9 vs. 3.2), andGSD (1.8 vs. 1.62) for active and passive VMN, respectively. The nebulization time was observed as 3–5 min for both thedevices demonstrating higher efficiency for active VMN.Conclusion: The results showed comparable aerodynamic aerosol, particle size, and total delivered dose or RF forglycopyrronium nebulizing solution delivered by the VMNs.

Reason analysis of ineffective triggering caused by a continuous nebulization airflow in mechanical ventilation / 中华危重病急救医学

Objective? To? analyze? the? ineffective? triggering? caused? by? nebulization? in? the? way? of?respiratory?mechanics.? Methods? A?test-lung?and?an?oxygen-driven?jet?nebulizer?were?connected?to?the?circuit?in?a?PB840?ventilator.?The?test-lung?was?pulled?outwards?in?manual?way?till?an?inspiration?was?effectively?triggered?separately?in?different?flow-trigger?modes?[flow-trigger?sensitivity?(VTrig)?3?L/min?and?5?L/min]?and?pressure-trigger?modes?[pressure-trigger?sensitivity?(PTrig)?2?cmH2O?and?4?cmH2O,?1?cmH2O?=?0.098?kPa]?with?the?nebulizer?being?closed?and?opened?in?turn.?The?corresponding?relationship?and?characteristics?between?the?flow?and?pressure?in?the?circuit?under?different?triggering?conditions?were?observed?by?adjusting?the?curve?amplitude?in?the?screen.?The?minimum?alveolar?pressure?(Pa)?which?could?cause?an?effective?triggering?and?the?variation?span?of?Pa?during?the?triggering?period?were?analyzed?in?respiratory?mechanics.? Results? ①?In?flow-trigger?mode:?Pa?was?pulled?down? from? positive? end-expiratory? pressure? (PEEP)? or? intrinsic? positive? end-expiratory? pressure? (PEEPi)? to?"PEEP－VTrigR"?(R?meant?airway?resistance)?without?nebulization,?and?the?span?of?Pa?was?"VTrigR"?or?"PEEPi－PEEP+VTrigR".?Pa?was?pulled?down?from?PEEP?or?PEEPi?to?"PEEP－(VTrig+N)?R"?(N?meant?nebulization?airflow)?with?nebulization,?and?the?span?of?Pa?was?"(VTrig+N)?R"?or?"PEEPi－PEEP+(VTrig+N)?R".?②?In?pressure-trigger?mode:?Pa?was?pulled?down?from?PEEP?or?PEEPi?to?"PEEP－PTrig－1R"?without?nebulization,?and?the?span?of?Pa?was?"PTrig+1R"?or?"PEEPi－PEEP+PTrig+1R".?Pa?was?pulled?down?from?PEEP?or?PEEPi?to?"PEEP－PTrig－(N+1)?R"?with?nebulization,?and?the?span?of?Pa?was?"PTrig+(N+1)?R"?or?"PEEPi－PEEP+PTrig+(N+1)?R".? ?Conclusions? Nebulization?airflow?increases?the?difficulty?of?inspiratory?triggering?in?mechanical?ventilation.?PEEPi?makes?it?more?difficult.

Comparação de duas técnicas inalatórias para administrar broncodilatador em crianças e adolescentes com crise aguda de asma: metanálise / Comparison of two inhalational techniques for bronchodilator administration in children and adolescents with acute asthma crisis: a meta-analysis

RESUMO Objetivo: Comparar a eficácia no tratamento da asma pediátrica por nebulizador e inalador dosimetrado com uso de espaçador (MDI-espaçador), no emprego das técnicas de resgate de pacientes asmáticos atendidos em emergências pediátricas. Fontes de dados: Realizou-se uma revisão sistemática para identificar os principais estudos randomizados controlados que comparam a administração de broncodilatador (β-2 agonista) por meio das técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. Foram pesquisadas as bases de dados PubMed, Scientific Electronic Library Online (SciELO) e ScienceDirect. Dois pesquisadores, de forma independente, aplicaram os critérios de elegibilidade, sendo incluídos na pesquisa apenas estudos randomizados controlados com o objetivo de comparar as técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. Síntese dos dados: Foram pré-selecionados 212 artigos, dos quais apenas nove seguiram os critérios de elegibilidade e foram incluídos na metanálise. Os resultados apontam não existir diferenças nas técnicas inalatórias em nenhum dos quatro desfechos analisados: frequência cardíaca (diferença -Df: 1,99 [intervalo de confiança de 95% - IC95% -2,01-6,00]); frequência respiratória (Df: 0,11 [IC95% -1,35-1,56]); saturação de O2 (Df: -0,01 [IC95% -0,50-0,48]); e escore clínico de asma (Df: 0,06 [IC95% -0,26-0,38]). Conclusões: Os achados demonstram não haver diferenças na frequência cardiorrespiratória, na saturação de O2 nem nos escores de asma, na administração de β-2 agonista entre as técnicas inalatórias (nebulizador e MDI-espaçador) em pacientes asmáticos atendidos em emergências pediátricas.

ABSTRACT Objective: To compare the efficacy of pediatric asthma treatment by nebulizer and metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue techniques for asthmatic patients assisted at pediatric emergency units. Data sources: A systematic review was conducted to identify the most relevant randomized controlled trials comparing the administration of a bronchodilator (β-2 agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat asthma in children at pediatric emergency units. The following databases were searched: PubMed, Scientific Electronic Library Online (SciELO), and ScienceDirect. Two researchers independently applied the eligibility criteria, and only randomized controlled trials that compared both inhalation techniques (nebulization and MDI-spacer) for asthma treatment at pediatric emergency units were included. Data synthesis: 212 articles were pre-selected, of which only nine met the eligibility criteria and were included in meta-analysis. Results show no differences between inhalation techniques for any of the four outcomes analyzed: heart rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]); respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation (Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI -0,26-0.38]). Conclusions: The findings demonstrate no differences in cardiorespiratory frequency, O2 saturation, and asthma scores upon administration of β-2 agonist by both inhalation techniques (nebulization and MDI-spacer) to asthmatic patients assisted at pediatric emergency units.

Nebulized therapy in children / 中华实用儿科临床杂志

Nebulization is widely used in treating respiratory disorders in younger patients and critically ill children.Jet nebulizers,ultrasonic nebulizers and vibrating mesh nebulizers are the main types of small volume nebu-lizers used in emergency room and pediatric intensive care unit.Glucocorticoids,bronchodilators,mucolytic agents can be administered via nebulization.Different compatibilities exist among these therapeutic agents.

Principle and influence factors of aerosolized antibiotics in the treatment of ventilator associated pneumonia / 中华危重病急救医学

Ventilator associated pneumonia (VAP) is a challenging complication of critical illness.Aerosolized antibiotic is an option for the management of VAP currently,as it is reported that it could increase levels of drug in alveolar without increasing systemic toxicity.The articles that focused on the aerosolized antibiotics in the treatment of VAP and its influence factors were reviewed,and it was found that to achieve maximum drug delivery efficiency and reduce the influence of nebulization method,some factors,such as ventilation modes,tidal volume,nebulizer type,should be adjusted and monitored during the treatment.

Effect of different jet nebulizer on in vitro deposition properties of inhalation suspension / 国际药学研究杂志

Objective To analyze and compare in vitro deposition results of budesonide inhalation suspension made by 3 jet nebulizers. Methods Self-made budesonide inhalation suspension was selected as a model drug, and the in vitro deposition properties was determined by breathing simulator and the next generation pharmaceutical impactor (NGI) with Pari Turob BOY N?BOY SX and Omron NE-C28 nebulizers. Results The mass median aerodynamic diameter (MMAD) of aerosol measured with the three kinds of nebulizers ranged between 4.95 and 6.54 µm, geometric standard deviation(GSD)ranged between 1.66 and 2.10,fine particle dose (FPD) ranged between 87.64 and 101.47 µg and fine particle fraction (FPF) ranged between 37.75% and 53.88%. Delivery rates of Pari Turob BOY N and BOY SX were similar, while the delivery rate of Omron NE-C28 was low. The total delivery of each nebulizer was about 0.11 µg. Statistical analysis showed that different nebulizer had no significant difference on delivered dose, but had significant difference on delivered rate(P<0.01)and aerodynamic measurement results(P<0.05). Conclusion Different jet nebulizers for budesonide inhalation suspension have certain influence on its in vitro deposition. The suitability of the Omron NE-C28 is the best among the three kinds of nebulizers.

Effect of different jet nebulizer on in vitro deposition properties of inhalation suspension / 国际药学研究杂志

Objective To analyze and compare in vitro deposition results of budesonide inhalation suspension made by 3 jet nebulizers. Methods Self-made budesonide inhalation suspension was selected as a model drug,and the in vitro deposition proper?ties was determined by breathing simulator and the next generation pharmaceutical impactor(NGI)with Pari Turob BOY N、BOY SX and Omron NE-C28 nebulizers. Results The mass median aerodynamic diameter(MMAD)of aerosol measured with the three kinds of nebulizers ranged between 4.95 and 6.54μm,geometric standard deviation(GSD)ranged between 1.66 and 2.10,fine particle dose (FPD)ranged between 87.64 and 101.47μg and fine particle fraction(FPF)ranged between 37.75%and 53.88%. Delivery rates of Pari Turob BOY N and BOY SX were similar,while the delivery rate of Omron NE-C28 was low. The total delivery of each nebulizer was about 0.11μg. Statistical analysis showed that different nebulizer had no significant difference on delivered dose ,but had signifi?cant difference on delivered rate(P<0.01)and aerodynamic measurement results(P<0.05). Conclusion Different jet nebulizers for budesonide inhalation suspension have certain influence on its in vitro deposition. The suitability of the Omron NE-C28 is the best among the three kinds of nebulizers.

The effects of daily bathing on symptoms of patients with bronchial asthma

BACKGROUND: The influence of bathing in asthma patients is not yet fully known. OBJECTIVE: We conducted an observational study to investigate changes in symptoms and their degree by bathing in asthmatic patients. METHODS: A questionnaire focusing on ever experienced bathing-induced symptom changes and their degree, as well as contributing factors, was designed and administered to asthmatic patients in the outpatient department of our institute between January 2012 and November 2013. RESULTS: Two hundred fifteen cases were recruited. In 60 cases (27.9%), asthmatic symptoms appeared, including 20 cases of chest discomfort (33.3%), 19 cases of cough (31.7%), and 21 cases of wheezing (35.0%). The triggering factors included vapor inhalation (32 cases, 53.3%), hydrostatic pressure on the thorax due to body immersion in the bathtub (26 cases, 43.3%), and sudden change of air temperature (16 cases, 26.7%). Thirty-eight cases (17.7%) experienced improvement in active asthmatic symptoms by bathing. Vapor inhalation was the most common contributing factor (34 cases, 89.5%), followed by warming of the whole body (13 cases, 34.2%). There was no relationship between asthma severity and the appearance of bathing-induced symptoms or improvement of active asthmatic symptoms by bathing. CONCLUSION: The effects of bathing in asthmatic patients widely differed from patient to patient and their etiology includes several factors. For those who suffer from bathing-induced asthma symptoms, preventive methods, such as premedication with bronchodilators before bathing, should be established. This study is registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan with the registration number UMIN000015641.

Evaluación de la capacidad de penetración de partículas a cavidades perinasales usando el nebulizador PARI LC SPRINT® SINUS con técnica modificada en individuos sanos y portadores de rinosinusitis crónica por fibrosis quística con cirugía de cavidades perinasales / Evaluation of the penetration ability into perinasal sinuses of particles using the PARI LC SPRINT® SINUS nebulizer with a modified technique in healthy individuals and in cystic fibrosis patients with chronic rhinosinusitis with endoscopic sinus surgery

Introducción: En pacientes con rinosinusitis crónica (RSC) por fibrosis quística (FQ), los microorganismos que colonizan la vía aérea alta son los mismos que dañan el pulmón. Los tratamientos locales con nebulización de las cavidades perinasales (CPN) serían de ayuda. Objetivo: Evaluar la penetración de las partículas nebulizadas a las cavidades perinasales. Material y método: Voluntarios sanos y pacientes con RSC por FQ con cirugía endoscópica funcional (CEF). Se utilizó el nebulizador pulsátil que PARI LC SPRINT® SINUS. La penetración de partículas a las CPN se evaluó con fusión de imágenes cintigráficas SPECT y de tomografía computarizada (CT). Resultados: Se evaluaron 5 voluntarios y 2 pacientes con FQ. El procedimiento indicado por el fabricante del nebulizador fue imposible de realizar. Se modificó la forma de nebulización. Se observó solo el 9% del material nebulizado en las CPN en voluntarios y el 4% en pacientes. Una proporción importante del material nebulizado se depositó en pulmones y tubo digestivo. Conclusión: Los resultados iniciales motivaron la interrupción del estudio original considerando que sería difícil demostrar la diferencia en la efectividad del nebulizado para alcanzar las CPN entre pacientes con y sin CEF. Además, el depósito mayoritario del nebulizado fuera de las CPN, impide aclarar el valor del efecto local respecto a un posible efecto por vía general.

Introduction: In cystic fibrosis patients with chronic rhinosinusitis, the same microorganisms that colonize the upper airway are the ones who damage the lung. Local treatments by nebulization of perinasal sinuses would be helpful in these cases. Aim: To evaluate the penetration ability of nebulized particles into perinasal sinuses. Material and method: Healthy volunteers and cystic fibrosis patients with chronic rhinosinusitis with endoscopic sinus surgery had nasal nebulization using the pulsating nebulizer PARI LC Sprint® SINUS. Fusion of scintigraphic SPECT and CT images was used to evaluate the particles penetration ability into perinasal sinuses. Results: Five volunteers and 2 patients with CF were evaluated. It was not possible to perform the nebulization procedure as indicated by the manufacturer. A continous nebulization was done instead. 9% of the nebulized material was deposited in the perinasal sinuses in volunteers and 4% in patients with CF, while the rest of the particles were distributed in the body, specially in lungs and digestive tract. Conclusions: The main deposition of the nasal nebulized solution was outside the perinasal sinuses. These results led to discontinuation of the study because it would be difficult to prove a difference in the effectiveness of nebulized particles among patients with and without surgery. It also seems impossible to define the real value of local perinasal sinus therapies considering a probable systemic effect.

An aerosol formulation of R-salbutamol sulfate for pulmonary inhalation

An aerosol formulation containing 7.5 mg of R-salbutamol sulfate was developed. The aerosol was nebulized with an air-jet nebulizer, and further assessed according to the new European Medicines Agency (EMA) guidelines. A breath simulator was used for studies of delivery rate and total amount of the active ingredient at volume of 3 mL. A next generation impactor (NGI) with a cooler was used for analysis of the particle size and in vitro lung deposition rate of the active ingredient at 5 °C. The anti-asthmatic efficacy of the aerosol formulation was assessed in guinea pigs with asthma evoked by intravenous injection of histamine compared with racemic salbutamol. Our results show that this aerosol formulation of R-salbutamol sulfate met all the requirements of the new EMA guidelines for nebulizer. The efficacy of a half-dose of R-salbutamol equaled that of a normal dose of racemic salbutamol.

Retrospective studies on drug utilization patterns of asthmatics in a Government hospital in Kedah, Malaysia.

Retrospective DUE is the reviewing of drug therapy after the patient has received the medication. Asthma is a common chronic disease in Malaysia. A National Health and Morbidity Survey in 1996 indicated that asthma prevalence in Malaysia was 4.2%. Statistics on the causes of death have noted asthma as one of the 10 principal causes of death (7.3%) in Malaysia. The purpose of the study was to compare drug utilization patterns amongst the asthmat-ics from the past two years (since 2009) in Kedah state. Asthmatics admitted to the hospital in the preceding two years were analyzed by their patient charts. This study focused on both smoker and non smoker asthmatics. It was observed that salbutamol was most commonly prescribed, followed by montelukast and prednisolone. In the combination therapy, the most commonly prescribed was Symbicort, followed by seretide and combivent. Corticoste-roids constituted the most prevalent class, followed by beta-2 agonists, leukotriene modifiers and methylxanthines. The study presented the most recent scenario on drug utilization pattern of asthmatics in Kedah state.

Retrospective studies on drug utilization patterns of asthmatics in a Government hospital in Kedah, Malaysia.

Retrospective DUE is the reviewing of drug therapy after the patient has received the medication. Asthma is a common chronic disease in Malaysia. A National Health and Morbidity Survey in 1996 indicated that asthma prevalence in Malaysia was 4.2%. Statistics on the causes of death have noted asthma as one of the 10 principal causes of death (7.3%) in Malaysia. The purpose of the study was to compare drug utilization patterns amongst the asthmat-ics from the past two years (since 2009) in Kedah state. Asthmatics admitted to the hospital in the preceding two years were analyzed by their patient charts. This study focused on both smoker and non smoker asthmatics. It was observed that salbutamol was most commonly prescribed, followed by montelukast and prednisolone. In the combination therapy, the most commonly prescribed was Symbicort, followed by seretide and combivent. Corticoste-roids constituted the most prevalent class, followed by beta-2 agonists, leukotriene modifiers and methylxanthines. The study presented the most recent scenario on drug utilization pattern of asthmatics in Kedah state.

Comparison of salbutamol efficacy in children- via the metered-dose inhaler (MDI) with Volumatic® spacer and via the dry powder inhaler, Easyhaler®, with the nebulizer - in mild to moderate asthma exacerbation: a multicenter, randomized study.

Background: β2 agonist administered via a nebulizer is the standard treatment for acute asthma exacerbation. There are some limitations for the use of nebulization. We conducted a study to determine the efficacy of salbutamol administered via the pMDI with Volumatic® spacer and the Easyhaler®(DPI) compared to nebulization in mild to moderate asthma exacerbations in children. Methods: A multicenter, randomized, controlled study was conducted in children between 5 and 18 years of age who presented at an emergency or outpatient department. They were randomized to receive either 6 puffs of salbutamol via the pMDI with Volumatic® spacer, or via the Easyhaler®, or 0.15 mg/kg of salbutamol nebulized via oxygen (or compressed air). The primary outcome was the clinical response which was assessed using the modified Wood’s asthma score. The secondary outcomes were: hospitalization, asthma re-visit within 3 days, systemic corticosteroid use and adverse events. The clinical score, oxygen saturation, PR, RR, BP and adverse events were recorded at time 0 (before treatment) and 20, 40 and 60 minutes after drug administration. Results: There were no statistically significant differences in the clinical response between the three groups at the 1st, 2nd or 3rd dose or for the SpO2 or the respiratory rate while the children in the Easyhaler® group had significantly less tachycardia after the 2nd dose. No significant adverse events were noted among the three groups. Conclusions: Salbutamol administered via pMDI with Volumatic® spacer or DPI (Easyhaler®) are as effective as salbutamol given via a nebulizer in providing effective relief of mild to moderate severity acute asthma exacerbation in children between 5 and 18 years of age.

Efficiency comparison of two nebulization inhalation therapy methods / 中国实用护理杂志

Objective To observe the efficiency of two nebulization inhalation therapy methods in patients with non-invasive ventilation. Methods 60 patients with non-invasive ventilation were divided in-to two groups (30 cases in each group). Based on combination therapy, the observation group received oxy- gen drived nebulizer inhalation therapy through tube system of non - invasive ventilator, the control group re- ceived inhalation therapy by oxygen drived nebulizer directly with halt of non- invasive ventilation. The effi- ciency of two methods was compared between the two groups. Results At the end of treatment SaO2 in the observation group remained nearly unchanged, while that of the control group significantly de-creased,beart rate increased in both groups,bot the amplitude was lower in the observation group. Patients in the observation group showed no evident discomfort, alleviated gasp and eosy expectoration. Conclu-sions Inhalation therapy through tube system of non- invasive ventilator was more efficient and it is worthy of wide clinical application.

The Effect of Intensive Therapy Using Nebulized Antibiotics after Endoscpic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are some difficulties and dilemmas in treating patients who show acute recurrent infection or persistent inflammation after sinus surgery. Recently, nebulized antibiotic therapy was recommended as another treatment option for these patients. Our study was to evaluate the effect of nebulized antibiotic therapy in these patients. SUBJECTS AND METHOD: We selected 38 adult patients who had received endoscopic surgery previously. They were patients of the refractory group who have showed persistent purulent rhinorrhea despite treatment for 2 months after sinus surgery and the acute exacerbation group who have showed repeated worsening of their symptoms more than 3 times for 6 months. Cultures were taken from all cases and proper oral antibiotics were used based on their culture results. Oral antibiotics were stopped during the nebulized antimicrobial therapy. Nebulized antibiotics therapy was performed 5 times a week for 4 weeks with cefmenoxime hydrochloride using ultrasonic nebulizer. The symptom score and endoscopic appearance were checked also before and 1, 2 and 3 months after the treatment. RESULTS: In 38 patients, 6 patients were excluded due to follow up loss or voluntary stop of treatment and 32 patients were available. S. aureus, P. aeruginosa and coagulase-negative Staphylococcus were most common organisms in all patients. The symptom score and endoscopic appearance after the treatment showed significant improvement. No complication was found in all cases. CONCLUSION: Nebulized antibiotic therapy might be considered as another therapeutic option for patients with refractory or acute exacerbation of chronic rhinosinusitis after endoscopic sinus surgery.

Intranasal Antimicrobial Aerosol Therapy

The intranasal anti-microbial aerosol therapy using a nebulizer is commonly suggested for the treatment of acute infection or recurrent bacterial infection among patients who underwent endoscopic sinus surgery. One benefit of the topical antimicrobial therapy is a greater concentration of medication being delivered directly into the sinonasal cavities with reduced systemic complications. Its results are, it significantly increases infection free intervals, and it promotes healing after sinus surgery. There are three main factors which influence the deposition efficiency: particle size, pressure gradient, and the size of the sinus ostium. However, it is still difficult to achieve an effective penetration of the drugs into the sinuses. Nevertheless, current literature has shown the low aerosolized particle deposition to be an efficient method in the para-nasal sinuses. So intranasal topical anti-microbial aerosol therapy is recommended as an additional treatment option for recurrent chronic sinusitis patients who have not responded to or are unable to tolerate oral and intravenous treatment.

The Effect of Antibiotic Nebulizer Therapy for Treatment of Pediatric Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : The management of chronic recurrent rhinosinusitis in children has become controversial, because there are now various treatment modalities. We assessed nebulized antibiotic therapy, which had been studied as a treatment option in the postoperative infection in adult patients, for its effectiveness in children with chronic rhinosinusitis. Subjects and METHOD : We have selected 34 pediatric chronic rhinosinusitis patients who have received treatment for 3 months or 3 times for recent 6 months with oral antibiotics. They were treated with a nebulized antibiotic therapy for 4 weeks. We have compared pre-and post-treatment symptom scores, physical scores, and radiologic scores. After 6 months of follow up, infection free period was assessed. RESULTS : In 34 patients, 25 patients were selected for study. The symptoms and physical findings were improved in 76%, and the radiologic findings were also improved in 56%. Improvement in rhinorrhea, nasal obstruction, coughing and nasal swelling were significant. Mean infection free period was 13.7 weeks. CONCLUSION : Nebulized antibiotic therapy might be considered as another therapeutic option for pediatric patients with chronic sinusitis who have failed to respond to oral antibiotics or who cannot tolerate them.

Bacterial Contaminations of Home Nebulizers in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Nebulizers are commonly used to treat children with asthma. Some pulmonary infections associated with contaminated nebulizer units have been reported. The aims of this study were to determine whether home nebulizers are repositories of bacteria and to ascertain how asthmatic patients use and maintain their nebulizers at home. METHODS: Fifty-five children with asthma aged 2 to 6 years were enrolled in this study. The parents were asked to bring their child's nebulizer units to regular follow-up visits. Bacterial samples which were obtained from the masks(or mouthpieces), nebulizer chambers and throat swabs were inoculated to blood agar, chocolate agar, and McConkey agar. Cultures were incubated at 5 percent CO2 incubator and observed after 24 hours. Parents completed a questionnaire regarding nebulizer usage and care in their child. RESULTS: Bacterial contamination was found in samples from 27(49.1%) of the 55 masks(or mouthpieces) and 24(43.6%) of the 55 chambers. The predominant microorganisms isolated were Acinetobacter baumannii, Bacillus subtilis, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans. The questionnaire revealed that 40 parents cleaned the nebulizer units with tap water(and soap) and dried then, as they had received cleaning and drying instructions from a medical staff member. Seven organisms from nebulizer units were indistinguishable from the patient's throat isolates. CONCLUSION: We have demonstrated that home nebulizers in these asthmatic children were frequently contaminated with aerobic bacteria. Aerosolization might transmit these bacteria to their upper respiratory tracts. The education and training of home caregivers should include the principles of cleaning and maintenance of their child's nebulizer units.