Abstract
Background: Inhaled medications are the mainstay of treatment for maintenance of lung health in patients with cystic fibrosis (CF). Compressor/nebulizer units are used an average of 100-120 minutes/day by patients with CF. Each compressor/nebulizer has unique flow/pressure characteristics that affect particle size distribution and drug output rate. Little data are available regarding longitudinal performance of compressor/nebulizers. We hypothesized that their use over a 24-week period under conditions similar to those of patients with CF will affect their performance.
Methods: Four new units of compressor/reusable nebulizers from 3 brands (Pari Vios/Pari LC Plus, Pulmoaide 5650D/Viox and Inspiration Elite/SideStream Plus) commonly used by CF patients were tested. Compressor/nebulizers were operated 1 hour twice-daily/five days/week for 24 weeks. Compressor flow/pressure characteristics were measured every 6 weeks. Maximal flow was recorded without and with the nebulizer (MF, and MF/NEB respectively). Pressure was recorded at cero flow (MP) and at MF/NEB (P/NEB). Particle size distribution, inhaled mass (IM) and IM in respirable range (IM-RR) were evaluated at baseline and every 12 weeks.
Results: Vios had significant decline in MP and P/NEB at each measurement compared to baseline (MP: 45.8 and 32.6 PSI and P/NEB: 16.7 and 14.3 PSI at week 0 and 24 respectively, P<.05) but other compressors didn’t. MF and MF/NEB were stable over time but significantly varied among brands. Vios had the greatest slope of flow/pressure relationship (Vios> Pulmoaide> Inspiration Elite). Two Vios units stopped working at weeks 11 and 24 respectively. All compressors maintained baseline IM, IM-RR and aerosol characteristics.
Conclusion: Long term use of compressor/nebulizers in a regimen similar to that of patients with CF affected their performance. Pari Vios was the most affected brand with decline in MP and P/NEB and 2 units that stopped working. Measurement of MF and MF/NEB could help identify compressors that are likely to fail.
Footnotes
- Corresponding Author Ariel Berlinski, MD Associate Professor University of Arkansas for Medical Sciences, Department of Pediatrics, Pulmonary Medicine, 1 Children’s Way, Slot 512-17, Phone: 501-364-1006, Fax: 501-364-3930, Little Rock, Arkansas 72202 E-mail: BerlinskiAriel{at}uams.edu
Conflict of interest for A Berlinski: Dr. Berlinski served as Principal Investigator in clinical trials sponsored by Johnson & Johnson, MPEX Pharmaceutical, Gilead, Philips, Genentech, Vertex Abvie, Janssen and Aptalis and was recipient of an unrestricted educational grant from S&T Technologies. Conflict of interest for S Awad: None. Conflict of interest for DK Williams: None.
Financial support: This research was supported, in part, by the University of Arkansas for Medical Sciences College of Medicine Children’s University Medical Group Fund Grant Program. The Pediatric Aerosol Research Laboratory at Arkansas Children’s Hospital Research Institute was partially established and receives partial support from the George Endowment for Asthma.
- Copyright © 2013 by Daedalus Enterprises Inc.