PT  - JOURNAL ARTICLE
AU  - Galindo-Filho, Valdecir C
AU  - Brandão, Daniella C
AU  - Ferreira, Rita de Cássia S
AU  - Menezes, Maria José C
AU  - Almeida-Filho, Paulo
AU  - Parreira, Verônica F
AU  - Silva, Tayse N
AU  - Rodrigues-Machado, Maria da Glória
AU  - Dean, Elizabeth
AU  - Dornelas de Andrade, Armèle
TI  - Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial
AID  - 10.4187/respcare.01371
DP  - 2013 Feb 01
TA  - Respiratory Care
PG  - 241--249
VI  - 58
IP  - 2
4099  - http://rc.rcjournal.com/content/58/2/241.short
4100  - http://rc.rcjournal.com/content/58/2/241.full
AB  - BACKGROUND: Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling β-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance. METHODS: In this controlled trial, 21 adults with moderate to severe asthma attack were randomized to a control group (n = 11) or experimental group (NIV + nebulizer group, n = 10). All subjects inhaled bronchodilators for 9 minutes, and after particles were counted with a gamma camera to analyze regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min. RESULTS: Breathing frequency (P = < .001) and minute ventilation (P = .01) were reduced, and tidal volume was increased (P = .01) in the NIV + nebulizer group, compared with the control group. The NIV + nebulizer group had improvement from baseline values, compared to the control group in the following parameters: FEV1 46.7 ± 0.5% of predicted vs 29.8 ± 8.9% of predicted, P = .02), FVC (41.2 ± 1.5% of predicted vs 23.2 ± 7.1% of predicted, P = .02), peak expiratory flow (67.3 ± 38.3% of predicted vs 26.9 ± 12.1% of predicted, P = .01), and inspiratory capacity (54.9 ± 28.8% of predicted vs 31.2 ± 9.1% of predicted, P = .01). No differences were observed between groups regarding radio-aerosol deposition index or pulmonary clearance. Negative correlations were found between FEV1, forced expiratory flow during the middle half of the FVC maneuver (FEF25–75%), inspiratory capacity, and radio-aerosol penetration index. CONCLUSIONS: Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050)