An in vitro analysis of the output of budesonide from different nebulizers☆,☆☆,★
Section snippets
Nebulizers and medication
Three jet nebulizer-compressor combinations were assessed: the LC Plus nebulizer and Turboboy compressor (38G00, operating pressure 0.7 bar, driving gas flow 5 L/min (Pari GmbH, Starnberg, Germany), the LC Star nebulizer and Turboboy compressor (38G00, Pari GmbH), and the Ventstream nebulizer and Portaneb compressor (operating pressure 0.95 bar, driving gas flow 6 L/min, Medicaid, Pagham, UK) were assessed with budesonide nebulizer suspension (500 μg in 2 mL, Pulmicort, Astra, Kings Langley,
Particle size
For the nebulizers assessed with the MSLI, the MMAD, the GSD, the mass of drug, and the percentage nebulizer output collected on stage 4 and the filter of the MSLI, representing drug particles smaller than 6.1 μg, are given in Table I.
Empty Cell MMAD (μm) GSD Drug <6.1 μm (μq) Percent <6.1 μm LC Plus/Turboboy 4.1 (3.9-4.2) 2.1 (2.0-2.2) 95.0 (87.0-103.1) 69.8 (67.6-72.0) LC Star/Turboboy 3.8 (3.5-4.0) 1.9 (1.8-1.9) 118.1 (113.1-123.1) 77.2 (71.3-83.1) Ventstream/Portaneb 3.1 (2.8-3.3)
DISCUSSION
This in vitro study has detected large differences in the delivery of a corticosteroid drug from different nebulizers. Patients using one nebulizer may receive more than twice as much drug from it compared with another. This may be crucial in the delivery of corticosteroids, where dose-dependent effects may occur.11 It is also important to define the dose of medication administered in drug trials and dose equivalence studies. Therapeutic failure may occur in such trials, or the wrong
Acknowledgements
We thank Judith Jackson for technical support.
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Supported by a grant from Pari GmbH.
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Reprint requests: Peter W. Barry, MRCPI, Department of Child Health, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester, LE2 7LX United Kingdom.
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