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Research ArticleOriginal Research

Use of a Viral Filter to Reduce Exposure to Exhaled Aerosol Does Not Affect Methacholine Dose Delivery During Bronchoprovocation Testing

Yosuf W Subat, Todd J Meyer, Keith D Torgerud, Kaiser G Lim, Paul D Scanlon and Alexander S Niven
Respiratory Care August 2022, 67 (8) 899-905; DOI: https://doi.org/10.4187/respcare.09703
Yosuf W Subat
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Todd J Meyer
Respiratory Care, Mayo Clinic, Rochester, Minnesota.
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Keith D Torgerud
Respiratory Care and Cardiopulmonary Diagnostics, Mayo Clinic, La Crosse, Wisconsin.
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Kaiser G Lim
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Paul D Scanlon
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Alexander S Niven
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Methacholine challenge testing (MCT) is a common bronchoprovocation technique used to assess airway hyper-responsiveness. We previously demonstrated that the addition of a viral filter to the nebulizer exhalation limb substantially reduced expelled particles during MCT. Our aim was to evaluate whether this modification affects the delivered dose of methacholine.

METHODS: A mechanical ventilator was connected to a lung simulator with breathing frequency 15 breaths/min, tidal volume 500 mL, inspiratory-expiratory ratio 1:1, with a sinusoidal waveform. We compared methacholine dose delivery using the Hudson Micro Mist or AeroEclipse II BAN nebulizers powered by either a dry gas source or a compressor system. A filter placed in line between the nebulizer and test lung was weighed before and after 1 min of nebulized methacholine delivery. Mean inhaled mass was measured with and without a viral filter on the exhalation limb. Dose delivery was calculated by multiplying the mean inhaled mass by the respirable fraction (particles < 5 μm) and inhalation time. Unpaired t test was used to compare methacholine dose delivery with and without viral filter placement.

RESULTS: The addition of a viral filter did not significantly affect methacholine dose delivery across all devices tested. Using a 50-psi dry gas source, dose delivered with or without a viral filter did not differ with the Hudson (422.3 μg vs 282.0 μg, P = .11) or the AeroEclipse nebulizer (563.0 μg vs 657.6 μg, P = .59). Using the compressor, dose delivered with and without a viral filter did not differ with the Hudson (974.0 μg vs 868.0 μg, P = .03) or the AeroEclipse nebulizer (818.0 μg vs 628.5 μg, P = .42).

CONCLUSIONS: The addition of a viral filter to the nebulizer exhalation limb did not affect methacholine dose during bronchoprovocation testing. Routine use of a viral filter should be considered to improve pulmonary function technician safety and infection control measures during the ongoing COVID-19 pandemic.

  • methacholine
  • aerosol
  • asthma
  • COVID-19
  • SARS-CoV-2
  • infection control
  • asthma

Footnotes

  • Correspondence: Alexander S Niven MD, Pulmonary Function Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905. E-mail: niven.alexander{at}mayo.edu
  • See the Related Editorial on Page 1058

  • The authors have disclosed no conflicts of interest.

  • No external sources of funding were involved in this study.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (8)
Respiratory Care
Vol. 67, Issue 8
1 Aug 2022
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Use of a Viral Filter to Reduce Exposure to Exhaled Aerosol Does Not Affect Methacholine Dose Delivery During Bronchoprovocation Testing
Yosuf W Subat, Todd J Meyer, Keith D Torgerud, Kaiser G Lim, Paul D Scanlon, Alexander S Niven
Respiratory Care Aug 2022, 67 (8) 899-905; DOI: 10.4187/respcare.09703

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Use of a Viral Filter to Reduce Exposure to Exhaled Aerosol Does Not Affect Methacholine Dose Delivery During Bronchoprovocation Testing
Yosuf W Subat, Todd J Meyer, Keith D Torgerud, Kaiser G Lim, Paul D Scanlon, Alexander S Niven
Respiratory Care Aug 2022, 67 (8) 899-905; DOI: 10.4187/respcare.09703
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Keywords

  • methacholine
  • aerosol
  • Asthma
  • COVID-19
  • SARS-CoV-2
  • infection control

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