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Introduction
Asthma exacerbations are a frequent cause of emergency department visits and hospital admissions. In patients with peak expiratory flow (PEF) < 50% of predicted, a larger improvement in PEF at 30 min after the initial bronchodilator treatment is associated with favorable outcomes.1,-,4 It is possible that the delivery method of bronchodilator in the emergency department impacts patient response to bronchodilators.5
Jet nebulizers (JNs) deliver aerosols of varying particle size and have been shown to be unreliable in delivering bronchodilator drugs to the lungs.6 Studies in both animals and humans have shown greater lung deposition with vibrating mesh nebulizer technology, presumably because their more uniform particle size in the 1–5 μm range permits deeper lung penetration.7,8 A retrospective study comparing vibrating mesh nebulizer to JN in emergency department subjects showed that vibrating mesh nebulizer was associated with fewer hospital admissions, shorter length of stay (LOS) in the emergency department, and a reduction in albuterol dose,9 but no spirometry was done. We hypothesized that bronchodilator aerosol delivery with a vibrating mesh nebulizer in adults with severe asthma exacerbations in the emergency department would provide a more rapid improvement in air flow than a JN.
Methods
This was a prospective, single-blinded, parallel, single-center, randomized controlled trial (RCT) in subjects 18–55 y old with severe asthma exacerbations, defined as PEF < 50% of predicted. Exclusion criteria included a history of COPD, non-asthmatic cause of bronchospasm as determined by the treating physician, acute coronary syndrome, mechanical ventilation, tachyarrhythmia other than sinus, agitated or uncooperative subjects, non–English-speaking subjects, and the inability to provide informed consent. The study was approved by the institutional review board at Tufts Medical Center and was registered at ClinicalTrials.gov (NCT number 03029156). All subjects gave written informed consent.
Subjects were randomized 1:1 …
Correspondence: Nicholas S Hill MD, Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, 800 Washington Street, #257, Boston, MA 02111. E-mail: Nhill{at}tuftsmedicalcenter.org
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