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Abstract
BACKGROUND: Jet nebulizers are commonly used for bronchodilator therapy in chronic obstructive pulmonary disease (COPD). High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer, on airway and lung function in patients with stable COPD.
METHODS: This randomized non-inferiority crossover physiologic study enrolled patients with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-hour washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in forced expiratory volume at 1 second (FEV1) from baseline. Secondary outcomes included changes in other respiratory related parameters and nebulization time compared between the two devices.
RESULTS: Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV1 from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] versus 20 [16-22] minutes, respectively; P < .001).
CONCLUSIONS: Bronchodilator therapy via HFNC-VMN is not inferior to jet nebulizer for patients with stable COPD, and can significantly improve airway oscillometry mechanics, and decrease nebulization time compared to jet nebulizer.
- aerosol therapy
- chronic obstructive pulmonary disease
- high-flow nasal cannula
- pulmonary function test
- vibrating mesh nebulizer
Footnotes
- Corresponding author: Nuttapol Rittayamai, MD Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand. Tel: (+66) 2–419-7757 (Ext. 11); Fax: (+66) 2–419-7760. E-mail: nuttapol.rit{at}mahidol.ac.th
- Received April 17, 2023.
- Accepted August 10, 2023.
- Copyright © 2023 by Daedalus Enterprises
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