Chest
Volume 125, Issue 2, February 2004, Pages 502-508
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Clinical Investigations
AEROSOLS
Comparison of Lung Deposition in Two Types of Nebulization: Intrapulmonary Percussive Ventilation vs Jet Nebulization

https://doi.org/10.1378/chest.125.2.502Get rights and content

Background

So-called intrapulmonary percussive ventilation (IPV), frequently coupled with a nebulizer, is increasingly used as a physiotherapy technique; however, its physiologic and clinical values have not been rigorously assessed.

Study objective

To compare in vitro and in vivo characteristics of the nebulizer of the IPV device (Percussionaire; Percussionaire Corporation; Sandpoint, ID) with those of standard jet nebulization (SST) [SideStream; Medic-Aid; West Sussex, UK].

Design

Aerodynamic particle size was studied by an cascade impactor. The deposition of 99mTc-diethylenetriaminepenta-acetic acid was measured in 10 healthy subjects by tomoscintigraphy during spontaneous breathing with both nebulizers.

Measurements and results

The mass median aerodynamic diameter (0.2 μm vs 1.89 μm for IPV and SST, respectively) and the fine-particle fraction (16.2% vs 67.5%, respectively) were significantly smaller with IPV. In vivo, respiratory frequency (RF) was lower with the IPV device (10.1 ± 3.4 breaths/min vs 14.6 ± 3.4 breaths/min, p = 0.002). Whole-body deposition was significantly higher with IPV (15.63% vs 9.31%), but it was due to a higher extrapulmonary deposition. Although intrapulmonary deposition (IPD) was not different with both devices (4.20% for SST vs 2.49% for IPV), it was much more variable with IPV, compared to SST. The penetration index into the lung was higher with IPV than SST when normalized for RF (0.045 ± 0.018 breaths/min vs 0.026 ± 0.013 breaths/min, p = 0.007).

Conclusion

The two techniques showed comparable lung deposition despite a large difference in particle size. However, IPV IPD was too variable and thus too unpredictable to recommend its use for drug delivery to the lung.

Section snippets

Subjects

Ten healthy men, all nonsmokers (mean age, 28 years; range, 23 to 43 years), were investigated. All subjects underwent standard spirometry according to American Thoracic Society guidelines.12 The Ethics Committee of our institution approved the study, and a written, informed consent was obtained from the volunteers.

Nebulizers

Both devices were driven by the same pressure: 3.5 bars of compressed air. For standard jet nebulization (SST), we chose a well-studied nebulizer (SideStream; Medic-Aid; West Sussex,

Lung Function Tests

Table 1 presents average anthropometric and lung function data of the subjects. All volunteers had spirometric values in the normal range.

Aerodynamic Particle Size Analysis

The FPFs were 67.5% and 16.2% for SST and IPV, respectively. The EDs were 13.4% and 1.45% for SST and for IPV, respectively. MMADs were 1.89 μm for SST and 0.2 μm for IPV. Output flow of the nebulizers was 10.3 L/min for SST and 70.6 L/min for IPV.

Pattern of Breathing During Nebulization

Table 2 summarizes the data of ventilation. Average RF was significantly lower with IPV than with SST. Average Vt

Discussion

We have found that nebulization combined with IPV resulted in a higher WBD than SST. This was due to a higher extrapulmonary deposition with the IPV. This device delivered intrapulmonary aerosols irregularly in a group of naive healthy subjects.

Although in vitro testings present some limitations and may give an overestimation of the lung deposition measured in vivo,17 it remains nevertheless an acceptable way to compare two methods in a standardized protocol. FPF was small, and particle size

ACKNOWLEDGMENT

The authors thank R. Vanbever and C. Bosquillon for help in collecting and interpreting in vitro data.

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    Partly supported by the Belgian “Fonds National de la Recherche Scientifique” grant No. 3.4536.98.

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