Abstract
Background and aims: Infant respiratory distresssyndrome and bronchopulmonary dysplasia areserious respiratory diseases in preterm infants. Aerosol therapy in these infants is challenging dueto narrow airways, low tidal volumes, high breathingfrequency, lack of cooperation and lack of specialiseddevices. Moreover, lung deposition is low. Our aimwas to evaluate efficiency and efficacy of standarddevices versus a modern aerosol delivery device.
Methods: Using salbutamol as a drug marker in5-6 measurements for each device, we studied inan upper airway model of a 32-wks preterm infant(1750 grams) PARI Pharma's investigational eFlow®nebuliser prototype for babies (VMD 3.0 µm), a jetnebuliser (Intersurgical® Cirrus, 3.5 µm VMD) anda pressurised metered dose inhaler (pMDI, GSK)with a detergent coated spacer (Aerotrach Plus®)as used in our NICU. A filter was placed below theinfant model's ‘trachea’ to capture the drug dose thatwould have been deposited in the lung (lung dose). Statistics were carried out using SPSS 17.0.
Results: Lung dose (% of nominal dose) was 1.5%,7% and 21% for the jet nebuliser, pMDI-spacer andinvestigational eFlow nebuliser respectively (p<0.001). Jet nebuliser residue was 69%, and 11% forthe investigational eFlow nebuliser (p< 0.001).
Conclusions: The lung dose was significantly lowerfor the jet nebuliser and pMDI-spacer compared withthe investigational eFlow nebuliser, but arguablystill sufficient for bronchodilator delivery. If higherlung doses are required, more specialised vibratingmembrane devices, designed specifically for use ininfants, might be considered.
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Tiemersma, S., Van Lingen, R., Devadason, S. et al. 1306 Modern Aerosol Delivery Devices in Preterm Neonates. Pediatr Res 68 (Suppl 1), 646 (2010). https://doi.org/10.1203/00006450-201011001-01306
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DOI: https://doi.org/10.1203/00006450-201011001-01306