title: Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand.
abstract: BACKGROUND
  Medication nebulizers are commonly used to delivery aerosolized medications to patients with respiratory disease. We evaluated output and respirable aerosol available to the patient (inhaled mass) for 17 medication nebulizers using a spontaneous breathing lung model.
  
  
  METHODS
  Three nebulizer fill volumes (3, 4, and 5 mL containing 2.5 mg of albuterol) and 3 oxygen flows (6, 8, and 10 L/min) were evaluated using the 17 nebulizers. A cotton plug at the nebulizer mouthpiece was used to trap aerosol during simulated spontaneous breathing. Following each trial, the amount of albuterol remaining in the nebulizer and the amount deposited in the cotton plug were determined spectrophotometrically. Aerosol particle size was determined using an 11-stage cascade impactor.
  
  
  RESULTS
  Increasing fill volume decreased the amount of albuterol trapped in the dead volume (p < 0.001) and increased the amount delivered to the patient (p < 0.001). Increasing flow increased the mass output of particles in the respirable range of 1 to 5 microns (p = 0.004), but the respirable mass delivered to the patient was affected to a greater extent by nebulizer brand (p < 0.001) than flow. Although 2.5 mg of albuterol was placed into the nebulizers, less than 0.5 mg in the respirable range of 1 to 5 microns was delivered to the mouthpiece.
  
  
  CONCLUSIONS
  The performance of medication nebulizers is affected by fill volume, flow, and nebulizer brand. When they are used for research applications, the nebulizer characteristics must be evaluated and reported for the conditions used in the investigation.
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: D
authors.initials: D
authors.lastname: Hess
authors.forename: D
authors.initials: D
authors.lastname: Fisher
authors.forename: P
authors.initials: P
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Pooler
authors.forename: R M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004867:Equipment Design; D006801:Humans; D008961:Models, Structural; D009330:Nebulizers and Vaporizers; D010316:Particle Size
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents; D000420:Albuterol