title: Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia.
abstract: The best means for optimal delivery of drugs into lungs of infants with bronchopulmonary dysplasia (BPD) is uncertain. We aimed to measure radio-aerosol deposition of salbutamol by jet nebulizer and metered dose inhalers (MDI) in ventilated and non-ventilated BPD infants. In a randomized, crossover sequence, salbutamol lung deposition was measured using an MDI (2 puffs or 200 micrograms) or sidestream jet nebulizer (5 minutes of nebulization with 100 micrograms/kg) in 10 ventilated (mean birthweight, 1,101 g) and 13 non-ventilated (mean birthweight, 1,093 g) prematurely born infants. Non-ventilated infants inhaled aerosol through a face mask, connected to a nebulizer or an MDI and spacer (Aerochamber). Ventilated infants received aerosol from an MDI + MV15 Aerochamber or a nebulizer inserted in the ventilator circuit. Lung deposition by both methods was low: mean (SEM) from the MDI was 0.67 (0.17)% of the actuated dose, and from the nebulizer it was 1.74 (0.21)% and 0.28 (0.04)% of the nebulized and initial reservoir doses, respectively. Corresponding figures for the ventilated infants were 0.98 (0.19)% from the MDI and 0.95 (0.23)% and 0.22 (0.08)% from the nebulizer. In both groups, and for both methods of delivery, there was marked inter-subject variability in lung deposition and a tendency for the aerosol to be distributed to the central lung regions.
authors.affiliation: Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada.
authors.forename: T F
authors.initials: TF
authors.lastname: Fok
authors.forename: S
authors.initials: S
authors.lastname: Monkman
authors.forename: M
authors.initials: M
authors.lastname: Dolovich
authors.forename: S
authors.initials: S
authors.lastname: Gray
authors.forename: G
authors.initials: G
authors.lastname: Coates
authors.forename: B
authors.initials: B
authors.lastname: Paes
authors.forename: F
authors.initials: F
authors.lastname: Rashid
authors.forename: M
authors.initials: M
authors.lastname: Newhouse
authors.forename: H
authors.initials: H
authors.lastname: Kirpalani
mesh_terms: D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001997:Bronchopulmonary Dysplasia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D011877:Radionuclide Imaging
chemical_list: D000336:Aerosols; D000420:Albuterol