Comparison of lung deposition in two types of nebulization: intrapulmonary percussive ventilation vs jet nebulization.
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.


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].


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


RESULTS
The mass median aerodynamic diameter (0.2 micro m vs 1.89 micro m 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).


CONCLUSIONS
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.
Reychler
Gregory
G
Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
Keyeux
André
A
Cremers
Caroline
C
Veriter
Claude
C
Rodenstein
Daniel O
DO
Liistro
Giuseppe
G
D000280:Administration, Inhalation; D000336:Aerosols / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000704:Analysis of Variance; D001682:Biological Availability; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D049669:History, 16th Century; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010316:Particle Size; D011336:Probability; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000379:methods*; D012680:Sensitivity and Specificity
D000336:Aerosols