Noninvasive ventilation coupled with nebulization during asthma crises: a randomized controlled trial.
BACKGROUND
Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling β-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance.


METHODS
In this controlled trial, 21 adults with moderate to severe asthma attack were randomized to a control group (n = 11) or experimental group (NIV + nebulizer group, n = 10). All subjects inhaled bronchodilators for 9 minutes, and after particles were counted with a gamma camera to analyze regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min.


RESULTS
Breathing frequency (P = < .001) and minute ventilation (P = .01) were reduced, and tidal volume was increased (P = .01) in the NIV + nebulizer group, compared with the control group. The NIV + nebulizer group had improvement from baseline values, compared to the control group in the following parameters: FEV(1) 46.7 ± 0.5% of predicted vs 29.8 ± 8.9% of predicted, P = .02), FVC (41.2 ± 1.5% of predicted vs 23.2 ± 7.1% of predicted, P = .02), peak expiratory flow (67.3 ± 38.3% of predicted vs 26.9 ± 12.1% of predicted, P = .01), and inspiratory capacity (54.9 ± 28.8% of predicted vs 31.2 ± 9.1% of predicted, P = .01). No differences were observed between groups regarding radio-aerosol deposition index or pulmonary clearance. Negative correlations were found between FEV1, forced expiratory flow during the middle half of the FVC maneuver (FEF(25-75%)), inspiratory capacity, and radio-aerosol penetration index.


CONCLUSIONS
Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050).
Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil.
Valdecir C
VC
Galindo-Filho
Daniella C
DC
Brandão
Rita de Cássia S
Rde C
Ferreira
Maria José C
MJ
Menezes
Paulo
P
Almeida-Filho
Verônica F
VF
Parreira
Tayse N
TN
Silva
Maria da Glória
Mda G
Rodrigues-Machado
Elizabeth
E
Dean
Armèle
A
Dornelas de Andrade
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D001249:Asthma / Q000503:physiopathology* / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D045422:Continuous Positive Airway Pressure; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D056152:Respiratory Rate; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics; D013990:Tidal Volume; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate