Figures
- Fig. 1.—
Relationship between aerosol aerodynamic diameter and deposition in the healthy adult lung (based on in vitro models). ○: total body; □: total lung; ⋄: oropharyngeal; •: central airways; ▪: peripheral airways. Reproduced with permission 5.
- Fig. 2.—
Schematic of Comité European de Normalisation methodology to measure nebulized aerosol droplet size. A constant inhalation of 15 L·min−1 is drawn over (or through) the nebulizer. Nebulized aerosol containing a NaF solute tracer mixes with the entrained air. A low flow cascade impactor (Marple Series 296/8X) samples aerosol at 2 L·min−1 from this flow, and impacted aerosol can be subsequently desorbed and analysed from each size fraction from which the droplet size distribution can be determined (not to scale).
- Fig. 3.—
Schematic of Comité European de Normalisation methodology to measure nebulized aerosol output. “Inhaled” aerosol output is subject to sinus flow breath simulation and aerosol is collected onto low resistance electrostatic filters. Aerosol contains trace concentrations of sodium fluoride which can be subsequently desorbed and quantified electrochemically (not to scale). rpm: revolutions per minute.
Tables
- Table 1
Site of action of commonly nebulized drug aerosol therapies and the droplet size thought ideal for maximum clinical benefit
Drug Target airway site Special considerations β2-agonists acute Central-peripheral Use O2 as driving gas unless there are concerns about CO2 retention Adults and children β2-agonists chronic Central-peripheral Reduce nebulization time for treatment compliance Adults and Children Anti-cholinergic Central Mouth piece (preferable) or tight sealing face mask Adults and Children (Mouth piece for glaucoma patients) Corticosteroid Central-peripheral Minimize skin and eye exposure Children and adults Mouthpiece (preferably) (or tightly sealed face mask) Amino-glycosides or Colomycin Central-peripheral Mouth piece Adults Filter or exhaust exhaled gases Pre-treat with β-agonist when necessary Pentamidine Peripheral Mouth piece Adults Pretreat with nebulized β-agonist Filter or exhaust exhaled gases Amphotericin Central Dilute with water not saline Adults Filter or exhaust exhaled gases RhDNase Central Mouthpiece -
O2: Oxygen
-
CO2: carbon dioxide
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RhDNase: recombinant human deoxyribonuclease
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- Table 2
Parameters to be standardized in the use of nebulizer systems
Nebulizer type Choice of driving gas Driving gas pressure Driving gas flow rate Drug and formulation Nebulizer fill volume (as recommended by manufacturer) Time of nebulization Accessories (Mouthpiece/face mask etc.) Residual solute volume (amount of drug left in chamber)
Jump To
- Article
- Aims of the European Respiratory Society Nebulizer Guidelines and target audience
- Format and development of European Respiratory Society Nebulizer Guidelines
- Problems with the scientific background of clinical nebulizer use
- Responsibilities of manufacturers
- Responsibilities of prescribers
- Technical aspects of nebulizer use
- Clinical uses of nebulizers
- Use of nebulizers in cystic fibrosis
- Service issues
- Implementation and dissemination of the European Respiratory Society Nebulizer Guidelines
- Areas of uncertainty and future research needs
- Acknowledgments
- References
- Figures & Data
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