Background: HFNC system is a novel device used with aerosol therapy and seems to be rapidly accepted. Although there are some studies conducted on HFNC and vibrating mesh nebulizer, the effect of HFNC on aerosol delivery using jet nebulizer or pressurized metered-dose inhaler (pMDI) has not been reported. In an effort to examine the effect of HFNC on aerosol deposition, this study was conducted to quantify aerosol drug delivery with or without a HFNC using either pMDI or jet nebulizer. Methodology: The SAINT model, attached to an absolute filter (Respirgard II, Vital Signs Colorado Inc., Englewood, CO, USA) for aerosol collection, was connected to a pediatric breathing simulator (Harvard Apparatus, Model 613, South Natick, MA, USA). To keep the filter and the SAINT model in upright position to collect aerosolized drug, an elbow adapter was connected between the absolute filter and the breathing simulator. An infant HFNC (Optiflow, Fisher & Paykel Healthcare LTD., Auckland, New Zealand) ran at 3 l/min O2 was attached to the nares of the SAINT model. Breathing parameters used in this study were Vt of 100 mL, RR of 30 breaths/min, and I:E ratio of 1: 1.4. Aerosol drug was administered using: 1) Misty-neb jet nebulizer (Allegiance Healthcare, McGaw Park, Illinois, USA) powered by air at 8 l/min using pediatric aerosol facemask (B&F Medical, Allied Healthcare Products, Saint Louis, MO, USA) to deliver albuterol sulfate (2.5 mg/3 mL NS), and 2) Four actuations of Ventolin HFA pMDI (90 μg/puff) (GlaxoSmithKline, Research Triangle Park, NC, USA) combined with VHC (AeroChamber plus with Flow-Vu, Monaghan Medical, Plattsburgh, NY, USA). Aerosol was administered to the model with and without the HFNC and another without (n=3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. Independent t tests were performed for data analysis. Statistical significance was determined with a p value of <0.05. Results: The mean inhaled mass percent was greatest for pMDI with (p = 0.0001) or without HFNC (p = 0.003). Removing HFNC from the nares before aerosol treatment trended to increase drug delivery with the jet nebulizer (p = 0.024), and increased drug delivery by 6 fold with pMDI (p = 0.003). Conclusions: Aerosol drug may be administered in pediatrics receiving HFNC therapy using either jet nebulizer or pMDI. However, using pMDI, either with or without HFNC, is the best option. When delivering medical aerosol by mask, whether by jet nebulizer or pMDI, removing HFNC led to an increase in inhaled mass percent. However, the benefit of increased aerosol delivery must be weighed against the risk of lung derecruitment when nasal prongs are removed.

BACKGROUND: Aerosol therapy using albuterol is one of the most prescribed asthma treatments. The most frequently used methods of aerosol delivery are pneumatic jet nebulizer (JN), pressurized metered-dose inhaler (pMDI), and breath-actuated nebulizer (BAN). Choosing among these devices is usually not based on thorough comparison of efficiency or cost. We compare the efficiency of these three devices using a spontaneously breathing adult model. METHODS: We connected each aerosol generator—JN, BAN, or pMDI with a valved holding chamber (VHC)—to the face of an adult teaching manikin. Below the bifurcation, an elbow adaptor was connected to a corrugated tube and was angled to be at a lower level than the collecting filter to prevent droplets from dripping directly into the collecting filter. From the collecting filter, another corrugated tube was connected to a prevention filter, which was then connected to an adult breathing simulator. Spontaneous breathing parameters were VT 450 mL, RR 20/min, and I: E ratio 1:2. First, we compared JN, BAN (2.5 mg/3 mL), and pMDI (4 puffs); second, we compared JN and BAN 2.5 mg/0.5 mL plus 0.5 mL normal saline. Data were analyzed using spectrophotometry (276 nm). One-way ANOVA and independent sample t-tests were used (p<0.05). RESULTS: There were no differences in inhaled mass percentage (p=0.172) JN, BAN, and pMDI in the first experiment. Treatment time with BAN was significantly longer (p=0.0001) than with JN or pMDI. In the second experiment, BAN delivered more medication (p=0.004) than jet nebulizer. Treatment time was significantly less with JN (p=0.010). There was no difference in residual volume among JN and BAN in both experiment (p=0.765, p=0.115). CONCLUSIONS: All the devices that were compared using a 3 ml or 4 pMDI puffs delivered comparable amount of medication with no significant difference. However, BAN using 1ml fill volume delivers more drug compared to JN. Additionally, treatment time was longest with BAN. Even with reduction of its filling volume, BAN delivers a higher amount of medication to that of pMDI but was not statistically significant.

L’aérosolthérapie a pour objectif de délivrer un médicament dans les voies respiratoires. Le nébuliseur pneumatique est un dispositif permettant de générer des gouttelettes de liquide de diamètre micrométrique. Son processus d’atomisation a cependant été peu analysé. Ainsi, les performances du nébuliseur, caractérisées par le diamètre des gouttes et la masse de médicament inhalable par le patient, et atteignent un palier. Notre travail consiste à utiliser un modèle numérique diphasique en 3D basé sur une géométrie donnée et paramétré sous ANSYS Fluent. Plusieurs méthodes sont utilisées pour caractériser expérimentalement la génération de l’aérosol : l’ombroscopie, la diffractométrie laser et l’anémométrie phase Doppler. Notre modèle est validé par rapport aux données expérimentales et peut donc être exploité pour analyser les processus de génération. L’influence de plusieurs paramètres physiques sur les caractéristiques de l’aérosol produit est étudiée. Ainsi, l’étape de génération de gouttelettes est optimisée pour le développement d’un nouveau nébuliseur. Le transport des gouttes aux poumons du patient est optimisé empiriquement. / The purpose of aerosol therapy is to deliver drugs into respiratory airways. The jet nebulizer is a device used to generate liquid droplets with a diameter lower than 5 μm. However its atomization process was not much analyzed. Nebulizer performances, which are characterized with droplet size and drug mass inhaled by the patient, are empirically optimized and have reached a plateau. Our work consists in setting a 3D diphasic numerical model on ANSYS Fluent, based on a given geometry. Several methods are used to experimentally characterize aerosol generation: shadowgraphy, laser diffractometry and phase Doppler anemometry. Our model is validated by experimental data and helps predicting generation processes. The influence of several geometric and physical parameters on the output is studied. From these data, droplet generation is optimized for the development of a new nebulizer. Droplet transport to the patient lungs is empirically optimized.