Medication nebulizer performance - Effects of diluent volume, nebulizer flow, and nebulizer brand

Background: Medication nebulizers are commonly used to delivery aerosolized medications to patients with respiratory disease, We evaluated output and respirable aerosol available to the patient (inhaled mass) for 17 medication nebulizers using a spontaneous breathing lung model. Methods: Three nebulizer fill volumes (3, 4, and 5 mL containing 2.5 mg of albuterol) and 3 oxygen flows (6, 8, and 10 L/min) were evaluated using the 17 nebulizers, A cotton plug at the nebulizer mouthpiece was used to trap aerosol during simulated spontaneous breathing, Following each trial, the amount of albuterol remaining in the nebulizer and the amount deposited in the cotton plug were determined spectrophotometrically. Aerosol particle size was determined using an 11-stage cascade impactor. Results: Increasing fill volume decreased the amount of albuterol trapped in the dead volume (p<0.001) and increased the amount delivered to the patient (p<0.001). Increasing flow increased tile mass output of particles in the respirable range of 1 to 5 mu m (p=0.004), but the respirable mass delivered to the patient was affected to a greater extent by nebulizer brand (p<0.001) than flow, Although 2.5 mg of albuterol was placed into the nebulizers, less than 0.5 mg in the respirable range of 1 to 5 mu m was delivered to the mouthpiece. Conclusions: The performance of medication nebulizers is affected by fill volume, flow, and nebulizer brand. When they are used for research applications, the nebulizer characteristics must be evaluated and reported for the conditions used in the investigation.