Research Article
No access
Published Online: 7 June 2011

A Comparison of Amount and Speed of Deposition Between the PARI LC STAR® Jet Nebulizer and an Investigational eFlow® Nebulizer

Publication: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Volume 24, Issue Number 3

Abstract

Background: The potency and physical properties of many of the drugs used in the treatment of cystic fibrosis necessitates the use of nebulization, a relatively time-consuming pulmonary delivery method. Newer, faster, and more efficient delivery systems are being proposed. The purposes of this study was to compare the length of time it took to deliver the equivalent of normal saline nebulized for 10 min in a PARI LC STAR® nebulizer to that of an investigational PARI eFlow®.
Methods: Six normal adults inhaled a 4-mL (36-mg) charge volume of saline from the LC STAR® or a 2.5-mL (22.5-mg) charge volume from the investigational eFlow®. The saline was mixed with 99mTc-DTPA to allow two-dimensional imaging. The inhalation was preceded by a xenon equilibration scan to allow more accurate separation of deposition into central and peripheral lung regions.
Results: The investigational eFlow® delivered 8.6 ± 1.0 mg, approximately 90% of the lung dose compared to the LC STAR®, 9.6 ± 1.0 mg, but did in less than half the time (p < 0.02 for both). There were no differences in central versus peripheral distribution for either device.
Conclusions: In conclusion the investigational eFlow® was both faster and more efficient than the LC STAR®.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Fuchs HJBorowitz DSChristiansen DHMorris EMNash MLRamsey BWRosenstein BJSmith ALWohl MEB. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosisN Engl J Med1994331637-642. 1. Fuchs HJ, Borowitz DS, Christiansen DH, Morris EM, Nash ML, Ramsey BW, Rosenstein BJ, Smith AL, and Wohl, MEB: Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. N Engl J Med. 1994;331:637–642.
2.
Ramsey BWBurns JSmith AL. Safety and efficacy of tobramycin solution for inhalation in patients with cystic fibrosis: the results of two Phase III placebo controlled clinical trialsPediatr Pulmonol199714S137-S138. 2. Ramsey BW, Burns J, and Smith AL: Safety and efficacy of tobramycin solution for inhalation in patients with cystic fibrosis: the results of two Phase III placebo controlled clinical trials. Pediatr Pulmonol. 1997;14:S137–S138.
3.
Nikolaizik WHVietzke DRatjen F. A pilot study to compare tobramycin 80 mg injectable preparation with 300 mg solution for inhalation in cystic fibrosisCan Respir J200815259-262. 3. Nikolaizik WH, Vietzke D, and Ratjen F: A pilot study to compare tobramycin 80 mg injectable preparation with 300 mg solution for inhalation in cystic fibrosis. Can Respir J. 2008;15:259–262.
4.
Weers JMetzheiser BTaylor GWarren SMeers PPerkins WR. A gamma scintigraphy study to investigate lung deposition and clearance of inhaled amikacin-loaded liposomes in healthy male volunteersJ Aerosol Med Pulm Drug Deliv200922131-138. 4. Weers J, Metzheiser B, Taylor G, Warren S, Meers P, and Perkins WR: A gamma scintigraphy study to investigate lung deposition and clearance of inhaled amikacin-loaded liposomes in healthy male volunteers. J Aerosol Med Pulm Drug Deliv. 2009;22:131–138.
5.
McKoy KSQuittner ALOermann CMGibson RLRetsch-Bogart GZMontgomery AB. Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosisAm J Respir Crit Care Med2008178921-928. 5. McKoy KS, Quittner AL, Oermann CM, Gibson RL, Retsch-Bogart GZ, and Montgomery AB: Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosis. Am J Respir Crit Care Med. 2008;178:921–928.
6.
Ratjen F. New pulmonary therapies in cystic fibrosisCurr Opin Pulm Med200713541-546. 6. Ratjen F: New pulmonary therapies in cystic fibrosis. Curr Opin Pulm Med. 2007;13:541–546.
7.
Katz SLAdatia ILouca ELeung KHumpl TReyes JTCoates AL. Nebulized therapy for childhood pulmonary hypertension: an In vitro modelPediatr Pulmonol200641666-673. 7. Katz SL, Adatia I, Louca E, Leung K, Humpl T, Reyes JT, and Coates AL: Nebulized therapy for childhood pulmonary hypertension: an In vitro model. Pediatr Pulmonol. 2006;41:666–673.
8.
Coates ALDenk OLeung KRibeiro NChan JGreen MMartin SCharron MEdwardes MKeller M. Higher tobramycin concentration, vibrating mesh technology can shorten antibiotic treatment time in cystic fibrosisPediatr Pulmonol2010(in press). 8. Coates AL, Denk O, Leung K, Ribeiro N, Chan J, Green M, Martin S, Charron M, Edwardes M, and Keller M: Higher tobramycin concentration and vibrating mesh technology can shorten antibiotic treatment time in cystic fibrosis. Pediatr Pulmonol. 2010 (in press).
9.
Mukhopadhyay SStaddon GEEastman CPalmer MRys Davies ECarswell F. The quantitative distribution of nebulized antibiotic in the lung in cystic fibrosisRespir Med199488203-211. 9. Mukhopadhyay S, Staddon GE, Eastman C, Palmer M, Rys Davies E, and Carswell F: The quantitative distribution of nebulized antibiotic in the lung in cystic fibrosis. Respir Med. 1994;88:203–211.
10.
Coates ALGreen MLeung KLouca ETservistas MChan JRibeiro NCharron M. The challenges of quantitative measurement of lung deposition using 99mTc-DTPA from delivery systems with very different delivery timesJ Aerosol Med200720320-330. 10. Coates AL, Green M, Leung K, Louca E, Tservistas M, Chan J, Ribeiro N, and Charron M: The challenges of quantitative measurement of lung deposition using 99mTc-DTPA from delivery systems with very different delivery times. J Aerosol Med. 2007;20:320–330.
11.
Coates GO'Brodovich HM. Measurement of pulmonary epithelial permeability with 99mTc-DTPA aerosolSemin Nucl Med198616275-284. 11. Coates G, and O'Brodovich HM; Measurement of pulmonary epithelial permeability with 99mTc-DTPA aerosol. Semin Nucl Med. 1986;16:275–284.
12.
O'Brodovich HMCoates GKay JMuysson D. Simultaneous measurement of lung clearance rates for Tc- and In-DTPA in normal and damaged lungsJ Appl Physiol1989662293-2297. 12. O'Brodovich HM, Coates G, Kay J, and Muysson D: Simultaneous measurement of lung clearance rates for Tc- and In-DTPA in normal and damaged lungs. J Appl Physiol. 1989;66:2293–2297.
13.
Regnis JARobinson MBailey DLCook PHooper PChan HKGonda IBye PTP. Mucociliary clearance in patients with cystic fibrosis and in normal subjectsAm J Respir Crit Care Med199415066-71. 13. Regnis JA, Robinson M, Bailey DL, Cook P, Hooper P, Chan HK, Gonda I, and Bye PTP: Mucociliary clearance in patients with cystic fibrosis and in normal subjects. Am J Respir Crit Care Med. 1994;150:66–71.
14.
Robinson MEberl STomlinson CDaviskas ERegnis JABailey DLTorzillo PJMenache MBye PTP. Regional mucociliary clearance in patients with cystic fibrosisJ Aerosol Med20001373-86. 14. Robinson M, Eberl S, Tomlinson C, Daviskas E, Regnis JA, Bailey DL, Torzillo PJ, Menache M, and Bye PTP: Regional mucociliary clearance in patients with cystic fibrosis. J Aerosol Med. 2000;13:73–86.
15.
Coates ALGreen MLeung KChan JRibeiro NLouca ERatjen FCharron MTservistas MKeller M. Rapid pulmonary delivery of inhaled tobramycin for pseudomonas infection in cystic fibrosis: a pilot projectPediatr Pulmonol200843753-759. 15. Coates AL, Green M, Leung K, Chan J, Ribeiro N, Louca E, Ratjen F, Charron M, Tservistas M, and Keller M: Rapid pulmonary delivery of inhaled tobramycin for pseudomonas infection in cystic fibrosis: a pilot project. Pediatr Pulmonol. 2008;43:753–759.
16.
Leung KLouca EGrey MTipples GACoates AL. Use of the new generation pharmaceutical impactor for particle size distribution measurements of live biological aerosolsJ Aerosol Med200518414-426. 16. Leung K, Louca E, Grey M, Tipples GA, and Coates AL: Use of the new generation pharmaceutical impactor for particle size distribution measurements of live biological aerosols. J Aerosol Med. 2005;18:414–426.
17.
Leung KLouca ECoates AL. Comparison of breath enhanced to breath actuated nebulizers for rate, consistency and efficiencyChest20041261619-1627. 17. Leung K, Louca E, and Coates AL: Comparison of breath enhanced to breath actuated nebulizers for rate, consistency and efficiency. Chest. 2004;126:1619–1627.
18.
Newman SPPitcairn GRHirst PHRankin L. Radionuclide imaging technologies and their use in evaluating asthma drug deposition in the lungsAdv Drug Deliv Rev200355851-867. 18. Newman SP, Pitcairn GR, Hirst PH, and Rankin L: Radionuclide imaging technologies and their use in evaluating asthma drug deposition in the lungs. Adv Drug Deliv Rev. 2003;55:851–867.
19.
Zhu X. Dosage of radiopharmaceuticals, internal dosimetryM CharronPractical Pediatric PET ImagingSpringerNew York37-462006. 19. Zhu X: Dosage of radiopharmaceuticals and internal dosimetry. In: M Charron (ed). Practical Pediatric PET Imaging. Springer, New York; pp. 37–46, 2006.
20.
Everard ML. Ethical aspects of using radiolabelling in aerosol researchArch Dis Child200388659-661. 20. Everard ML: Ethical aspects of using radiolabelling in aerosol research. Arch Dis Child. 2003;88:659–661.
21.
Macey DJMarshall R. Absolute quantitation of radiotracer uptake in the lungs using a gamma cameraJ Nucl Med198223731-735. 21. Macey DJ, and Marshall R: Absolute quantitation of radiotracer uptake in the lungs using a gamma camera. J Nucl Med. 1982;23:731–735.
22.
Pitcairn GRNewman SP. Tissue attenuation corrections in gamma scintigraphyJ Aerosol Med199710187-198. 22. Pitcairn GR, and Newman SP: Tissue attenuation corrections in gamma scintigraphy. J Aerosol Med. 1997;10:187–198.
23.
Coates ALMacNeish CFDinh LRollin TGagnon SHo SLLands LC. accounting for radioactivity before and after nebulization of tobramycin to insure accuracy of quantification of lung depositionJ Aerosol Med200013169-178. 23. Coates AL, MacNeish CF, Dinh L, Rollin T, Gagnon S, Ho SL, and Lands LC: accounting for radioactivity before and after nebulization of tobramycin to insure accuracy of quantification of lung deposition. J Aerosol Med. 2000;13:169–178.
24.
O'Callaghan CClarke ARMilner AD. Inaccurate calculation of drug output from nebulisersEur J Pediatr1989148473-474. 24. O'Callaghan C, Clarke AR, and Milner AD: Inaccurate calculation of drug output from nebulisers. Eur J Pediatr. 1989;148:473–474.
25.
Coates ALMacNeish CFLands LCSmountas AMeisner DKelemen SVadas EB. Factors influencing the rate of drug output during the course of wet nebulizationJ Aerosol Med199811101-111. 25. Coates AL, MacNeish CF, Lands LC, Smountas A, Meisner D, Kelemen S, and Vadas EB: Factors influencing the rate of drug output during the course of wet nebulization. J Aerosol Med. 1998;11:101–111.
26.
Kwong EMacNeish CFMeisner DKelemen SVadas EBCoates AL. The use of osmometry as a means of determining changes in drug concentration during jet nebulizationJ Aerosol Med19981189-100. 26. Kwong E, MacNeish CF, Meisner D, Kelemen S, Vadas EB, Coates AL: The use of osmometry as a means of determining changes in drug concentration during jet nebulization. J Aerosol Med. 1998;11:89–100.
27.
Bland JMAltman DG. Statistical methods for assessing agreement between two methods of clinical measurementLancet19861307-310. 27. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
28.
Laube BLJashnani RDalby RNZeitlin PL. Targeting aerosol deposition in patients with cystic fibrosis: Effects of alteration in particle size and inspiratory flowsChest20001181069-1076. 28. Laube BL, Jashnani R, Dalby RN, Zeitlin PL: Targeting aerosol deposition in patients with cystic fibrosis: Effects of alteration in particle size and inspiratory flows. Chest. 2000;118:1069–1076.
29.
Ilowite JSGorvoy JDSmaldone GC. Quantitative deposition of aerosolized gentamycin in cystic fibrosisAm Rev Respir Dis19871361445-1449. 29. Ilowite JS, Gorvoy JD, Smaldone GC: Quantitative deposition of aerosolized gentamycin in cystic fibrosis. Am Rev Respir Dis. 1987;136:1445–1449.
30.
Smaldone GCFuhrer JSteigbigel RTMcPeck M. Factors determining pulmonary deposition of aerosolized pentamidine in patients with human immunodeficiency virus infectionAm Rev Respir Dis1991143727-737. 30. Smaldone GC, Fuhrer J, Steigbigel R T, McPeck M: Factors determining pulmonary deposition of aerosolized pentamidine in patients with human immunodeficiency virus infection. Am Rev Respir Dis. 1991;143:727–737.
31.
Sorenson JAPhelps DL. Problems in radioactive detection, measurementPhysics in Nuclear MedicineGrune and Gratton Inc.Orlando, FL208-2281980. 31. Sorenson JA, Phelps DL: Problems in radioactive detection and measurement. In: Physics in Nuclear Medicine. Grune and Gratton Inc., Orlando, FL; pp.208–228,1980.
32.
Modi ACQuittner AL. Barriers to treatment adherence for children with cystic fibrosis: what gets in the wayJ Pediatr Psychol200631846-858. 32. Modi AC, Quittner AL: Barriers to treatment adherence for children with cystic fibrosis: what gets in the way. J Pediatr Psychol. 2006;31:846–858.
33.
Ho SLKwong WTJCoates AL. Evaluation of four breath-enhanced nebulizers for home useJ Aerosol Med200114467-475. 33. Ho SL, Kwong WTJ, Coates AL: Evaluation of four breath-enhanced nebulizers for home use. J Aerosol Med. 2001;14:467–475.
34.
Mitchell JPNagel MWNichols SNerbrink O. Laser diffractometry as a technique for rapid assessment of aerosol particle size from inhalersJ Aerosol Med200619409-433. 34. Mitchell JP, Nagel MW, Nichols S, Nerbrink O: Laser diffractometry as a technique for rapid assessment of aerosol particle size from inhalers. J Aerosol Med. 2006;19:409–433.

Information & Authors

Information

Published In

cover image Journal of Aerosol Medicine and Pulmonary Drug Delivery
Journal of Aerosol Medicine and Pulmonary Drug Delivery
Volume 24Issue Number 3June 2011
Pages: 157 - 163
PubMed: 21361784

History

Published online: 7 June 2011
Published in print: June 2011
Published ahead of print: 1 March 2011
Accepted: 16 November 2010
Received: 9 September 2010

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Allan L. Coates
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Maria Green
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Kitty Leung
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Jeffrey Chan
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Nancy Ribeiro
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Felix Ratjen
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
Martin Charron
Divisions of Nuclear Medicine and Respiratory Medicine, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.

Notes

Reviewed by:Patrice DiotPaula Anderson
Address correspondence to:Allan L. Coates, M.D.C.M.Hospital for Sick Children,555 University AvenueToronto, Ontario Canada, M5G 1X8E-mail: [email protected]

Author Disclosure Statement

No conflicts of interest exist for any of the authors.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top