Vibrating Membrane Devices Deliver Aerosols More Efficient than Standard Devices: A Study in a Neonatal Upper Airway Model

Abstract

Abstract

Background:

Aerosol therapy in preterm infants is challenging, as a very small proportion of the drug deposits in the lungs.

Aim:

Our aim was to compare efficiency of standard devices with newer, more efficient aerosol delivery devices.

Methods:

Using salbutamol as a drug marker, we studied two prototypes of the investigational eFlow^® nebulizer for babies (PARI Pharma GmbH), a jet nebulizer (Intersurgical^® Cirrus^®), and a pressurized metered dose inhaler (pMDI; GSK) with a detergent-coated holding chamber (AeroChamber^® MV) in the premature infant nose throat-model (PrINT-model) of a 32-week preterm infant (1,750 g). A filter or an impactor was placed below the infant model's “trachea” to capture the drug dose or particle size, respectively, that would have been deposited in the lung.

Results:

Lung dose (percentage of nominal dose) was 1.5%, 6.8%, and 18.0–20.6% for the jet nebulizer, pMDI-holding chamber, and investigational eFlow nebulizers, respectively (p<0.001). Jet nebulizer residue was 69.4% and 10.7–13.9% for the investigational eFlow nebulizers (p<0.001). Adding an elbow extension between the eFlow and the model significantly lowered lung dose (p<0.001). A breathing pattern with lower tidal volume decreased deposition in the PrINT-model and device residue (p<0.05), but did not decrease lung dose.

Conclusions:

In a model for infant aerosol inhalation, we confirmed low lung dose using jet nebulizers and pMDI-holding chambers, whereas newer, more specialized vibrating membrane devices, designed specifically for use in preterm infants, deliver up to 20 times more drug to the infant's lung.