With the advent of diagnosis related groups reimbursement schedules, the cost-effectiveness of therapies needs to be assessed. The safety and efficacy of intermittent positive pressure breathing (IPPB) has been controversial. IPPB employs the dilating effects of positive-pressure ventilation to deliver aerosolized particles to small and medium-sized bronchi of patients with obstructive airways disease. IPPB is expensive to implement and maintain. The hazards of IPPB (infection, pneumothorax, decreased cardiac output), although rare, could prolong hospital stays. Except for severely ill patients with fatigued respiratory muscles, IPPB offers no advantages over the less costly and safer compressor-nebulizer or metered-dose delivery of a β-agonist.
GoldbergICherniachRM. The effect of nebulized bronchodilator therapy with and without IPPB on ventilatory function in chronic obstructive emphysema. Am Rev Respir Dis1965; 91: 13–20.
4.
BarachALSwensonP. Effect of breathing gases under positive pressure on lumens of small and medium sized bronchi. Arch Intern Med1939; 63: 946–8.
5.
BarachAL. In: BarachAL, ed. Principles and practices of inhalation therapy. Philadelphia: Lippincott, 1944: 95.
6.
FowlerWSHelnholzHFMillerRD. Treatment of pulmonary emphysema on aerosolized bronchodilator drugs and intermittent positive pressure breathing. Mayo Clin Proc1953; 28: 743–6.
7.
KrupePEMcNairR. Successful substitution of aerosol nebulization therapy for IPPB at a Veterans Administration medical center. Milit Med1981; 146: 689–92.
8.
SimonssonBGAruiossonIHaldeborgMTreatment of airways obstruction by continuous nebulization with and without assisted ventilation. Scand J Respir Dis1977; 101 (suppl): 103–7.
9.
DolovichMBDermottKWolffRKPulmonary aerosol deposition in chronic bronchitis: Intermittent positive pressure breathing versus quiet breathing. Am Rev Respir Dis1977; 115: 397–402.
10.
DeTroyerADeisserP. The effects of intermittent positive pressure breathing on patients with respiratory muscle weakness. Am Rev Respir Dis1981; 124: 132–7.
Choo-KangYFJGrantIWB. Comparison of administering bronchodilator aerosol to asthmatic patients. Br Med J1975; 2: 119–20.
13.
CaytonRMWebberBPattersonJWA comparison of salbutamol given by pressure-packed aerosol or nebulization via IPPB in acute asthma. Br J Dis Chest1978; 72: 222–30.
14.
WebberBACollinsJVBranthwaiteMA. Severe acute asthma: A comparison of three methods of inhaling salbutamol. Br J Dis Chest1982; 76: 69–74.
15.
ChangNLevisonH. The effect of a nebulized bronchodilator administered with or without intermittent positive pressure breathing on ventilatory function in children with cystic fibrosis and asthma. Am Rev Respir Dis1972; 106: 867–74.
16.
ShenfieldCMEvansMEPattersonJW. The effect of different nebulizers with and without positive pressure breathing on the absorption and metabolism of salbutamol. Br J Clin Pharmacol1974; 1: 295–300.
17.
PattersonJW. A comparison of three different techniques for giving nebulized albuterol to asthmatic patients. Am Rev Respir Dis1974; 110: 293–300.
18.
LorenMChaiHMidlichDComparison between simple nebulization and intermittent positive-pressure in asthmatic children with severe bronchospasm. Chest1977; 72: 145–7.
The Intermittent Positive Pressure Group. Intermittent positive pressure breathing therapy of chronic obstructive pulmonary disease. Ann Intern Med1983; 99: 612–20.
21.
ChesterEHRaczIBarlowPBBronchodilator therapy: Comparison of acute response to three methods of administration. Chest1972; 62: 394–9.
22.
FogelJM. Racemic epinephrine in the treatment of croup. Nebulization alone versus nebulization with intermittent positive pressure breathing. J Pediatr1982; 101: 1028–31.
