Vibrating Mesh versus Jet Nebulizers for High-Dose Albuterol in Exacerbations of COPD and Asthma

Abstract

Background:

Patients presenting to the emergency department (ED) with exacerbations of COPD and asthma are often treated with high-dose albuterol, traditionally administered using a jet nebulizer (JN). Vibrating mesh nebulizers (VMNs) may enhance aerosol delivery and shorten treatment time, but data comparing VMN with JN for high-dose albuterol in exacerbations are limited.

Methods:

We conducted a single-center, retrospective, pre and post study of adults prescribed high-dose albuterol for COPD or asthma exacerbation in the ED, comparing JN with VMN. Historically, high-dose albuterol (7.5–15 mg) was delivered over ∼60 min via JN. Following a protocolized change from JN to VMN, doses were standardized to 5–10 mg and delivered rapidly over ∼10 min. The primary outcome was need for repeat albuterol within 4 h. Analyses were intent-to-treat.

Results:

Three hundred fifty-one subjects were included in the study (JN n = 189; VMN n = 162). Twenty-two (13.6%) subjects in the VMN arm received JN but were analyzed with VMN. The need for repeat albuterol within 4 h was similar in both arms: 19.6% (JN) versus 22.2% (VMN), P = .54; multivariate results were concordant. VMN protocol was associated with greater heart rate increases at 10 and 60 min, and the proportion with ≥20 beat-per-minute rise was substantially higher with VMN. ED stay was modestly longer with VMN. Admission rates and escalation of ventilatory support were similar. No adverse events other than tachycardia were observed.

Conclusions:

In adults with asthma or COPD exacerbations receiving high-dose albuterol, the JN and VMN protocols resulted in similar need for repeat bronchodilator therapy. VMN therapy led to greater heart rate increases. These findings suggest that for delivery of high-dose albuterol, rapid VMN delivery does not provide benefit over traditional JN but may increase side effects. Additional prospective randomized trials are needed to further clarify the role of VMN for high-dose albuterol administration.

Keywords

chronic obstructive pulmonary disease asthma exacerbation nebulizer albuterol jet nebulizer vibrating mesh nebulizer

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References

1. Cairns

CKK

. National Hospital Ambulatory Medical Care Survey: 2022 emergency department summary tables. Available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc22-ed-508.pdf

2. Agustí

, Celli

, Criner

, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207: 819–837; doi: 10.1164/rccm.202301-0106PP

3. Camargo

Jr. , Rachelefsky

and Schatz

. Managing asthma exacerbations in the emergency department: summary of the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations. J Emerg Med 2009; 37: S6–S17; doi: 10.1016/j.jemermed.2009.06.105

4. Dugernier

, Hesse

, Vanbever

, et al. SPECT-CT comparison of lung deposition using a system combining a vibrating-mesh nebulizer with a valved holding chamber and a conventional jet nebulizer: a randomized cross-over study. Pharm Res 2017; 34: 290–300; doi: 10.1007/s11095-016-2061-7

5. Dhand

. Nebulizers that use a vibrating mesh or plate with multiple apertures to generate aerosol. Respir Care 2002; 47: 1406–1418; doi: 10.1177/002013240204701203

6. Crumm

, DiBlasi

, Barry

, et al. A retrospective observational study of vibrating mesh nebulizers in the pediatric emergency department. Pediatr Emerg Care 2025; 41: 599–605; doi: 10.1097/pec.0000000000003372

7. Moody

, Luckett

, Shockley

, et al. Clinical efficacy of vibrating mesh and jet nebulizers with different interfaces in pediatric subjects with asthma. Respir Care 2020; 65: 1451–1463; doi: 10.4187/respcare.07538

8. Cinesi-Gomez

, Garcia-Palacios

, Bernabe-Vera

, et al. Vibrating mesh nebulization increases tidal volume relative to jet nebulization during NIV in COPD exacerbation. Respir Med Res 2026; 89: 101248; doi: 10.1016/j.resmer.2026.101248,

9. Avdeev

, Nuralieva

, Soe

, et al. Comparison of vibrating mesh and jet nebulizers during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease. J Aerosol Med Pulm Drug Deliv 2021; 34: 358–365; doi: 10.1089/jamp.2020.1665

10.

10. Chweich

, Idrees

, Rideout

, et al. Randomized controlled trial assessing a vibrating mesh nebulizer compared to a jet nebulizer in severe asthma exacerbations. Respir Care 2024; 69: 345–348; doi: 10.4187/respcare.10980

11.

11. Dunne

and Shortt

. Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department. Am J Emerg Med 2018; 36: 641–646; doi: 10.1016/j.ajem.2017.10.067

12.

12. Emerman

and Cydulka

. Effect of different albuterol dosing regimens in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med 1997; 29: 474–478; doi: 10.1016/s0196-0644(97)70219-1

13.

13. Sabato

, Ward

, Hawk

, et al. Randomized controlled trial of a breath-actuated nebulizer in pediatric asthma patients in the emergency department. Respir Care 2011; 56: 761–770; doi: 10.4187/respcare.00142

14.

14. Fowler

and Lipworth

. Pharmacokinetics and systemic beta2-adrenoceptor-mediated responses to inhaled salbutamol. Br J Clin Pharmacol 2001; 51: 359–362; doi: 10.1046/j.1365-2125.2001.01362.x

15.

15. Abbas

, Ahmed

, Iqbal

, et al. A 10-year interval of cardiovascular effects of albuterol in asthma management: graphical review. Curr Res Pharmacol Drug Discov 2025; 9: 100236; doi: 10.1016/j.crphar.2025.100236

16.

16.American Thoracic Society Pulmonary Rehabilitation Assembly Outcomes Working Group. Dyspnea/Breathlessness. Available from: https://site.thoracic.org/assemblies/pr/outcome-measures/dyspnea-breathlessness

17.

17. Hajiro

, Nishimura

, Tsukino

, et al. Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 1185–1189; doi: 10.1164/ajrccm.158.4.9802091

18.

18. Liew

, Hsu

, Ko

, et al. Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010-2018. BMC Pulm Med 2023; 23: 217; doi: 10.1186/s12890-023-02518-0,

19.

19. Qin

, Zahran

and Malilay

. Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010-2015. J Asthma 2021; 58: 565–572; doi: 10.1080/02770903.2020.1713149

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