Aerosol delivery device selection for spontaneously breathing patients: 2012

Area of Science:

• Respiratory Medicine
• Clinical Practice Guidelines
• Pharmacology

Background:

• Aerosol therapy is crucial for delivering respiratory medications.
• Optimizing aerosol delivery requires careful selection of devices and administration techniques.
• Evidence-based guidelines are essential for standardizing best practices.

Purpose of the Study:

• To update clinical practice guidelines for aerosol therapy.
• To provide evidence-based recommendations on aerosol generator and interface selection.
• To guide healthcare providers in optimizing aerosol medication delivery.

Main Methods:

• Systematic literature search of PubMed from January 1990 to August 2011.
• Review of 84 clinical trials, 54 reviews, 25 in vitro studies, and 7 evidence-based guidelines.
• Application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Main Results:

• Recommendations for device selection based on patient age, ability, cost, and drug availability.
• Specific guidance on nebulizers, pressurized metered-dose inhalers (pMDIs), and dry-powder inhalers (DPIs) for different patient groups.
• Emphasis on proper patient education, relaxed breathing, unit-dose medications, and avoiding certain techniques like blow-by.

Conclusions:

• Patient-centered selection of aerosol generators and interfaces is paramount.
• Proper technique and patient education are critical for effective aerosol therapy.
• Guidelines support the use of nebulizers or pMDIs during noninvasive ventilation.