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Vibrating Mesh versus Jet Nebulizers for High-Dose Albuterol in Exacerbations of COPD and Asthma
Laura Reindl1, Sarah Bazelak1, Brittany Steinpas1
1Ms. Reindl, Bazelak, and Ms. Steinpas are affiliated with Respiratory Care Services, Advocate Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA.
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.
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