Combining Inhalation By A Breath-Actuated Nebulizer (BAN) With Exhalation Through An Oscillating Positive Pressure Device (OPEP) Offers The Potential For Combined Therapy

Jolyon Mitchell, Jason Suggett, Mark Nagel, Valentina Avvakoumova, Rubina Ali, Heather Schneider

A novel hand-held oscillating positive expiratory pressure (OPEP) therapy device (Aerobika*, Trudell Medical International (TMI), London, Canada) has been developed that can be used in conjuction with the AeroEclipse®-II breath actuated nebulizer (BAN, TMI). The Aerobika* OPEP device by itself has shown promising signs from lung imaging studies for the opening of secretion-obstructed airways. A follow-on study is reported here, evaluating how the OPEP-BAN configuration performs for the delivery of three different inhaled medications deliverable by nebulizer that might be used clinically in support of improving airway patency or reducing underlying inflammation. Combining the AeroEclipse-II® BAN with the Aerobika* OPEP therapy device reduced only slightly the overall aerosol delivery in terms of either total emitted mass (TEM) with all three formulations. The resulting aerodynamic particle size distribution (APSD) data were also slightly displaced to finer sizes by the presence of the OPEP device. These size shifts represent marginally increased retention of the coarser, less therapeutically beneficial particles in transit through the OPEP device, most likely due to inertial effects at the valve support as otherwise the flow path contains no obstructions or bends that might increase turbulent deposition. Hence, in terms of fine particle mass (FPM), the presence of the Aerobika* device resulted in no difference for two of the three formulations (paired t-test, p ≥ 0.38), and only a statistically marginal reduction for the third.

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