Rationale
Inhaled tobramycin is recommended for use in cystic fibrosis patients for treatment of Pseudomonas aeruginosa infection. This in vitro study looked at antibiotic delivery using a BA nebulizer/compressor system and two BE nebulizer/compressor systems.
Method
AeroEclipse® XL BAN™ Nebulizer (BA) with Ombra® Table Top Compressor was evaluated in breath actuated mode with 300 mg tobramycin (5 mL) and an adult tidal breathing waveform (tidal volume = 500 mL; duty cycle = 33%; breaths/minute = 13) delivered by a breathing simulator (ASL 5000). A filter at the nebulizer mouthpiece captured emitted aerosol at minute intervals until onset of sputter. Total Mass (TM) delivered was determined after assaying for tobramycin by HPLC. Parallel measurements of Fine Droplet Fraction <5.4μm diameter (FDF<5.4μm ) were made with each nebulizer, sampling emitted aerosol via a chilled Next Generation Pharmaceutical Impactor. Fine Droplet Mass (FDM<5.4μm ) was determined as the product of TM and FDF<5.4μm. All components of the system were assayed for medication and the difference between mass recovered and mass placed within the nebulizer at start of test was deemed to be Environmental Loss expressed as a percentage of initial dose. Similar measurements were undertaken with PARI LC PLUS† (BE) with DeVilbiss† Pulmo-Aide† compressor and with PARI Vios† compressor.
Results
FDM<5.4μm/min data was similar for the BA/compressor system and one of the BE/compressor systems. However, FDM<5.4μm for the BA/compressor system was higher than both BE/ compressor systems. (mean ± SD; n= 5 devices/group)
Conclusion
• The breath actuated system offers similar or better delivery of antibiotic than both breath enhanced systems with the added benefit of markedly reduced fugitive emissions for a safer nebulizer environment.
• This study also highlights the difference in aerosol delivery between compressors used to operate the same type of nebulizer.
• On the basis of this study, clinicians could select AeroEclipse® XL BAN™ Nebulizer with Ombra® Table Top Compressor for tobramycin delivery as an alternative to the PARI LC PLUS† Nebulizer with DeVilbiss† Pulmo-Aide† compressor or with PARI Vios† compressor recommended on tobramycin monographs