RhDNase I aerosol deposition and related factors in cystic fibrosis

Characterization of the laryngeal jet using phase Doppler interferometry

The purpose of this study was to characterize the effects of the laryngeal jet on inhalation air flows in the trachea, and to extend these ideas to further an understanding of aerosol deposition in this region. Phase Doppler Interferometry was used to characterize axial velocity and turbulence intensity contours in the tracheal section of a cadaver-based larynx-trachea model. An array of 30 measurements was made at each of 6 downstream planes within the tracheal portion of the model (immediately downstream of the larynx, and at 0.5, 1, 2, 3, and 4 diameters further downstream). The flow was characterized for steady state flow at three Reynolds numbers (1250, 1700, and 2800). The Re = 1250 case approximates the inhalation of a 6-year-old child. Reverse flows with significant velocities were noted in the anterior trachea within one diameter downstream of the larynx, for all three flow cases. The cross sectional area of the reverse flow regions was larger for the lower Reynolds number cases. These reverse flows are a consequence of the nearly triangular shape of the lumen between the vocal folds in the larynx and constitute a potential deposition mechanism. High levels of axial turbulence intensity were noted near the anterior/left tracheal walls within one diameter downstream of the larynx. This indicates the potential for deposition due to turbulence in this region. Turbulence levels were still significant after four downstream diameters, indicating the potential for turbulent deposition at positions further downstream, including the bronchial tree where passage diameters are smaller. Contrary to expectations, turbulence levels were approximately 20% higher for the Re = 1250 case compared to the Re = 2800 at the furthest downstream locations (with 99% confidence). This is likely due to the complex nature of the confined jet flow.

Lung delivery of aerosolized dextran

The ability of nebulizers to deliver dextran (nominal molecular mass, 4,000 g/mol) to the lung as an inhaled aerosol is evaluated by in vitro experimental methods and mathematical models. Dextran in isotonic saline was aerosolized by four nebulizer types (Pari LC STAR, Hudson T-Updraft II, Acorn II, and Sonix 2000) at dextran concentrations </= 400 mg/ml and with 2.5- and 4-ml volume fills. Aerosols inhaled during breath simulation were characterized by in-line phase Doppler anemometry, filter collection, osmometry, and gravimetry. Mathematical models were used to estimate amounts of the characterized aerosols depositing in the different regions of lung models, and mathematical models of mucous thickness were then developed to estimate initial concentrations of the depositing dextran in the mucus of each conducting airway generation. Models of three subjects (4 yr old, 8 yr old, and adult) were used. The high viscosity of the dextran solutions tested (up to seven times that of water) negatively impacts nebulization, and results in poor performance with most delivery systems tested. Our results suggest that airway mucosal dextran concentrations associated with efficacy in previous animal and in vitro models are achievable with reasonable delivery times (</= 12 min) with only one of the delivery systems/formulations tested: the Pari LC STAR nebulizer, using a 2. 5-ml volume fill and a dextran concentration of 200 mg/ml.

Impact of constant and breath-synchronized nebulization on inhaled mass of nebulized budesonide in infants and children

The aim of the present study was to compare the output of a breath-synchronized jet nebulizer to a conventional constant output nebulizer over a fixed period of time in terms of inhaled mass of budesonide, i.e., the amount of budesonide deposited on a filter interposed between the nebulizer and the face mask. One hundred and sixty-five asthmatic children (103 boys) were enrolled in this open, randomized, crossover trial. Their age ranged from 6 months to 7.9 years, height from 69 to 132 cm, and weight from 8.2 to 31.3 kg. Their duration of asthma ranged from less than 1 to 7 years. Budesonide suspension, 0.5 mg mL-1, 2 mL, was used. With 5 min of constant output nebulization, the mean inhaled mass of budesonide in percent of the nominal dose was 11.4% in the youngest children and 14.9% in the 7-year-old children. Expressed in percent of the total output of budesonide, i.e., the amount that left the nebulizer as an aerosol, the inhaled mass ranged from 34.6-48.6%. Thus, 51.4-65.4% of the total output was deposited on the expiratory filter. With 5 min of breath-synchronized nebulization, the mean inhaled mass ranged from 10.5-14.9% of the nominal dose. For the youngest patients less than 3-4 years of age, it was approximately 80-90% of the total output. For the older patients the inhaled mass was approximately 95% of the total output, i.e., only small amounts of budesonide were deposited on the expiratory filter. For both modes of nebulization the between-subject variation in inhaled mass was large: up to 6-fold in the young children and 3-4-fold in the older ones. The results of the present study showed that the inhaled mass of budesonide was significantly age-dependent with both modes of nebulization, i.e., the inhaled mass was less in younger children. Breath-synchronized nebulization resulted in reduced waste of drug during expiration.