Breath-actuated nebulizer for patients with exacerbation of COPD: efficiency and cost.

Aerosolized bronchodilators have been the first line therapy for exacerbation of COPD (ECOPD) to relieve bronchoconstriction and shortness of breath. Administration of bronchodilators in acute settings is commonly done with small-volume nebulizers, which deliver higher inhaled drug mass, compared to other devices such as pressurized metered-dose inhaler (pMDI) and dry powder inhaler (DPI).1 Small-volume nebulizers (SVNs), according to design, are categorized as constant-output, breath-enhanced, and dissymmetric (or breath-actuated).2 The breath-actuated nebulizer (BAN) produces aerosol during inspiration, when the negative pressure generated by the patient is sufficient to pull the actuator down into position, sealing the jet nozzle to allow medication to be drawn from the reservoir, generating aerosol. Studies report greater inhaled dose, less environmental contamination, and smaller particle size with the BAN, associated with 2–3 fold increased treatment time, than with other types of jet nebulizers.2,3 In a study in this issue of RESPIRATORY CARE, Haynes compared the BAN to continuous flow SVNs in patients with ECOPD.4 This represents the first study examining the clinical response of combined short acting adrenergic and anticholinergic bronchodilators from the BAN and the SVN in ECOPD by assessing inspiratory capacity (IC) and dyspnea via the Borg scale.