Bronchodilator Efficacy of High-Flow Nasal Cannula in COPD: Vibrating Mesh Nebulizer Versus Jet Nebulizer

Itthiphat Arunsurat; Nuttapol Rittayamai; Benjamas Chuaychoo; Suwat Tangchityongsiva; Simaporn Promsarn; Somruthai Yuenyong; Chung-Wai Chow; Laurent Brochard

doi:10.4187/respcare.11139

Bronchodilator Efficacy of High-Flow Nasal Cannula in COPD: Vibrating Mesh Nebulizer Versus Jet Nebulizer

Respir Care. 2024 Jan 24;69(2):157-165. doi: 10.4187/respcare.11139.

Authors

Itthiphat Arunsurat¹, Nuttapol Rittayamai², Benjamas Chuaychoo¹, Suwat Tangchityongsiva¹, Simaporn Promsarn¹, Somruthai Yuenyong¹, Chung-Wai Chow³, Laurent Brochard⁴

Affiliations

¹ Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. nuttapol.rit@mahidol.ac.th.
³ Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and Toronto Lung Transplant Programme, Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada.
⁴ Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 37607815
PMCID: PMC10898469 (available on 2025-02-01)
DOI: 10.4187/respcare.11139

Abstract

Background: Jet nebulizers are commonly used for bronchodilator therapy in COPD. High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer on airway and lung function in subjects with stable COPD.

Methods: This randomized non-inferiority crossover physiologic study enrolled subjects with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-h washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in FEV₁ from baseline. Secondary outcomes included changes in other respiratory-related parameters and nebulization time compared between the 2 devices.

Results: Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV₁ from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] min vs 20 [16-22] min, respectively, P < .001).

Conclusions: Bronchodilator therapy via HFNC-VMN was not inferior to jet nebulizer for subjects with stable COPD and can significantly improve airway oscillometry mechanics and decrease nebulization time compared to jet nebulizer.

Keywords: COPD; aerosol therapy; high-flow nasal cannula; pulmonary function test; vibrating mesh nebulizer.

Publication types

Equivalence Trial
Randomized Controlled Trial

MeSH terms

Administration, Inhalation
Albuterol
Bronchodilator Agents*
Cannula
Cross-Over Studies
Humans
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive* / drug therapy
Respiratory Aerosols and Droplets

Substances

Albuterol
Bronchodilator Agents