Effective application of bronchodilator aerosols from metered-dose inhalers (MDI) via resuscitator-bag and adapter

Abstract

We developed an adapter enabling the application of therapeutic aerosols from metered-dose inhalers (MDI) via a resuscitator bag. This modification permits the bag to act as a spacer which is commonly acknowledged to be a means of improving the efficiency of inhaled aerosolized drugs by reducing impaction in the upper airways and improving the intrapulmonary deposition of particles small enough for intraalveolar penetration. The normal function of the resuscitator bag remains unchanged enabling use with intubated patients receiving artificial ventilation.

Methods: A total of 24 patients receiving a bronchodilator response test were treated with 200 microg salbutamol from a MDI combined with either a spacer or our bag. Bodyplethysmography and a lung-function-test were performed before and after treatment.

Results: Both treatments showed a statistically significant reduction of airways resistance. However, no significant difference between the bag and the spacer could be detected.

Conclusions: We conclude that the modified resuscitator-bag is well suited for the inhalative application of drugs by making use of the established MDI-spacer principle. Use of our modified bag will offer emergency preclinical therapy of bronchospasm for patients in need of rapid effective relief who were formerly dependent on intravenous treatment. Application in anaesthesia and intensive care also seems possible.