Effect of driving pressure and nebulizer model on aerosol output during intermittent delivery with a dosimeter

Recent guidelines reinforce the need for a standardized technique during inhalational bronchoprovocation challenge testing. We investigated the effects of nebulizer model and dosimeter driving pressure on nebulizer output using a nebulized saline model. Four nebulizers (Hudson 1720, Salter 8900, Baxter Airlife, and DeVilbiss 644) were evaluated at two driving pressures (20 and 50 pounds per square inch [psi]) via a dosimeter (Salter 700) that delivered a 0.6-sec actuation. Output was determined gravimetrically after 20 actuations of saline at constant respiratory flow and volume. Output per actuation at 20 psi was 2.83 +/- 0.41 mg (mean +/- SD), 4.58 +/- 0.66, 4.75 +/- 0.42, and 4.75 +/- 1.37 for the Hudson, Salter, Baxter, and DeVilbiss, respectively, and 6.75 +/- 0.61 mg, 9.17 +/- 0.88, 9.42 +/- 1.32, and 9.83 +/- 1.75 at 50 psi. The Hudson delivered a lower volume than the other nebulizers (p < 0.0005). At 20 psi, output from the DeVilbiss had greater variability (coefficient of variation = 28.8%) compared to the Baxter (CV = 8.8%; p = 0.045). The output was greater at 50 psi than 20 psi for all models (p < 0.0005). These results demonstrate that, when choosing a nebulizer driven by a dosimeter, it is important to base that selection on published data describing aerosol output under different driving pressures.