EFFECTS OF REPETITIVE USE AND CLEANING TECHNIQUES OF DISPOSABLE JET NEBULIZERS ON AEROSOL GENERATION

Study objective: Patients with cystic fibrosis use disposable jet nebu lizers for the self-administration of antibiotics, DNase, and bronchod ilators several times per day. Most patients elect to reuse their disp osable nebulizers. The purpose of this study was to determine if signi ficant changes in particle size distribution or output (mL/min) occurr ed with reuse. Design: In vitro studies were performed using four disp osable models and one durable jet nebulizer for up to 100 runs; measur ements of particle size and output were obtained at 10 run intervals, using saline solution alone, tobramycin, gentamicin, or a mixture of a lbuterol and cromolyn. Particle size determinations were made with a l aser diffraction analyzer. Results: There was no significant differenc e between the baseline performance of the four disposable models and t he durable Pari LC, when measuring particle size distribution of the a erosol; the Pari LC had an output rate two to three times higher than the four disposable models. For each of the four solutes tested, there was no clinically significant change in performance for up to 100 cyc les, when the nebulizers were properly cleaned between uses. Unwashed units containing tobramycin started to fail by 40 runs. Conclusions: W hen properly maintained, there was no trend of deterioration of perfor mance with repeated use of disposable nebulizers. Microbial contaminat ion was not addressed in this study and must be considered prior to re commendations for the reuse of disposable nebulizers.