Breath-synchronized nebulization diminishes the impact of patient-device interfaces (face mask or mouthpiece) on the inhaled mass of nebulized budesonide

The choice of patient-device interface (face mask or mouthpiece) influences the inhaled mass and the lung deposition of nebulized drugs. The use of a mouthpiece has been shown to double the lung deposition compared with use o f a face mask. We have determined the inhaled mass of budesonide using a je t nebulizer with mouthpiece in either a constant output or breath-synchroni zed mode in children. We have also determined the inhaled mass when the jet nebulizer is used with a nonsealing face mask in a constant output mode. T he study was a 1-day, randomized, crossover, single-center study involving 158 asthmatic children (age range 5.1-15.7 years). Nebulized budesonide was administered in three single nominal doses of 1.0 mg by means of a jet neb ulizer. The inhaled mass of budesonide was defined as the amount of drug de posited on filters positioned between the nebulizer and the mouthpiece or f ace mask. The mean inhaled mass of budesonide from different age groups ran ged from 17.1% to 21.6% of the nominal dose with breath-synchronized nebuli zation with a mouthpiece. With constant output nebulization with a mouthpie ce, the mean inhaled mass ranged from 8.9% to 12.2%, and with a nonsealed f ace mask the mean inhaled mass ranged from 5.0% to 6.9%. For children using jet nebulizers with mouthpiece, breath-synchronized nebulization appears t o be superior to conventional constant output nebulization. The use of jet nebulizers with nonsealing face masks should be avoided.