Breath-actuated nebulizer versus small-volume nebulizer: efficacy, safety, and satisfaction.

The breath-actuated nebulizer (BAN, AeroEclipse, Trudell Medical International, London, Ontario, Canada) has been available as an aerosol delivery option for several years. This small-volume jet nebulizer is primarily designed to generate aerosol during inspiration in response to the patient’s inspiratory flow triggering the opening valve.1,2 Some studies report that BAN provides smaller particles and greater dose delivery efficiency than continuous jet nebulizers.2–5 This increased drug efficiency is associated with decreased release of aerosol to the atmosphere, but comes at the cost of increased treatment time, by 2–3-fold with standard unit doses.2 Despite an increasing interest in use of the BAN in hospitals, clinical studies comparing use of BAN with other nebulizers are limited. In a study in this issue of RESPIRATORY CARE, Arunthari and colleagues compared BAN to the standard continuous small-volume nebulizer (SVN) in terms of safety, efficacy, and satisfaction. This is the first study examining not only the safety and efficacy of BAN and SVN in adults with obstructive airway diseases, but also patient and respiratory therapist (RT) satisfaction with these nebulizers.6 This study employed a randomized cross-over design, which is increasingly popular in clinical research, due to its advantage of randomly assigning 2 arms of the study (BAN and SVN) to each subject. This design exposes each patient to each alternative device, and unbalanced groups are less of an issue.