Impact of different nebulisers' connections on aerosol therapy

Int J Clin Pract. 2021 Oct;75(10):e14493. doi: 10.1111/ijcp.14493. Epub 2021 Jun 21.


Background: Aerosol therapy has the advantage of a higher safety because of the local deposition of inhaled medication to the lung; however, the main drawback is the low and variable amount of delivered drug to patients. Hence, this study aimed to investigate the effect of different accessory connections on aerosol delivery from different nebulisers.

Method: This study consisted of 3 main models: in vitro, in vivo and ex vivo models. In vitro model, 6 nebulisers (3 Jet (Dolphin (2030 2001), Philips (SideStream) and Tylenol (TL009002)) and 3 vibrating mesh nebulisers (VMNs) (Aerogen Pro, Solo, an Nivo)) were charged with 5 mg/2 mL salbutamol and connected to 2 different connections (T-piece and Circulaire II Hybrid) with an inhalation filter attached to a breathing simulator. Inhaled amounts of drug (inhalation filter) and that remained inside nebuliser were measured. Concerning ex vivo and in vivo models, 24 subjects were involved in the study and they received 5 mg/2 mL salbutamol from 1 Jet nebuliser and 1 VMNs using both connections. Two urine samples were collected post 30 minutes and pooled 24 hours urine collection. For the ex vivo model, inhaled amounts of salbutamol were collected on filters placed between the subjects and the nebuliser.

Results: Inhaled amounts of salbutamol expressed by the amount of drug detected on inhalation filters (for both in vitro and ex vivo) were significantly higher from both Jet and VMNs connected to the Circulaire II Hybrid connection than that released from nebulisers connected to T-piece. VMNs delivered a higher amount compared with jet nebulisers. The amount released from jet nebulizers were variables, unlike VMNs. Regarding in vivo results, amounts of drug detected in 30 minutes urine samples were consistent with in vitro and ex vivo models reflecting higher and significant amounts of drug delivered to the patient's lung for Circulaire II Hybrid connection compared with T-piece regarding both nebulisers.

Conclusion: Using a valved chamber with jet and VMNs significantly improved the inhaled amount of the emitted aerosol. VMNs were more effective than jet nebulisers with both connections.

MeSH terms

  • Administration, Inhalation
  • Aerosols
  • Albuterol
  • Bronchodilator Agents*
  • Humans
  • Nebulizers and Vaporizers*


  • Aerosols
  • Bronchodilator Agents
  • Albuterol