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Second-hand Aerosols in Acute Care
Therapist Exposure Risk and the Potential Impact of Device Selection.
*A Brief Review of the Literature on Second-hand Aerosols and the Effects of Occupational Exposure
• Danger in the Air, Proctor S., Advance for Respiratory Care
• Second-hand (S)-Albuterol: RT Exposure Risk Following Racemic
Practitioners, January 24, 2005.
Albuterol, Carnathan, et al. Respiratory Care, October 2001, V46,
In a review and expansion of the 2004 Chest article this publication states “respiratory therapists are at an increased risk of developing Whether exposure to nebulized medications such as Racemic asthma and asthma-related symptoms due to their involvement in Albuterol (RAC) contribute to increased incidence of asthma among the diagnosis and treatment of patients with respiratory conditions.” respiratory therapists is unknown. This in vivo study was designed In separate communications with the lead author, Advance reports to determine if the S and R isomers in RAC are detectable in the “Routine monitoring and care of patients can expose therapists to plasma of RTs. After a two-day work holiday blood was drawn at trace amounts of airborne agents that can trigger respiratory baseline, 2, 4, and 8 hours after exposure on days 1 and 4. Subjects symptoms and cause exacerbations of acute asthma;” and “Under were exposed to an average of 31mg of RAC for 4.3 hours each day.
current conditions, control of exhaust aerosols is paramount. … Results indicate RAC isomers increased with exposure. The study this includes use of scavengers, developing shut-off devices for concludes S isomer (proinflammatory effects) achieves higher plasma levels (1.6 to 2.5 fold) than R isomer (confers all off the bronchodilatory effects) and stays in the systemic circulation for a • Respiratory Health Survey of Respiratory Therapists, Dimich-Ward,
Study showed that RTs have an elevated prevalence of asthma • Asthma Risk and Occupation as a Respiratory Therapist,
diagnosis after they enter into the profession, and when compared Christiana DC, Kern DG. American Review Respiratory Disease 1993, to a control group of Physical Therapists, are more than twice as likely to develop respiratory symptoms. The study also found that A study of 2,086 respiratory therapists and 2,030 physical the administration of specific aerosolized medications was therapists found a history of physician diagnosed asthma in 16% of associated with an increased risk of asthma.
respiratory therapists and 8% of control subjects. When analysis was restricted to those who developed asthma after entry into the profession, RTs still had a significant excess, 7.4% versus 2.8%.
• Respiratory Therapists Twice as Likely to Have Asthma Than Other
Therapists – Exposure to Patient Treatments May Increase
This article concludes efforts should be directed to identifying Therapists’ Asthma Risk, Canadian Society of Respiratory Therapists
potential agents responsible for this form of occupational asthma.
R.S. Irwin MD, FCCP, President of the American College of Chest Physicians, quoted in the article states, “It is important for respiratory therapists and other medical professionals to recognize and understand the possible respiratory effects related to the administration of aerosolized substances and take appropriate steps to minimize their exposure to these medications during patient • Mist-ical Problem — Aerosolized Patient Exhaust May Jeopardize
Practitioner Airways, Advance for Respiratory Care Practitioners,
“. . . evidence suggests some RTs are at risk of developing occupational asthma when treating asthmatics. At issue is an unintended consequence of liquid nebulization.” Patrick Dunn, quoted in the article speculates, “The higher than average occupational asthma rate is probably related to passive inhalation of the exhaust of patients’ aerosolized medications. The reality is we need to change the way nebulizers are designed. You are giving the room a treatment.” Manufacturers have responded to this emerging need with filter attachments and nebulizers designed for low environmental loss such as the AeroEclipse® breath-actuated
nebulizer that produces aerosol in response to the patient’s AeroEclipse ® II BAN – Breath actuation proven
These studies used the AeroEclipse® Breath Actuated Nebulizer, not the AeroEclipse® II Breath
to reduce exposure to second-hand aerosol
Actuated Nebulizer (BAN) which is currently on the market. The AeroEclipse® BAN and AeroEclipse®
II BAN are equivalent in regards to in vitro performance.1 Changing the way nebulizers are designed can reduce the risk of second-hand aerosols.
The AeroEclipse® II Breath Actuated Nebulizer (BAN) is engineered to reduce the environmental loss of aerosol. The
literature supports the unique benefit of this SVN to reduce occupational exposure to second-hand aerosols.
Performance Comparison of Nebulizer Designs:
Constant-Output, Breath-Enhanced, and Dosimetric.
Aerosol Disposition Percent – Exhaled
Rau, et al. Respiratory Care, February 2004, Vol 49 No 2, to Ambient and Total Inhaled1
This study (also mass balance) evaluated the in vitro dose disposition (delivered to patient, lost to the equipment and lost to ambient) with 5 different nebulizer models representing 3 product types—constant output, breath-enhanced and dosimetric—using simulated normal, adult breathing. Theresults concluded, “The nebulizers we tested differ signifi- AeroEclipse® provided the largest inhaled drug mass and the
lowest loss to the ambient air …” (See chart at right.) 1 Study used 2.5mg Albuterol in 3ml fill volume.
Delivery of a Suspension Corticosteriod Formulation by
Small Volume Nebulizers: A Comparative Bench Study.
Micrograms of Budesonide
Mitchell, et al. ERS Congress, September 2001, Abstract#290.
• This study reports the in vitro delivery of 0.25% mg/ml
Budesonide suspension in two types of SVNs including the
AeroEclipse® and Pari LC®D under simulated adult breathing
conditions. The study reported total drug mass delivered to
the patient and the environment. (See chart at right.) The
authors conclude “The breath-actuation feature of the
AeroEclipse® SVN minimizes aerosol release to the
environment during exhalation, which may cause adverse
effects to both patient and health care provider.”
Breath Actuated AeroEclipse® II Nebulizer: Performance
Validation and Comparison to Competitive Products.
Percent of Environmental Loss (%)
• This study measures the in vitro environmental loss of the
AeroEclipse® II BAN and competitive other small volume
nebulizers including: Hudson MicroMist®, VixOne™, Airlife™
Charat to come
Brand Misty Max 10™ and the Salter 8900 Series. The study
reported total environmental loss for each nebulizer based on
2.5mg Albuterol dosing. (See chart at right.) The findings
conclude the AeroEclipse® II BAN delivers far less aerosol to
the environement. As the AeroEclipse® II BAN delivers
aerosol only on patient inspiration, the vast majority of the
aerosolized drug goes to the patient and not into the
environment.
1 ARE FIRST AND SECOND GENERATION, MECHANICALLY-OPERATED BREATH-ACTUATED NEBULIZERS (BAN) COMPARABLE BASED J. Schmidt, J. Pevler, C. Doyle, K. Wiersema, M. Nagel. J. Mitchell; Respiratory Drug Delivery, 2006: 817-819.
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