One-way nebulizer

Question

Hello,
many thanks for your information about the Porta-Neb. The one-way nebulizer is unfortunately only recommended for bronchodilators.
Are there further inhalation devices with one-way nebulizer (suitable for Colistin and DNAse?) or what do you recommend for a journey abroad in a host family, where the disinfection is too "complicated"?
Many thanks

Answer

Hello,
first of all I want to comment on your statement, that the one-way nebulizer Side-stream is only recommended for bronchodilators. It has also been tested in studies which showed that it can also be used with Colistin (as long as the concentration in the inhalation solution is correct) as well as with DNAse. Please see the literature at the end of this answer. One-way nebulizers are used seldomly for the inhalation of CF patients in Germany.
The recommendation of the work group physiotherapy of the Mukoviszidose e.V. [German patient organization] on the hygienic procedure of nebulizers can be found in the red manual "Physiotherapy in CF", which can be purchased over the Mukoviszidose e.V., In den Dauen 6, 53117 Bonn, Germany.
On the hompage of the Mukoviszidose e.V. (www.muko.info) you also find a list of qualified physiotherapists, which are trained in the specific questions of hygiene and inhalation in CF.

In general, cleaning of the reusable nebulizer is recommended after every inhalation. Concerning the sterilization with boiling/vaporization there is no uniform opinion / recommendation. The manufacturers lefleats recommend a daily sterilzation of the equipment. In the red manual of the German patient organization it says that sterilization should be performed at least once a week, better daily. From my experience and the data existing I would say that in case the nebulizer stays at one and the same patient, a disinfection can be abandonned as the circumstances require.
Here there is quite a good datapool from studies (e.g. Lindemann, Hüls, Monatsschrift Kinderheilkunde, 1994), which prove, that drying is the essential process.
Would say: a complete disassembly of the nebulizer, rinsing under running, hot water and a thorough drying of the single parts is sufficient, in case the nebulizer is not given to other patients.
In the above mentioned study, after the described rinsing (with a drying time of at least 4 hours resp. acceleration of the drying with a hair dryer) primarily uncritical hygienic findings were detected. In a not published study of the specialized clinic Satteldüne (Dittmar, Koch, Hüls, 2007, n= 169) we were either not able to detect any germs at the respecively rinsed and dried nebulizers.
For a journey, this could therefore be an alternative. Another alternative for your journey could be the reduction of the frequency of the sterilizing process from daily to once a week as the red manual of the German patient organization suggests.
In case you will not like to refrain from a thermical disinfection, nebulizers could also be cooked in a saucepen for 10-15 minutes with boiling water (beneath the usual disinfection with a vaporisator). In case of a sufficient number of reusable nebulizers this can be done once a day and represents for many patients an accepatable effort of time.
I hope I could have answered your question with this conclusively.
Yours sincerely,
B. Dittmar
physiotherapist


Literature:

-Shah PL et al., Eur Respir J. 1997 Jun;10(6):1261-6.An evaluation of two aerosol delivery systems for rhDNase.
- Allan Weber et. al., Pediatric Pulmonology 1997 23:249-260, Effect of Nebulizer Type and Antibiotic Concentration on Device Performance
- Geller et al., Pediatric Pulmonology 1998 25:83-87, Effect of Smaller Droplet Size of Dornase Alfa on Lung Function in Mild Cystic Fibrosis

12.08.2011