BACKGROUND: Jet nebulizers are commonly used for bronchodilator therapy in chronic obstructive pulmonary disease (COPD). High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer, on airway and lung function in patients with stable COPD. METHODS: This randomized non-inferiority crossover physiologic study enrolled patients with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-hour washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in forced expiratory volume at 1 second (FEV₁) from baseline. Secondary outcomes included changes in other respiratory related parameters and nebulization time compared between the two devices. RESULTS: Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV₁ from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] versus 20 [16-22] minutes, respectively; P < .001). CONCLUSIONS: Bronchodilator therapy via HFNC-VMN is not inferior to jet nebulizer for patients with stable COPD, and can significantly improve airway oscillometry mechanics, and decrease nebulization time compared to jet nebulizer.

中文翻译：

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高流量鼻插管在 COPD 中的支气管扩张功效：振动网状雾化器与喷射雾化器。

背景：喷射雾化器通常用于慢性阻塞性肺疾病（COPD）的支气管扩张剂治疗。带振动网状雾化器的高流量鼻插管（HFNC-VMN）是最近开发的系统；然而，很少有研究比较稳定型 COPD 中通过 HFNC-VMN 给予支气管扩张剂与喷射雾化器的疗效。本研究旨在比较通过 HFNC-VMN与喷射雾化器施用沙丁胺醇对稳定期 COPD 患者气道和肺功能的影响。方法：这项随机非劣效性交叉生理学研究纳入了稳定期慢性阻塞性肺病患者。通过 HFNC-VMN 或喷射雾化器以随机顺序雾化沙丁胺醇，交叉序列之间有 4 小时的冲洗期。在基线和每次干预后进行肺活量测定、肺容量和脉冲振荡测定。主要结果是 1 秒用力呼气量 (FEV ₁ ) 相对于基线的变化。次要结果包括两种设备之间其他呼吸相关参数和雾化时间的变化。结果：十七名受试者被纳入。_{HFNC-VMN 和喷射雾化器均使 FEV 1}较基线显着改善（分别为P = .005 和P = .002）。与基线相比，HFNC-VMN 后 5 Hz 和 20 Hz 时的呼吸阻力差异显着下降 ( P = .02)，而喷射雾化器后未观察到显着变化 ( P = .056)。与基线相比，HFNC-VMN 组的电抗面积和电抗共振频率均显着降低（分别为P = .035 和P = .03），并且 5 Hz 时的呼吸电抗显着增加（P = .02），表明改善了肺力学，喷射雾化器没有显着变化。HFNC-VMN 的雾化时间较短（分别为 6 [5-9]与20 [16-22] 分钟；P < .001）。结论：对于稳定期 COPD 患者，HFNC-VMN 支气管扩张剂治疗并不逊色于喷射雾化器，并且与喷射雾化器相比，可以显着改善气道示波力学，缩短雾化时间。