• Ephraim Bar-Yishay, Avraham Avital, Chaim Springer, and Israel Amirav.
• Institute of Pulmonology, Hadassah University Hospital and Hebrew University-Hadassah Medical School, Jerusalem, Israel. ephraimby@gmail.com
• Isr Med Assoc J. 2011 Jan 1; 13 (1): 39-43.

BackgroundIn infants, small volume nebulizers with a face mask are commonly used to facilitate aerosol therapy. However, infants may be disturbed by mask application, causing poor mask-to-face seal and thus reducing the dose delivered.ObjectivesTo compare lung function response to bronchodilator nebulization via two delivery devices: hood versus mask.MethodsWe studied 26 recurrently wheezy infants aged 45.8 weeks (95% confidence interval 39.6-52.0). Inhalations of 0.30 mg/kg salbutamol were administered in two alliqots 30 minutes apart using mask and hood in alternating order (M+H or H+M). Response to inhalations was measured by maximal expiratory flows at functional residual capacity (V'maxFRC) at 5 minute intervals after each dose, and area under the V'maxFRC curve (AUC) was documented.ResultsA small but significant response to salbutamol was observed following the second inhalation with V'maxFRC, improving by 31.7% (7.2-56.2, P (0.02) and AUC by 425% x min (-154, 1004; P < 0.02). The improvement following salbutamol was similar by both delivery modalities but with a small but significantly better response when H was used after M (P < 0.01).ConclusionsNebulized salbutamol induced a variable but positive response in wheezy infants. Salbutamol via hood was as effective as conventional face mask delivery. Since it is simple and patient-friendly, it could replace the face mask method particularly with uncooperative infants.

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