Okay, I've narrowed it down to three finalists: eFlow, Aeroneb Go, and PARI Trek S. I'm waiting for return emails from Aeroneb and PARI regarding a couple general things, but also specifically their effectiveness with Albuterol, Pulmozyme, and TOBI.
Here's where I'm a little confused and hopefully someone can help. I know that particle size is very important and specifically TOBI "particles in the range of 1 to 5 µm in diameter are most desirable for pulmonary delivery" (<a target=_blank class=ftalternatingbarlinklarge href="http://pediatrics.aappublications.org/cgi/content/full/106/6/e89">http://pediatrics.aappublicati...content/full/106/6/e89</a>). I couldn't find any reference for a preferred Pulmozyme particle size. There seems to be concern that the PARI Trek S isn't suitable for Pulmozyme and/or TOBI due to the particle size it produces, however according to the Trek S brochure (<a target=_blank class=ftalternatingbarlinklarge href="http://pari.com/pdd/pdfs/TREK_S_BROCHURE.pdf">http://pari.com/pdd/pdfs/TREK_S_BROCHURE.pdf</a> ) it produces a particle size of 3.8 µm using the "Sprint" med cup and the PRONEB Ultra II (<a target=_blank class=ftalternatingbarlinklarge href="http://pari.com/pdd/pdfs/ULTRA_II_BROCHURE.pdf">http://pari.com/pdd/pdfs/ULTRA_II_BROCHURE.pdf</a> ), which is a specifically approved compressor listed by Pulmozyme (<a target=_blank class=ftalternatingbarlinklarge href="http://www.pulmozyme.com/taking/nebulizers.jsp">http://www.pulmozyme.com/taking/nebulizers.jsp</a> ), produces a particle size of 3.5 µm using the "Sprint" med cup. For what it's worth, Aerneb (<a target=_blank class=ftalternatingbarlinklarge href="http://www.aerogen.com/uploads/File/Go/Aeroneb%20Go%20Boilable%20Brochure.pdf">http://www.aerogen.com/uploads...oilable%20Brochure.pdf</a> ) claims 3.6 µm and eFlow 3.8 µm (however that number is specifically for TOBI according to a cut and paste research section in NoExcuses eFlow section, which everyone needs to check out if they're interested in eFlow because it has more information on one page then I could find on any internet sites combined).
So, here's my confusion, is the Trek S really not desirable for regular use with these meds, or has the compressor/med cup efficiency recently been improved to the point that it's now okay for regular use, or am I missing something all together?
Just got the return email from PARI and they of course couldn't give any specific particle size figures for Pulmozyme and/or TOBI but did mention the Trek S is about 18% less powerful then the Ultra II and directed me to reference a 2006 CFF article (<a target=_blank class=ftalternatingbarlinklarge href="http://www.cff.org/UploadedFiles/LivingWithCF/StayingHealthy/LungHealth/WhichNebulizer/WhichNebulizerForWhichDrug.pdf">http://www.cff.org/UploadedFil...ulizerForWhichDrug.pdf</a> ) on matching nebulizers with medicines. So, unless I'm missing something, it seems like the Trek S is acceptable with the right med cup, but would probably take a few minutes longer due to its less powerful compressor.
My last bit of confusion comes from something a nurse said once that I can't seem to verify anywhere. I'll ask our primary CF doctor later, but this nurse (who's medical knowledge in general wasn't that great) led me to believe that two of the medicines (can't remember which one's, Tobi/Pulmozyme?) could never share the same nebulizer med cup, even if properly sanitizing in between using each one. I'm not talking about mixing the meds into one cup, but using one cup for all the meds and cleaning in between each med. Is this true? If so, does the eFlow and or Aeroneb Go come with different med cup inserts to prevent cross contamination?
Anyway, thanks Candice, Jamie, AnD, and AJ for all the input, it's very helpful and I appreciate you sharing your thoughts and experiences. And NoExcuses, your blog is outstanding, especially all the information you've compiled on eFlow. All of it is extremely useful and helpful and I hope you continue to blog-on well into the future. BTW, congratulations on your internship, I hope it exceeds your expectations and leads to many future successes.
Thanks again,
D&C
Here's where I'm a little confused and hopefully someone can help. I know that particle size is very important and specifically TOBI "particles in the range of 1 to 5 µm in diameter are most desirable for pulmonary delivery" (<a target=_blank class=ftalternatingbarlinklarge href="http://pediatrics.aappublications.org/cgi/content/full/106/6/e89">http://pediatrics.aappublicati...content/full/106/6/e89</a>). I couldn't find any reference for a preferred Pulmozyme particle size. There seems to be concern that the PARI Trek S isn't suitable for Pulmozyme and/or TOBI due to the particle size it produces, however according to the Trek S brochure (<a target=_blank class=ftalternatingbarlinklarge href="http://pari.com/pdd/pdfs/TREK_S_BROCHURE.pdf">http://pari.com/pdd/pdfs/TREK_S_BROCHURE.pdf</a> ) it produces a particle size of 3.8 µm using the "Sprint" med cup and the PRONEB Ultra II (<a target=_blank class=ftalternatingbarlinklarge href="http://pari.com/pdd/pdfs/ULTRA_II_BROCHURE.pdf">http://pari.com/pdd/pdfs/ULTRA_II_BROCHURE.pdf</a> ), which is a specifically approved compressor listed by Pulmozyme (<a target=_blank class=ftalternatingbarlinklarge href="http://www.pulmozyme.com/taking/nebulizers.jsp">http://www.pulmozyme.com/taking/nebulizers.jsp</a> ), produces a particle size of 3.5 µm using the "Sprint" med cup. For what it's worth, Aerneb (<a target=_blank class=ftalternatingbarlinklarge href="http://www.aerogen.com/uploads/File/Go/Aeroneb%20Go%20Boilable%20Brochure.pdf">http://www.aerogen.com/uploads...oilable%20Brochure.pdf</a> ) claims 3.6 µm and eFlow 3.8 µm (however that number is specifically for TOBI according to a cut and paste research section in NoExcuses eFlow section, which everyone needs to check out if they're interested in eFlow because it has more information on one page then I could find on any internet sites combined).
So, here's my confusion, is the Trek S really not desirable for regular use with these meds, or has the compressor/med cup efficiency recently been improved to the point that it's now okay for regular use, or am I missing something all together?
Just got the return email from PARI and they of course couldn't give any specific particle size figures for Pulmozyme and/or TOBI but did mention the Trek S is about 18% less powerful then the Ultra II and directed me to reference a 2006 CFF article (<a target=_blank class=ftalternatingbarlinklarge href="http://www.cff.org/UploadedFiles/LivingWithCF/StayingHealthy/LungHealth/WhichNebulizer/WhichNebulizerForWhichDrug.pdf">http://www.cff.org/UploadedFil...ulizerForWhichDrug.pdf</a> ) on matching nebulizers with medicines. So, unless I'm missing something, it seems like the Trek S is acceptable with the right med cup, but would probably take a few minutes longer due to its less powerful compressor.
My last bit of confusion comes from something a nurse said once that I can't seem to verify anywhere. I'll ask our primary CF doctor later, but this nurse (who's medical knowledge in general wasn't that great) led me to believe that two of the medicines (can't remember which one's, Tobi/Pulmozyme?) could never share the same nebulizer med cup, even if properly sanitizing in between using each one. I'm not talking about mixing the meds into one cup, but using one cup for all the meds and cleaning in between each med. Is this true? If so, does the eFlow and or Aeroneb Go come with different med cup inserts to prevent cross contamination?
Anyway, thanks Candice, Jamie, AnD, and AJ for all the input, it's very helpful and I appreciate you sharing your thoughts and experiences. And NoExcuses, your blog is outstanding, especially all the information you've compiled on eFlow. All of it is extremely useful and helpful and I hope you continue to blog-on well into the future. BTW, congratulations on your internship, I hope it exceeds your expectations and leads to many future successes.
Thanks again,
D&C