Recommended Citation
Reindl L, Bazelak S, Knox K, et al. Vibrating Mesh vs. Jet Nebulizers for High-Dose Albuterol in COPD Exacerbations: A Non-Inferiority Study. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Inhaled β-agonists are central to the management of COPD exacerbations, and high-dose albuterol is often administered via jet nebulizer (JN) to ensure adequate bronchodilation. Vibrating mesh nebulizers (VMNs) may enhance aerosol delivery efficiency and substantially reduce treatment time compared to JNs, but evidence comparing these devices for high-dose therapy in COPD exacerbations remains limited.
Purpose:
This quasi-experimental, before-and-after non-inferiority study evaluated clinical outcomes associated with transitioning from continuous JN to VMN delivery of high-dose albuterol in the emergency department (ED).
Methods:
This institutional review board–approved study was conducted in the ED of a tertiary care hospital. Historically, high-dose albuterol (>5 mg) was delivered continuously by JN over approximately 60 minutes at doses of 10–15 mg. In December 2024, a protocol change standardized the use of a VMN (Aerogen Solo Ultra or inline) for all high-dose treatments, with dosing modified to 5 mg or, in cases of severe respiratory distress, 10 mg, delivered over approximately 10 minutes. Patients with COPD exacerbations who received high-dose albuterol during December 2023–January 2024 (JN arm) and December 2024–January 2025 (VMN arm) were included. Analyses were intent-to-treat. The primary outcome was needed for repeat albuterol treatment in the ED, with a non-inferiority margin of 5%.
Results:
A total of 132 subjects were included (JN n=83; VMN n=49). One patient in the VMN arm crossed over to JN delivery. Repeat albuterol treatment was required in 16% of VMN patients versus 29% of JN patients (p=0.01 for non-inferiority). Secondary clinical outcomes, including hospital admission, need for ventilatory support, and ED length of stay, were similar between groups.
Conclusion:
In adults presenting to the ED with COPD exacerbation requiring high-dose nebulized albuterol, rapid VMN treatment is non-inferior to continuous JN delivery in preventing the need for repeat bronchodilator therapy. VMN delivery may allow faster treatment without compromising clinical effectiveness.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Oral/Podium Presentation
Vibrating Mesh vs. Jet Nebulizers for High-Dose Albuterol in COPD Exacerbations: A Non-Inferiority Study
Background/Significance:
Inhaled β-agonists are central to the management of COPD exacerbations, and high-dose albuterol is often administered via jet nebulizer (JN) to ensure adequate bronchodilation. Vibrating mesh nebulizers (VMNs) may enhance aerosol delivery efficiency and substantially reduce treatment time compared to JNs, but evidence comparing these devices for high-dose therapy in COPD exacerbations remains limited.
Purpose:
This quasi-experimental, before-and-after non-inferiority study evaluated clinical outcomes associated with transitioning from continuous JN to VMN delivery of high-dose albuterol in the emergency department (ED).
Methods:
This institutional review board–approved study was conducted in the ED of a tertiary care hospital. Historically, high-dose albuterol (>5 mg) was delivered continuously by JN over approximately 60 minutes at doses of 10–15 mg. In December 2024, a protocol change standardized the use of a VMN (Aerogen Solo Ultra or inline) for all high-dose treatments, with dosing modified to 5 mg or, in cases of severe respiratory distress, 10 mg, delivered over approximately 10 minutes. Patients with COPD exacerbations who received high-dose albuterol during December 2023–January 2024 (JN arm) and December 2024–January 2025 (VMN arm) were included. Analyses were intent-to-treat. The primary outcome was needed for repeat albuterol treatment in the ED, with a non-inferiority margin of 5%.
Results:
A total of 132 subjects were included (JN n=83; VMN n=49). One patient in the VMN arm crossed over to JN delivery. Repeat albuterol treatment was required in 16% of VMN patients versus 29% of JN patients (p=0.01 for non-inferiority). Secondary clinical outcomes, including hospital admission, need for ventilatory support, and ED length of stay, were similar between groups.
Conclusion:
In adults presenting to the ED with COPD exacerbation requiring high-dose nebulized albuterol, rapid VMN treatment is non-inferior to continuous JN delivery in preventing the need for repeat bronchodilator therapy. VMN delivery may allow faster treatment without compromising clinical effectiveness.
Affiliations
Aurora St. Luke's Medical Center