What is the difference between budesonide and albuterol

The SideStream has a traditional continuous output, although enriched with an open-vent system through which extra air may be drawn into the nebulizer reservoir; VentStream-Pro is a breath-enhanced nebulizer.

The aim of this study was to evaluate the aerosol consequences of mixing budesonide or becomethasone with albuterol and ipratropium. Table 1 describes the tested drugs. One combined drug liquid consisted of 0. The other consisted of 0. The mixtures were prepared in accordance with our usual clinical practice and the product-information sheet. All the experiments used a fill volume of 4. I unsystematically chose 6 SideStream and 6 VentStream-Pro nebulizers from standard commercial lots and water-tested them to determine intra-lot aerosol-output variability.

I then selected the 2 units of each brand with the lowest aerosol-output variability at the mid-to-high aerosol-output range. Both nebulizers were driven with the double-piston AirClinic compressor. All experiments were carried out in triplicate, and the reported values are means from 3 experiments.

I weighed the nebulizer with the reservoir empty, after charging the reservoir with 4. I deemed nebulization complete when no visible aerosol had been produced for 60 seconds, without any shaking or tapping of the nebulizer. After charging the nebulizer, I connected the nebulizer to the filter, and the filter to the vacuum pump, turned on the vacuum pump, and after 10 seconds switched on the nebulizer compressor.

After nebulization, the residual drug liquid in the nebulizer reservoir and the circuit was also collected, mixed for homogeneity, and assayed. The medication concentrations were calculated based on standard calibration curves prepared with 8 known drug concentrations. The nominal dose was calculated based on the drug concentration indicated in the product-information sheet.

Preliminary experiments indicated that, to prevent sample overload on the impactor stages, the optimal nebulization times were 4 min and 9 min, respectively, when the drugs were nebulized separately and mixed. The impactor throat and each impactor stage plate were eluted with 0. I used 2-way analysis of variance to determinate differences between the nebulizers and between the different formulations.

For the different formulations with the same nebulizer, and for the different nebulizers with same formulation, I compared aerosol output, nebulization time, drug output, and aerodynamic characteristics. Table 2 shows the aerosol output and nebulization time data. The SideStream and VentStream-Pro aerosol output never significantly differed with the same formulation except for ipratropium when nebulized alone. Table 3 shows the drug output and residual liquid volume data.

There was no difference between nebulizers in the amount of drug retained in the reservoir. Drug-mixing had a trend, although not always significant, of reduced drug output with the SideStream, whereas the results with VentStream-Pro were more variable. Table 4 shows the mass median aerodynamic diameter and geometric standard deviation data.

Drug-mixing did not significantly change the geometric standard deviation, except for budesonide with SideStream. Figure 2 shows the respirable-fraction data. Figure 3 shows the respirable-mass data. Overall, drug-mixing tended to reduce the respirable mass with SideStream, but not always with VentStream-Pro.

Respirable fraction expressed as percent of nominal dose. Respirable mass, expressed as percent of nominal dose. Comparison of one drug alone versus in combination with other drugs, with the same nebulizer. The primary aim of this study was to evaluate whether mixing of either budesonide or beclomethasone with albuterol and ipratropium modified the drug output or aerosol particle size distribution. In the past, aerosol output was evaluated only by weighing the nebulizer before and after nebulization.

It was known that the gravimetric measurement, independently of volume fill or concentration of the solvent, overestimates the output of albuterol, compared to the filtering method. By gravimetrics I found that the formulations containing corticosteroids, both alone and mixed, had a greater aerosol output, but it was only more solvent, not more drug, that was nebulized, as shown by the filtering-method results.

I used continuous flow in these experiments, which is a study limitation because constant flow does not mimic the varying flow of the in vivo respiratory cycle. The importance of using a simulated breathing pattern rather than continuous flow in the assessment of nebulizer performances was clearly shown with budesonide, even if that difference was less evident with a breath-enhanced nebulizer such as VentStream-Pro. Nebulizing 2 mL of budesonide 0.

More importantly, drug-mixing did not severely compromise drug output, which always remained good. Drug collection on the inspiratory filter represents all aerosol drug delivered to the patient, not just that deposited in the lungs. Only droplets less than about 5. Mixing the drugs tended to increase droplet size, but not always with VentStream-Pro. However, the MMAD of the studied drugs, nebulized alone or mixed, was always acceptable. This finding is in accordance with another recent in vitro study, in which a mixture of beclomethasone and albuterol, nebulized with the BimboNeb and the Nebula nebulizer systems, had mean MMADs of 6.

Little other information is available about mixing of corticosteroids with bronchodilators. Di Berardino and Scaglione 27 reported a substantial reduction in respirable fraction when albuterol was mixed with either beclomethasone or flunisolide, but they performed particle size analysis with laser diffraction, which is unsuitable for suspensions such as corticosteroids, because it cannot distinguish between droplets that contain drug and those constituted only of solvent.

It is noteworthy that mixing beclomethasone or budesonide with the bronchodilators did not substantially reduce the respirable mass, as was previously supposed. This problem did not occur in the present study, as I always used the same fill volume. However, with regard to the respirable mass, because significant differences between nebulizers have been observed for the corticosteroid and bronchodilator mixtures, I suggest limiting these findings only to the SideStream and VentStream-Pro used with the AirClinic compressor.

Further in vitro studies should assess whether other nebulizers are suitable to nebulize drug mixtures that contain corticosteroids, and the consequences of drug-mixing on pH, osmolality, turbidity, and other physical and chemical properties.

Beasley R, et al. N Engl J Med. Wong GWK. Wong reports he is an associate editor for NEJM. Healio News Pulmonology Asthma. American Thoracic Society International Conference. Read next. May 19, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on. You've successfully added to your alerts. If you have a history of heart disease, hypertension, hyperthyroidism or pheochromocytoma, it may not be safe for you to take Albuterol.

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