Effects of vibrating mesh nebulisation in patients with COPD during non-invasive ventilation

Background: Vibrating mesh nebulisers (VMN) show superior drug deposition versus jet nebulisers (JN), yet clinical evaluation during non-invasive ventilation remains limited. With increasing NIV use in COPD patients, optimal on-ventilation nebuliser selection is crucial. We compared physiological effects of VMN (Aerogen Solo, Aerogen) and JN during NIV in stable COPD patients. Methods: This pilot randomised crossover trial recruited COPD patients on home NIV. Participants received salbutamol via VMN and JN using oronasal vented NIV masks on separate visits with a 48-hour washout period. Primary outcome was change in neural respiratory drive measured in the 2nd parasternal space (NRD: ΔEMGpara%max) at 30 minutes. Secondary outcomes included dyspnoea numerical rating score (NRS) and spirometry. Results: 12 patients completed the study (age 66±6yrs, 67% female, FEV1 23.4±13.6% predicted). Both devices significantly reduced NRD and dyspnoea NRS over time (p=0.0048, p