Flexible Tubing Modification of Jet Nebulizers in Supine Patients: A Crossover Pilot Trial

Abstract

Background: Jet nebulizers are widely used in patients with respiratory disorders such as chronic obstructive pulmonary disease, asthma, and pneumonia. Their effectiveness depends on maintaining the medication cup in an upright position, which limits use in supine patients or those unable to sit upright. This limitation often reduces comfort and treatment efficiency, indicating the need for a more flexible device design.
Objective: To develop a flexible tubing modification for a jet nebulizer and to evaluate its feasibility and preliminary effectiveness through expert judgment and an in vivo pilot crossover trial.
Methods: This study employed a Research and Development approach using the MANTAP model, followed by a randomized crossover pilot trial. Product feasibility was assessed through expert judgment involving pulmonologists, physiotherapists, and academic experts. Six hospitalized patients received both standard and modified jet nebulizer interventions in randomized order with a 48-hour washout period. Patient satisfaction was measured using the Patient Satisfaction and Preference Questionnaire, and nebulization duration was recorded. Data were analyzed using the Wilcoxon signed-rank test.
Results: Expert evaluation confirmed that the modified nebulizer was feasible for clinical use. Patient satisfaction was significantly higher with the modified device than with the standard nebulizer (Z = −2.232; p = 0.026). Nebulization duration was also significantly shorter with the modified design (Z = −1.992; p = 0.046).
Conclusion: The flexible tubing modification of a jet nebulizer improved patient satisfaction and reduced treatment duration compared with the standard design, demonstrating potential benefits for nebulization therapy in supine patients.