What is the best method of giving acapella with nebulizer?

Shown here is nebulizer distal to acapella.
Studies show this is not best method.

Your question:  When giving a breathing treatment with Acapella, where is the best place to put the nebulizer?

My answer:  A recent study by Mesquita et tested airway distribution by placing the nebulizer distal to the acapella as the manufacturer suggests, and airway distribution by placing the nebulizer between the acapella and the and the patient airway.  The researchers concluded that placing the nebulizer distal to the acapella resulted in less lung distribution compared to placing the nebulizer between the acapella and the patient's airway.  \

Reference:

1. Mesquita, Fabricio, et al., "Scintigraphic Assessment of radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Varoius Nebulizer Configurations," Respiratory Care, March, 2014, volume 59, number 3, pages 328-333

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