Nebulized inhalation, also known as aerosol inhalation, is commonly used in the treatment of a variety of respiratory diseases, with the advantages of local medication directly to the lesion site to quickly play a therapeutic effect, less dosage, less side effects, easy to grasp, etc., and has become a necessary and irreplaceable means of treatment for bronchial asthma, chronic obstructive pulmonary disease, hormone-sensitive cough, allergic rhinitis, pharyngeal, laryngitis and other diseases. The correct mastery of the indications, the correct choice of drugs and nebulizer, and the correct mastery of nebulized inhalation methods are crucial to the efficacy.
I. Which diseases need or can be treated by nebulized inhalation?
Acute attacks of bronchial asthma, acute attacks of chronic obstructive pulmonary disease, hormone-sensitive cough and acute attacks of allergic rhinitis, pharyngitis and laryngitis need nebulizer inhalation treatment; other respiratory infectious diseases with difficulty in sputum removal, allergic diseases and diseases requiring airway humidification can be treated by nebulizer inhalation.
Second, how to choose the correct inhalation device – nebulizer?
Ultrasonic nebulizer is suitable for upper respiratory tract diseases and sputum induction test, with a diameter of 3.7-10.5µm, which is easily deposited in the upper respiratory tract and atmospheric tract; lower respiratory tract (bronchial and lung)
Diseases are preferable to jet nebulizers, with a mist particle diameter of <5µm, which are easily deposited in the diseased bronchi or alveoli to function. The violent shock heating of ultrasound is not good for drugs containing proteins or peptides. Ultrasonic nebulization is also less effective than jet nebulization for suspensions (e.g., glucocorticoid solutions); in addition, oxygen-driven jet nebulization may be beneficial for patients requiring adequate oxygenation, such as bronchial asthma. For patients who are prone to CO2 retention (such as COPD with respiratory failure), high flow oxygen may aggravate CO2 retention.
Which drugs are suitable for nebulized inhalation therapy?
1.Glucocorticoids.
Budesonide: nebulized inhalation form is available in China; fluticasone propionate: nebulized inhalation form is not yet available in China.
2.Bronchodilators: salbutamol solution or terbutaline nebulizer solution (SABA), ipratropium bromide or compound ipratropium bromide nebulizer solution (SAMA or SAMA+SABA).
3.Mucolytic agent: Ambroxol hydrochloride, in view of ultrasonic nebulization can make the nebulized liquid heated to protease denaturation, it is not recommended to use ultrasonic nebulized drug delivery mode, it is appropriate to use jet nebulized drug delivery.
4, antibacterial drugs: At present, except tobramycin is approved by FDA for nebulized inhalation treatment of cystic fibrosis disease, the safety of the rest of the drugs have not been confirmed. Amphotericin B is available in China.
Which drugs are not recommended as nebulized inhalation drugs?
1, dexamethasone: no lipophilic group in structure, large water solubility, difficult to play through the cell membrane and glucocorticoid receptor binding; low deposition rate in the lung, short retention time in the airway, difficult to play local anti-inflammatory effect through inhalation; and long half-life, easy to accumulate in vivo, the inhibition of the thalamus-pituitary-adrenal axis is enhanced, so it is not recommended.
2, epinephrine and isoprenaline: except for anaphylaxis, it is not recommended for the treatment of asthma and chronic obstructive pulmonary disease.
3.α-Chymotrypsin: peptidase, there is no evidence that it can be inhaled to produce therapeutic effects in small and medium airways, and there is no data of pharmacological studies related to compatibility, so it is prohibited to nebulize treatment by ultrasound.
4, gentamicin: more clinical applications in China, but its efficacy and safety is still lack of sufficient evidence-based medical evidence.
5, theophylline: irritating effect on the airway epithelium, not recommended for nebulized inhalation therapy.
6, Chinese patent medicine injection: application experience and research is insufficient, the reliability of efficacy and safety are yet to be verified, not recommended.
V. What are the correct methods and precautions for nebulized inhalation?
Correct inhalation method selection, appropriate drug selection, correct dosage, correct combination, attention to the prevention and control of adverse reactions and complications, such as drug-related adverse reactions, bronchospasm, nosocomial infection, airway burns and ineffective airway hydration, etc.