The recent period is a high incidence of respiratory diseases, and the mountains of people in the hospital are too scary. Parents who take their children to the doctor must bring a mask to prevent cross-infection.
Recently, many parents bought a nebulizer machine, I give you the drugs that can be nebulized.
Nebulized inhalation therapy is the local treatment of the respiratory tract by dispersion of drugs or water into mist particles or particles suspended in gas by an inhalation device and deposited in the respiratory tract and/or lungs by inhalation. By nebulized inhalation administration, the effect of relieving bronchospasm, thinning sputum and preventing respiratory tract infections can be achieved. In many respiratory diseases, such as chronic obstructive pulmonary disease (COPD) in adults, bronchial asthma in children, acute laryngitis, allergic cough and other diseases, can be treated with nebulized inhalation. Since nebulized inhalation has the advantages of rapid drug onset, low dosage, high local drug concentration and low systemic adverse reactions, nebulized inhalation has become an important adjunctive treatment measure in the treatment of respiratory system diseases.
In clinical practice, according to different diseases and different treatment purposes, different drugs can be used for nebulized inhalation. At present, the following drugs are commonly used. Specific to the hospital to consult a doctor, do not private configuration, general family nebulization for a week, the effect is not good, to go to the hospital in time for follow-up, each nebulization after, pay attention to wipe the face and rinse mouth. Children’s nebulization, each nebulization time of about 5 to 10 minutes is good. Again, if there is a lack of oxygen, to go to the hospital under the oxygen drive is the safest.
What are the drugs for nebulization
1.Bronchodilator
Mainly used for the treatment of acute attacks of bronchial asthma and release of bronchospasm, commonly used drugs are
Anticholinergic drugs Commonly used drug is ipratropium bromide, the concentration of aqueous solution is 0,025%. Adults each time 2ml, children each time 0,4 ~ 1ml, add equal amount of saline nebulized inhalation, can also be directly inhaled in the original solution, 2 ~ 3 times a day. 10%-30% of the inhaled dose is deposited in the lungs, the gastrointestinal mucosa absorption is small, and it has a high selectivity to the smooth muscle of the respiratory tract. The effect starts in 10-30 minutes after inhalation, and reaches its peak in 1-2 hours, and the effect can be maintained for 6-8 hours after one inhalation. It is mainly used for the treatment of acute exacerbation of COPD and acute exacerbation of bronchial asthma.
The adverse effects of the drug are minimal, but there have been reports of acute urinary retention after inhalation. Therefore, it should be used with caution in patients with prostatic hypertrophy, glaucoma, and in pregnant and lactating women.
β2 agonists The drugs commonly used in clinical practice are salbutamol. The concentration of its aqueous solution is 0.05%, and after nebulization, it forms aerosol particles with a diameter of 2~4μm, which can reach the lower respiratory tract by 10%~20% of inhalation administration. The conventional dose is 2ml of the drug plus an equal amount of saline nebulized inhalation. The effect can be started in 5 minutes after inhalation, and the peak can be reached in 15 minutes, and the drug effect can be maintained for 4~6 hours. It is mainly used in patients with severe bronchial asthma attacks and COPD with significant bronchospasm. Since these drugs also have a partial agonistic effect on beta receptors of the heart and skeletal muscle, some patients may experience palpitations and skeletal muscle tremors after inhalation.
The usual dose for children under 12 years of age is 0.5 mL (2.5 mg of salbutamol sulfate), administered in injectable saline diluted to 2.0-2.5 mL, and some children may require doses as high as 5.0 mg. There is no clinical utility data on the use of this drug in infants under 18 months of age. Transient hypoxemia may occur, and therefore oxygen therapy should be considered.
2.Glucocorticoid
With local efficiency and systemic safety, commonly used drugs are
Budesonide drug concentration of 1mg/2ml, each use of 2ml, 2 to 3 times a day. About 10% of the drug volume given by aerosol is deposited in the lungs, with a distribution volume of about 300L for adults and 3,1~4,8L/kg for children, showing that it has high tissue affinity and can play a strong local anti-inflammatory role, and a small dose can play a therapeutic role. Nebulized inhalation of budesonide has a rapid onset of action, with airway anti-inflammatory effects in 10-30 minutes, and is suitable for the treatment of acute attacks of severe bronchial asthma, especially for children with asthma. If combined with anticholinergic drugs and/or β2 agonists, the treatment effect is even better.
It should be noted that the physician should instruct the patient to rinse the mouth thoroughly after the nebulizer inhalation to prevent mucosal Candida infection in the oral cavity and pharynx.
3.Mucolytic agents
Although α-chymotrypsin can reduce the viscosity of sputum and make it dilute and easy to discharge, long-term nebulized inhalation can lead to squamous metaplasia of the airway epithelium and occasionally cause allergic reactions, and is now slowly used less clinically.
Ambroxol hydrochloride can regulate the secretion of respiratory epithelial plasma and mucus; stimulate the synthesis and secretion of alveolar surface active substance by alveolar type II epithelial cells to maintain the stability of alveoli; increase the oscillation of respiratory epithelial cilia, so that sputum can be easily coughed out. Its solution concentration is 15mg/ml. 2~4ml per time for adults, nebulized inhalation 2~3 times a day. Any child with respiratory tract infection with phlegm that cannot be easily coughed up can use it, 10 to 30 mg (imported out of Ambroxol has the best effect), add it to 5 ml of saline and nebulize it.
4.Antibiotics
Nebulized inhalation antibiotics have a certain therapeutic effect on respiratory system infections. However, it is not recommended for private use, and the method is not recommended for children.
Intermittent or short-term prophylactic inhalation of antibiotics can effectively reduce the rate of colony formation of gram-negative bacteria in the upper respiratory tract. Currently, nebulized inhalation of antibiotics is used clinically, mainly for the treatment of hospital-acquired pneumonia in critically ill patients with combined Gram-negative bacterial infections. It is important to note that the superficial fluid covering the respiratory epithelium is isotonic and has a neutral pH. High osmolarity or low pH of inhaled antibiotics can cause coughing and even lead to airway spasm. The pH of tobramycin sulfate and ceftazidime is suitable for inhalation administration. The inhaled antibiotics should be dissolved in saline at a concentration of 100mg/ml.
5.Combined medication
In order to enhance the effect of nebulized inhalation or shorten the time of nebulized inhalation, physicians will mix multiple drug solutions or suspensions and let patients inhale them at the same time. For example, the combination of anticholinergic drugs and β2 agonists has a synergistic effect, and the effect of bronchodilatation is stronger, with rapid onset of action and lasting effect. Clinically, 2ml of each of the above 2 drugs can be used for nebulized inhalation. However, when mixing the liquids for inhalation, attention must be paid to the physical and chemical properties of the various drugs and their compatibility, whether there are contraindications to the combination, etc.
In general, budesonide, ipratropium bromide, salbutamol, can be combined. Data indicate that the use of ipratropium bromide with sodium cromoglycate is not recommended because the mixture of the two can produce an oil-like, non-crystalline compound and precipitate. Tobramycin should not be combined with budesonide and sodium cromoglycate.
It is worth noting that
Although some drugs can be stably dosed, their aerodynamic properties may change after mixing, and the temperature, storage time after configuration, and the increase in the amount of liquid in the nebulizer cup after mixing may affect the nebulization effect. Therefore, it is not the more drugs added, the better.
In clinical practice, some intravenous drugs such as glucocorticoids, aminophylline and gentamicin were often used as nebulized inhalation drugs in the past, which have been gradually eliminated.
Some studies have shown that the injectable form of glucocorticoids such as dexamethasone, hydrocortisone, etc., when inhaled by local nebulization of the respiratory tract, the nebulized particles produced are large and do not reach the effective particles of 3-5 μm, thus the drug can only be deposited in the atmospheric tract. Due to the absence of lipophilic groups in its structure, it has a low affinity for glucocorticoid receptors and weak local anti-inflammatory effects. Its water solubility is large, and it binds less to airway mucosal tissues and has a low deposition rate in the lungs, making it difficult to produce efficacy.
Although theophylline can dilate the bronchi, it has an irritating effect on the airway epithelium, so it is not clinically advocated for nebulized inhalation therapy.
Gentamicin is an alkaline, water-soluble antibiotic due to its molecule containing several hydroxyl groups and alkaline groups, which is non-dissociated in alkaline environment and has good effect. The acidic and anaerobic environment of pus and sputum often affects the antibacterial activity of aminoglycosides, so there are some limitations of such drugs for nebulized inhalation. The drug is also ototoxic and is not recommended for children and patients with ear disease. Animal tests have shown that gentamicin can produce both irritation to the airway mucosa, which triggers an inflammatory response, the aggregation of inflammatory cells and mediators in the airway, secondary free radical damage, etc.; and toxicity to the airway mucosa, so that the mucous cilia clearance function of the epithelial surface of the airway mucosa is impaired.
Therefore, medicine is three parts poisonous, nebulization, although good, to be used under the guidance of a doctor, many times, nebulization treatment is only an adjuvant therapy, treating the symptoms but not the root cause, the child has a disease, looking for the cause is the most important, if the effect of nebulization 3 days no significant improvement, please hurry to take the child to the hospital for review.
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