We know – wheezing is a common symptom of pediatric respiratory disease, and children with repeated episodes of wheezing are at risk of developing bronchial asthma later in life. Children with acute bronchitis or bronchopneumonia or capillary bronchitis can often exhibit wheezing, which often results in shortness of breath, crying, and a blue complexion, seriously affecting the child’s health and daily life, as well as troubling parents and distressing adults.
After 6 months of age, the level of antibodies acquired by the mother gradually decreases, and the resistance to the outside world is weakened. After a cold or upper respiratory tract infection, if the condition is not well controlled, it will develop into the lower respiratory tract, and the cough will worsen and wheeze will appear, and severe coughing and wheezing will not only affect the growth and development of the child, but may even be life-threatening.
So what is the best way to treat wheezing? We know that the common methods for treating the disease are oral, intramuscular, intravenous, and nebulized inhalation therapy. The first three methods are systemic medications, and the last nebulized inhalation therapy is a local airway medication, which is the safest and most direct treatment method.
Nebulized inhalation therapy is a method of drug delivery in which drugs made into aerosols, dry powders or solutions are dispersed into tiny droplets or particles through nebulizing devices, which are suspended in the gas and inhaled into the airway through breathing action.
The use of inhalation therapy in the treatment of wheezing, compared with the conventional application of oral drug delivery, has the following advantages.
1, the role of direct: wheezing target organs are trachea, bronchi, lungs, inhalation therapy so that the drug acts directly on the airway, without having to make the drug subject to oral bioavailability and liver first pass effect.
2, rapid action: such as inhalation of salbutamol aerosol or nebulized liquid, inhalation of 3-5 minutes after the onset of action, while oral drugs at least 15 minutes to take effect.
3, the required drug dose is small.
4. Small systemic adverse reactions: for example, inhaled glucocorticoids rarely have systemic adverse reactions caused by oral hormones in the recommended dose.
The nebulized drugs we use for children’s wheezing are nebulized liquid or suspension, aerosol, dry powder inhaler, etc.; the commonly used nebulized drugs are glucocorticoids (such as budesonide, fluticasone propionate, etc.), bronchodilators, mucolytics, etc., among which bronchodilators are subdivided into β2-adrenergic agonists (such as terbutaline, salbutamol, etc.) and anticholinergic drugs (such as ipratropium bromide).
Parents may have some concerns about inhaled hormones for fear of side effects. In fact, glucocorticoid inhalation is currently recognized worldwide as the most effective anti-inflammatory measure for the treatment of asthma. Proper use of glucocorticoid inhalation under the guidance of a doctor and gradual reduction of dosage according to the condition can have a good effect on the treatment and prevention of asthma. A large number of studies have confirmed that inhaled glucocorticoid therapy can effectively relieve asthma symptoms, improve quality of life, improve lung function, reduce airway obstruction, control airway inflammation, and reduce the number of acute attacks and morbidity and mortality rates. Inhaled glucocorticoids are also frequently used to treat childhood respiratory diseases such as acute laryngotracheobronchitis, capillary bronchitis and bronchopulmonary dysplasia. They are also used to treat other chronic respiratory diseases such as occlusive fine bronchitis and interstitial lung disease. It should be noted that the systemic absorption of the drug can be reduced by drinking water and rinsing the mouth after inhaling the hormone to flush out the hormone left in the mouth.
And bronchodilator nebulizer inhalation, especially the use of rapid-acting bronchodilators is one of the most important treatment measures to relieve wheezing. It can provide rapid relief of wheezing symptoms and improve the quality of life. Fast-acting β2-agonists (salbutamol, terbutaline,) are the drugs of choice for acute asthma/asthma attacks and for the prevention of exercise asthma, but should not be used long-term. Short-acting anticholinergic drugs (e.g. ipratropium bromide) have weaker bronchodilatory effects than β2-agonists, and have a slower onset of action and longer duration of maximum action.
When we do nebulization with nebulizing solution, there are often two types of nebulizers (machines) to choose from: jet nebulizer and ultrasonic nebulizer, each of which has its own advantages and disadvantages, but the jet nebulizer is more commonly used in clinical practice. Generally speaking, it is best to choose the jet nebulizer if it is for the treatment of wheezing. Ultrasonic nebulizer inhalation is not recommended for children with wheezing because ultrasonic nebulization has a higher temperature, which may destroy the drug molecules, and the aerosol particles are uneven in size and tend to increase airway resistance.
When using nebulizer inhalation therapy, attention should be paid to.
1, regular disinfection of the nebulizer to avoid contamination and cross-infection.
2, regular replacement of the nebulizer to ensure effective output.
3.When bronchospasm is severe, avoid using β-agonists in excessive doses to prevent the occurrence of serious arrhythmias.
4. avoid hypotonicity of the drug solution and low aerosol temperature during nebulization
5, stimulation of the whistle tract.
6, when using oxygen-driven nebulization, attention should be paid to the safety of oxygen, prohibit smoking or burning open fire near the oxygen; try not to eat half an hour before nebulization to avoid vomiting caused by aerosol stimulation during nebulized inhalation.
When using inhalation therapy such as aerosols or dry powder inhalers, the greater the inspiratory pressure and the greater the inspiratory flow rate, the more the drug is deposited in the lower whistle, the better the effect. To ensure the effectiveness of inhaled drugs, the following operations should be noted after opening the inhaler cap.
1. shake the inhaler several times to disperse the drug evenly in the ejectant.
2.Whistle, but need not be too deep.
3, open the mouth, then place the interface part of the inhaler between the upper and lower lips, tightly wrapped.
4.After starting to inhale slowly, press the bottom of the drug reservoir to release the drug particles.
5, hold your breath and count 1, 2 ……10 or longer to deposit as many drug particles as possible into the airway.
Quantitative aerosol inhaler: The most commonly used aerosol generating device at present. It has the advantages of quantitative, simple operation, easy to carry, readily available, no need for regular sterilization, no nosocomial cross-infection problems, etc., so its use is widely welcomed. However, it should be noted that this type of medicine needs to be used in children under 5 years of age with the aid of a storage canister (device) to assist in the inhalation of medicine.
Dry powder inhalers, including DuPont devices, quasi-nasal devices (such as sulforaphane).
1, single-dose inhaler often has a rotary or rotating inhaler, its rotating disc and rotating disc with a sharp needle, the dry powder of the drug to be inhaled is held in the capsule. When using the drug capsule first loaded into the inhaler, and then slightly rotate that let the needle on the rotating disc and rotating disc pierce the capsule, the patient through the oral tube for deep inhalation can drive the inhaler internal spiral blade rotation, stirring the drug dry powder to become aerosol particles and inhalation.
2, multi-dose inhalers often have vortex inhalers and disc inhalers, the dry powder of the drug to be inhaled is held in the capsule. Inhaler can be filled with multiple doses at a time. When using rotating the shell or pushing and pulling the sliding disc to transfer one dose at a time, the patient pulls up the cover shell with a needle blade to puncture the capsule containing the powder, that is, the inhaler containing the inhaler nozzle to inhale the powder with a deep inhalation, after inhaling and holding the breath for 5-10 seconds and then slowly whistling. The multi-dose inhaler can be used repeatedly, and the inhalation aerosol particles are pure powder, without booster and surface activator, the operation method is relatively simple and convenient to carry, so it is quite popular among patients and also meets the requirements of environmental protection.
How do children with wheezing choose the most suitable inhalation therapy for themselves? This requires a doctor to make a clear diagnosis through medical history, physical examination, lung function and other tests, and to guide the wheezing child to choose the appropriate medication and modality for nebulized inhalation therapy based on individual factors.