Nebulized inhalation is commonly used to treat a variety of respiratory tract 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., has become a necessary and irreplaceable treatment for bronchial asthma, bronchitis, capillary bronchitis, pneumonia, allergic cough, allergic rhinitis, pharyngitis, laryngitis and other diseases.
The correct mastery of the indications, the correct choice of drugs and nebulizer, and the correct mastery of the nebulization inhalation method are crucial to the efficacy of the treatment, especially in children whose cough reflex is not obvious, and nebulization treatment is especially important.
I. Which diseases in children must be treated by nebulized inhalation or can be treated by nebulized inhalation?
Bronchial asthma, bronchitis, capillary bronchitis, pneumonia, allergic cough, allergic rhinitis, acute attacks of pharyngitis and laryngitis must be treated by nebulized inhalation; other respiratory infectious diseases with difficulty in sputum removal, allergic diseases and diseases requiring airway humidification can be treated by nebulized inhalation.
Second, how to choose the correct inhalation device – nebulizer?
For upper respiratory tract diseases (common laryngitis and pharyngitis), ultrasonic nebulizer inhaler is suitable, the diameter of fog particles is 3.7-10.5?m, easy to deposit in the upper respiratory tract and atmospheric tract; for lower respiratory tract (bronchial, capillary bronchial and pulmonary) diseases, jet nebulizer is suitable, the diameter of fog particles is <5?m, easy to deposit in the diseased bronchial or alveolar 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 (such as glucocorticoid solutions); in addition, oxygen-driven jet nebulization may be beneficial for patients who require adequate oxygenation, such as bronchial asthma.
Third, which drugs are suitable for nebulized inhalation therapy?
1.Glucocorticoid: budesonide suspension: the only type of glucocorticoid that can be used for nebulization in China at present.
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, antimicrobial 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, qualified nebulization machine, appropriate drug selection, correct dosage, correct combination, attention to adverse reactions and prevention of complications, such as drug-related adverse reactions, bronchospasm, nosocomial infection, airway burns and ineffective prevention of airway hydration. Some misconceptions about nebulized inhalation therapy
Myth 1: “Inhaled budesonide is a hormone and has a lot of side effects”. In fact, budesonide suspension by nebulization treatment is only a local drug, which can play a rapid anti-inflammatory effect on the airways and lungs, and is not absorbed systemically, so basically there are no side effects.
Myth 2: “Any machine that can spray fog can be used to treat cough”. There are very strict requirements for nebulization to treat tracheal and lung diseases in children. One is that the pressure should be very stable, and the other is that the particles emitted should be of uniform size, with a particle diameter of <5?m, so that the drug can be deposited in the diseased bronchus or alveoli and take effect. The machine used for nebulization is not qualified is also the reason why many children with the same drug nebulization effect is not good.
Myth 3: “Nebulization is useless”, so many parents usually refuse to nebulize for the reason that their children do not cooperate. When a baby is suffering from asthma, capillary bronchitis, bronchitis or pneumonia, it is crucial to keep the respiratory tract open. Nebulization is usually carried out simultaneously with the triad of anti-inflammatory, antispasmodic and cough expectorant drugs, which has a fast onset of action, little side effects and shortens the course of the disease, so as to get twice the result with half the effort.