How effective is nebulization when done daily?
Some questions about nebulizer inhalation therapy
Nebulizer inhalation therapy, as a special treatment measure in clinical practice, especially in respiratory medicine, has its own unique physical principles and hardware conditions. However, for various reasons, this operation is difficult to perform optimally. For nebulized inhalation therapy to be truly effective, it is not simply a matter of adding the drug to the nebulizer and instructing the patient to inhale it regularly.
For nebulizer inhalation therapy, have you considered where the target location of this treatment is, small airways or alveoli? Is the amount of drug solution sufficient and is the driving gas adequate? Is the type of nebulizer appropriate, is the nebulizer positioned properly, and is the patient breathing correctly?
One of the questions and answers
What is nebulizer inhalation therapy?
Aerosol inhalation therapy is a treatment method that involves the inhalation of bronchodilators, antibiotics or antifungal drugs in the form of smoke or mist into the airways and lungs through the mouth, nasal cavity or trachea, including tracheotomy tubes, in order to treat the disease or delay the symptoms.
Explanation of doubts and questions
Why do I need nebulizer?
Direct access to the lesion: It allows the drug to reach the airway or lungs directly;
Low dosage: Nebulizer treatment requires a smaller dosage than systemic medication;
Rapid onset of action: the onset of action is faster than that of oral medications (e.g. oral salbutamol takes about 30 minutes while nebulized inhalation takes about 5 minutes);
Low side effects: The side effects are low compared to systemic medication.
Inhalation by nose or mouth
Clarify the anatomy
Before answering this question, it is important to be clear about some basic concepts. There are three mechanisms of aerosol deposition, of which when passing through the nasal cavity, many particles of larger diameter adhere to the lining of the nasal cavity within the turbulence formed by the nasal cavity, while our nebulization is to be administered through the lower airway, so to avoid wasting the drug, aerosol inhalation is appropriate via the mouth than the nasal cavity.
This is mainly determined by the anatomy of the nasal cavity, which has a smaller caliber than the oral cavity, and the mucosal turbinates are curved, making it easier for particles to settle as they pass through. Regardless of the settling mechanism, the nasal cavity settles more than the oral cavity, which means that the amount of wasted drug in the nasal cavity increases and the number of particles reaching the alveoli or small airways decreases, thus not achieving the desired therapeutic effect.
Inhalation by nose or by mouth II
How are aerosols deposited?
There are three mechanisms of aerosol deposition.
inertialimpaction
Gravitational sedimentation
Diffusion
Inhalation by nose or mouth III
Where do all the inhaled drugs go?
The above diagram clearly shows us where the drug reaches during nebulized inhalation. The destinations that the particles need to reach during nebulized inhalation therapy are different.
Drug inhalation: it can act directly in the upper or lower airway, at the alveoli, and also locally in the interstitial lung, and it can be absorbed through the airway and act in other parts of the body.
The amount of drug required is calculated by taking a comprehensive approach when administering the drug, including: the amount of drug remaining in the nebulization device, the amount lost in the air, the amount lost in the mouth with mouthwash, the amount of drug exhaled, and the amount entering the body (oropharyngeal nasopharyngeal drug amount, the amount at all levels of the airways as well as the lungs, and the amount of drug going to the gastrointestinal tract).
Systemic utilization during inhalation includes the sum of the amount entering the gastrointestinal tract and the lungs, and it is necessary to consider the pulmonary utilization as well as the first-pass metabolism in the liver, etc.
To be effective
The key is technique
Take the most commonly used oxygen nebulizer inhaler as an example.
Assemble the tubing, cup and mouthpiece.
Place the medication in the reservoir cup so that the total volume is 4 to 5 ml.
The patient must remain in a straight sitting position.
Connect the oxygen unit and adjust the oxygen flow rate, usually 6~8L/min.
A normal breathing pattern is used, interspersed with intermittent deep breaths until only a minimal amount of liquid is sprayed or until no aerosol is produced.
Keep the reservoir cup upright at all times while using the nebulizer.
Rinse and air-dry the nebulizer with sterile or distilled water after use and rinse the mouth with warm boiled water promptly.