According to reports from multiple US media, respiratory syncytial virus (RSV) is spreading at abnormally high levels among children in the United States, overwhelming children's hospitals. Several children's hospitals said they have been "flooded" with patients, and a doctor at Connecticut Children's Hospital said that in his 25 years of work, he had never seen such a surge in RSV-infected patients entering the hospital.

(Source: The Washington Post)

RSV is a common respiratory virus. About 70% of children are infected with RSV within the first year after birth, and almost 100% of children are infected with RSV before the age of two [1]. Symptoms after infection are usually mild and look like a common cold, including runny nose, loss of appetite, cough, sneezing, fever, etc. Symptoms usually last for one to two weeks and can be eliminated by resting and drinking water. However, for some children, especially young infants, RSV can cause dehydration, difficulty breathing, and more serious illnesses such as bronchiolitis or pneumonia.

Data show that RSV is an important viral pathogen that causes acute lower respiratory tract infections (ALRTI) in children under 5 years of age worldwide. In 2019, 3.6 million RSV-related ALRTIs required hospitalization worldwide, and the incidence of RSV-related deaths in children aged 28 days to 6 months was 3.6% [2]. Severe RSV infection can not only cause dysfunction of multiple tissues and organs throughout the body [3], but is also closely related to repeated wheezing and asthma in infants and young children in the late stages of infection [4].

(Source: U.S. Centers for Disease Control and Prevention)

Reference:

[1]HuM, BogoyevitchMA, JansDA. Impact of respiratory syncytial virus infection on host functions: implications for antiviral strategies[J]. Physiol Rev, 2020, 100(4):1527-1594. DOI: 10.1152/physrev.00030.2019.

[2]LiY, WangX, BlauDM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis[J]. Lancet, 2022, 399(10340): 2047-2064. DOI: 10.1016/s0140-6736(22)00478-0.

[3]EisenhutM. Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review[J]. Crit Care, 2006, 10(4):R107. DOI: 10.1186/cc4984.

[4]RestoriKH, SrinivasaBT, WardBJ, et al. Neonatal immunity, respiratory virus infections, and the development of asthma[J]. Front Immunol, 2018, 9:1249. DOI: 10.3389/fimmu.2018.01249.

At present, nebulizer inhalation therapy has been widely used in the clinical treatment of pediatric respiratory diseases. However, in primary pediatrics, medical equipment is relatively backward, medical resources are limited, and nebulizer inhalation therapy is not well popularized. This means that most children with respiratory diseases in the local area can only control their condition through intravenous infusion. Primary hospitals that have carried out nebulizer inhalation therapy often have safety hazards due to the lack of understanding of nebulizer inhalation therapy by doctors and unreasonable selection of nebulizer inhalation drugs. Therefore, this article mainly analyzes the current status of nebulizer inhalation in primary pediatrics, and studies how to standardize nebulizer inhalation therapy in primary pediatrics so that nebulizer inhalation therapy can be better popularized in primary pediatrics.

Respiratory diseases are one of the most common diseases in primary pediatrics. With the increase in the number of asthmatic diseases in children, the application of nebulizer inhalation therapy in pediatrics is also increasing. Now nebulizer inhalation therapy has been widely used in pediatric clinical treatment, such as post-infectious cough, bronchial asthma, bronchiolitis, mycoplasma pneumonia, allergic cough, acute pharyngitis, bronchopulmonary dysplasia and other pediatric respiratory diseases [1]. However, nebulizer inhalation therapy is not yet popular in primary pediatrics. Many doctors are not very clear about the method of nebulizer inhalation and the choice of drugs, and do not understand the working principle of nebulizers. As a result, nebulizer inhalation therapy in primary pediatrics is not standardized. For example, many primary hospitals, especially township health centers, are still using ultrasonic nebulizers to treat bronchial asthma, dexamethasone injection nebulizer inhalation, and Chinese patent medicine injection nebulizer inhalation, etc., all of which have safety risks. How to make primary pediatric doctors better understand the principle of nebulizer inhalation therapy and standardize medication, how to standardize nebulizer inhalation therapy, and reduce intravenous infusion are the key points that need to be studied.

【Key words】 nebulized inhalation therapy; respiratory diseases; primary pediatrics;

In recent years, the detection rate of pulmonary nodule lesions has increased significantly. Clinically, lesions within the lung parenchyma that are less than or equal to 3 cm (excluding atelectasis and enlarged lymph nodes) are called nodules, lesions larger than 3 cm are called masses, and nodules smaller than 1 cm are called small nodules, and those smaller than 5 mm are called micronodules. The reason for this definition is that lesions larger than 3 cm are mostly malignant, while smaller lesions may be benign or malignant. There is a correlation between the size of the nodule and the benign or malignant nature of the nodule. Small nodules are more likely to be benign.

There are several types of people who should not take it lightly when they find small lung nodules during physical examinations. They should actively receive formal further examinations and timely treatment:

(1) People who have smoked for more than 20 years, smoke more than 20 cigarettes a day, or have been exposed to passive smoking for a long time;

(2) People who are over 40 years old and have symptoms such as chest pain, cough, unexplained blood in sputum, emaciation, weight loss, etc.;

(3) People with a family history of tumors, especially a family history of lung cancer;

(4) Nodules larger than 1 cm in size, accompanied by changes such as spicule-like, lobed or ground-glass-like, and pleural indentation.

In chest CT examination, nodules smaller than 5 mm are too small to have obvious characteristics of benign or malignant, and various examinations are difficult to determine their nature. More than half of single small nodules in the lungs with a diameter greater than 1 cm are malignant, while more than 90% of tiny nodules smaller than 5 mm are benign. Therefore, lung nodules smaller than 5 mm can be reexamined by CT every 6 months; lung nodules of 5-10 mm should be reexamined by CT every 3 months; and lung nodules of 10 mm should be reexamined by CT every 1 to 2 months. If the follow-up finds no change in the lesion, the reexamination is often extended to 3-6 months or 1 year. If a small lung nodule is found to have no change for 2 years, it can be generally considered a benign nodule. When changes are found in the lesion, the next step of treatment is determined based on the changes.

The Fleischner Society Guidelines (2017) recommend the selection of 6 mm (100 mm3) as the main cutoff value for shortening the follow-up interval. For multiple solid nodules, if the size is<6 mm (100 mm3), if classified as high risk, follow-up is recommended at 12 months, otherwise no routine follow-up is required; for those with the main lesion ≥6 mm (100 mm3), follow-up is recommended for 3 to 6 months, and a second follow-up is selectively performed at 18 to 24 months. For multiple subsolid nodules, follow-up for 3 to 6 months is recommended, and subsequent treatment is determined based on the most suspicious nodule. Among them, multiple pGGNs <6 mm are mostly benign, but high-risk patients are recommended to be followed up in the second and fourth years.

Early testing, early intervention, and early treatment effectively improve our understanding of lung conditions.

With the vision of "providing a third way of dosing", Feellife® focuses on the field of medical nebulization and respiratory health. With its strong scientific research capabilities and deep insight into user demands, it has devoted itself to the research and development of more than 220 atomization patents with AiMesh® as the core for more than ten years, and has pioneered the development of intelligent variable frequency atomization technology, quantitative atomization technology, and respiratory sensing atomization technology, all of which have been successfully applied to atomizers. Through the business model of "intelligent nebulizer + nebulization liquid", it provides atomization solutions to the world and serves the global atomization ecosystem.

At the same time, feellife's pulmonary function testing equipment obtained FDA certification in 2023, adding luster to the creation of a closed loop of respiratory and lung health prevention, treatment and rehabilitation.

We have launched a "three-piece set of tuberculosis rehabilitation" treatment plan, including the Air Smart TT lung function test, the fit series of lung training, and the Airbar Pro 1 oxygen concentrator. For home use, you can choose a more compact and portable portable respiratory measurement device. With one blow every day, you can monitor your health in real time. The mobile phone APP generates health data, and trend changes are clear at a glance.

In addition, you can perform lung function training every day. Try the portable Airfit1 at home to train your respiratory muscles, increase your respiratory and cardiopulmonary functions, make it easier to breathe during exercise, and make lung exercise easier.

As a home oxygen concentrator, the main function of Airbar Pro 1 is to provide users with pure medical oxygen, improve symptoms such as dyspnea and hypoxia, and improve the quality of life. At the same time, the oxygen content can be as high as 93%.

Nebulization of budesonide is a common way of administering medicine. It can make the medicine reach the symptomatic site to the greatest extent, and is especially suitable for children. For babies, this type of medicine can also be used for treatment. It is very effective in preventing cough and treating bronchitis. During the process of nebulization treatment, it is also necessary to take the medicine orally as prescribed by the doctor.

The efficacy of budesonide nebulization on babies.

Since atomization itself is only a method of drug administration, a special atomization device is used to atomize the drug solution into tiny particles, which are inhaled into the respiratory tract and lungs to deposit the drug in the respiratory tract to treat diseases. Compared with the traditional injection and medication, small particles are The baby does not suffer much pain. This treatment method is administered in small doses and effectively reduces side effects.

Budesonide suspension is the most commonly used aerosolized drug in clinical practice. The drug mechanism is that ICS surface inhaled hormones. Everyone gets nervous when they hear about hormones, thinking that the doctor is going to give me hormones again. They are anxious about whether I will gain weight or my blood sugar will increase if I use hormones.

In fact, budesonide suspension is a surface inhaled hormone. Its main function is to control inflammation through atomization, reduce inflammatory cells, reduce the ability to secrete mucus, and reduce the level of secreted mucus and inflammatory factors. In short, it can clear the airway, inhibit airway inflammation, and play a role in dilating the airway through local deposition in the airway, so not many components enter the blood. This kind of local atomization causes patients to react to hormones, including increased blood sugar and obesity, and these side effects are very small.

Local use of hormones has such a rapid onset, which can relieve spasms and asthma, and at the same time will not cause changes in the blood sugar level of the whole body. Therefore, in patients with COPD, patients with bronchial asthma, and cough variant asthma, these clinical symptoms appear, surface inhaled hormones and inhaled budesonide suspension are very common treatments, and the effect is very fast and effective.

Comparison of drug delivery efficiency between mesh nebulizer, jet nebulizer and pMDI during noninvasive ventilation

Aerosol administration during non-invasive ventilation (NIV) is a common clinical drug administration method, but the drug administration efficiency of different drug delivery devices is different.

In a study, researchers used mesh nebulizers, jet nebulizers and pMDI, and applied different NIV masks to simulate adult lung models to explore drug administration efficiency.

Salbutamol sulfate (2.5 mg/3 ml) was nebulized in a mesh nebulizer and a jet nebulizer, and the pMDI was sprayed 4 times (108 ug/puff). The drug was eluted from the filter and analyzed by UV spectrophotometry at 276 nm.

Conclusion: In the simulated adult lung model, the use of nebulizer and mask affects the drug delivery efficiency. The drug delivery volume of the mesh nebulizer is about 7 times higher than that of the pMDI and about 2 times higher than that of the jet nebulizer.

Reference: 

AlQuaimi MM, Fink JB, Ari A. Efficiency of different aerosol devices and masks during noninvasive positive pressure ventilation in a simulated adult lung model. J Respir Med Lung Dis. 2017;2(3):1018.

Micromesh nebulizer

Micromesh nebulizer: The working principle is to connect a perforated plate to a transistor that can generate high-frequency vibrations, and produce an impact on the liquid to produce aerosol; another way is that the liquid is driven by a pulse current to force it through the mesh to produce aerosol.

The micromesh nebulizer produced by Feellife Health Inc. ,has the characteristics of both compression atomizers and ultrasonic nebulizers, and has made breakthroughs in its technology. The spray method is to use tiny ultrasonic vibrations and a mesh spray head structure to spray, and use electronic high-frequency oscillations (which are absolutely harmless to humans and animals) through the high-frequency resonance of the ceramic atomizer to break up the liquid water molecule structure and produce a naturally flowing water mist, forming ultra-fine particles of about 3 microns, achieving an efficient spray effect. It is a home medical nebulizer for all respiratory diseases, which is easy to carry and use anytime, anywhere.

Respirable range

0.5 to 5 microns

Aerosol particles larger than 5 microns settle in the mouth and throat and are swallowed

Particles smaller than 0.5 microns do not settle in the lungs and are exhaled

Respirable particle fraction

The percentage of particles smaller than 5 microns in aerosol

The higher the value, the better

The standards of medical institutions recommend that drugs contain at least 50% particles smaller than 5 microns (i.e., the mass median diameter is 5 microns or less)

►Micro-mesh nebulizers are completely different from compressed nebulizers and are a revolutionary change in nebulization treatment equipment.

►Using high-frequency electronic oscillations (absolutely harmless to humans and animals), through the high-frequency resonance of ceramic nebulizers, the drug solution is driven to the mesh. Due to the extremely fast movement of positive and negative electrons, high-density atomized particles are produced and ejected outward.

►Since the Raffles micro-mesh atomizer has a 3-micron diameter screen at the nozzle, the sprayed liquid particles are all atomized particles with a diameter of less than 5 microns, of which 2.5-micron particles account for 75%.

Nebulizer inhalation saves the pain of intravenous and intramuscular injections for special groups such as the elderly and children, bringing good news and becoming the preferred treatment for respiratory diseases. With the popularity of nebulizer inhalation, the choice of nebulizer has become the focus.

Types of medical nebulizers

There are three common nebulizers:

Ultrasonic nebulizer (officially used in clinical practice for about 10 years)

Compressed nebulizer (officially used in clinical practice for about 50 years)

Portable mesh nebulizer (officially launched in the US market in 2012)

Use of medical nebulizers

Medical nebulizers are mainly used to treat various upper and lower respiratory system diseases, such as colds, fever, coughs, asthma, sore throats, pharyngitis, rhinitis, bronchitis, pneumoconiosis and other diseases occurring in the trachea, bronchi, alveoli, and chest cavity. Nebulizer inhalation therapy is an important and effective treatment method for respiratory diseases. The nebulizer inhaler is used to atomize the drug solution into tiny particles, and the drug enters the respiratory tract and lungs through inhalation, thereby achieving the purpose of painless, rapid and effective treatment.