Nebulizing inhalation inhalation combined with non-invasive ventilation therapy in COPD
2024-06-12

Nebulizing inhalation combined with non-invasive ventilation therapy in COPD patients with respiratory failure and nursing. XU Xiao-ya,JIANG Mei-fang,WANG Yong-sheng,et al. China Aviation Industry 363 Hospital,Chengdu,Sichuan 610041,China


【Abstract】 Objective To explore the application and nursing of oxygen-driven inhalation joint with non-invasive ventilation therapy in COPD patients with respiratory failure. 

Nebulizing inhalation inhalation combined with non-invasive ventilation therapy in COPD

Methods 39 cases diagnosed COPD with respiratory failure during January 2011 to December 2012 in our department were randomly divided into two groups: the experimental group( 21 cases) and control group( 18cases) . The eperimental group useing non-invasive ventilation combined oxygen-driven inhalation otherwise the control group using conventional inhalation therapy ( off-hook inhalation) . Compare the improving of hypoxiacarbon dioxide retentiondyspneadifficulty in expectorationdry mouth and sore throat caused by noninvasive ventilation and improveing of lung function. Results Lung function and blood gas analysis results were all improved in Two groups after treatment. In addition to 1 cases in observation group was send to ICU due to exacerbationother cases were successfully weaned from non-invasive ventilator. The length of stay and ventilation time in experimental group were significantly lower than the control group. The ratio of sore throadry mouth and difficulty in expectoration in experimental group was statistically significante lower than the control groupP<0. 05. 

Nebulizing inhalation inhalation combined with non-invasive ventilation therapy in COPD


Conclusion Oxygen-driven inhalation therapy can improve the therapeutic effect and quality of life in COPD patients with respiratory failure using non-invasive ventilation during hospitalization and worthy of clinical application.

Clinical evidence for nasal aerosol inhalation
2024-06-04

Nasal aerosol inhalation is increasingly used in intensive care units (ICUs). In pediatric wards in the United States, 75% of patients receive nasal aerosol inhalation therapy, while the rest use traditional nebulization methods.

 

HFNC combined with nebulizer therapy

For patients with severe hypoxemia, routine use of high-flow nasal oxygen therapy (HFNC) can help improve oxygenation and ultimately avoid intubation or reintubation. HFNC nasal aerosol inhalation combines the advantages of HFNC and aerosol therapy.

Since 2008, in vivo/in vitro studies have explored the many factors that affect the effect of HFNC aerosol inhalation and the clinical effectiveness of the nasal aerosol inhalation route.

 

Adult patients - inhaled salbutamol via HFNC 

In 2018, Braunlich et al. studied 26 patients with stable chronic obstructive pulmonary disease (COPD) and found that HFNC (TNI Medical AG, Germany) combined with an airflow of 35 L/min had a similar bronchodilator effect compared with inhalation of 2.5 mg salbutamol and 0.5 mg ipratropium bromide via a small volume jet nebulizer (JN) (P=0.5). Similarly, ReMiniac et al. studied 25 stable patients with reversible airflow obstruction and found that HFNC (Airvo2, New Zealand) combined with a vibrating mesh nebulizer (VMN) (Aerogen Solo, Ireland) nebulization therapy had a comparable improvement in forced expiratory volume in the first second (FEV1) compared with inhalation of 2.5 mg salbutamol via a mask JN (P=0.11). Madney et al. compared the bioavailability of salbutamol after inhalation of JN or VMN combined with HFNC at a flow rate of 5 L/min in a crossover randomized controlled trial of 12 patients with stable COPD. The results showed that the urinary salbutamol excretion in the VMN group was twice that in the JN group after 30 minutes and 24 hours (P<0.05).

Clinical evidence for nasal aerosol inhalation

In the United States and Europe, the labeled dose of albuterol solution is 2.5 mg. Li et al. conducted a dose-response analysis in 42 patients with stable asthma or COPD. It is known that these patients respond to 400 mcg of albuterol inhaled via a metered dose inhaler (MDI) combined with a nebulizer (SPACER). The subjects received increasing doses of albuterol inhaled via HFNC combined with VMN at an airflow of 15 to 20 L/min. When the cumulative dose of albuterol reached 1.5 mg, the improvement in FEV1 with HFNC combined with VMN was comparable to that with MDI combined with SPACER (P=0.878) (Figure 1).

 

Adult patients - inhaled prostacyclin via HFNC

Inhaled prostacyclin is a pulmonary vasodilator that can be used to treat patients with pulmonary hypertension and/or refractory hypoxemia who require mechanical ventilation. Two small retrospective studies found that adult patients with pulmonary hypertension and refractory hypoxemia had improved oxygenation after inhaled prostacyclin with 40 L/min of HFNC airflow. Bedside individualized titration of HFNC airflow based on the patient's response to prostacyclin was effective in reducing mean pulmonary artery pressure compared with a constant HFNC airflow. Future prospective studies with larger sample sizes are needed to validate this finding.

  

Pediatric patients - Inhaled albuterol via HFNC 

In 2015, Morgan et al. conducted a study on 5 infants and found that children with acute bronchiolitis and dyspnea did not respond to JN nebulization treatment via mask. However, after inhaling salbutamol via HFNC combined with VMN, the infants showed good comfort, which indicates that the combination of salbutamol and HFNC can benefit patients. Compared with salbutamol nebulization via mask combined with VMN, the heart rate of patients in the HFNC combined with VMN group was significantly increased (P<0.001). The reason for the significant increase in heart rate may be that the dose of salbutamol inhaled via HFNC combined with VMN is higher. Compared with mask combined with JN, the comfort and satisfaction of patients after salbutamol nebulization via HFNC (about 8 L/min) combined with VMN was significantly improved. A retrospective analysis of 39 children with status asthmaticus who failed to receive JN nebulized albuterol (10 of whom had severe acidosis, pH < 7.30) found that the maximum airflow of intermittent albuterol administration via HFNC was 1.0 (0.8-1.1) L/kg/min, which was one of the reasons for avoiding endotracheal intubation.

 

Summary 

The standard airflow for nebulized bronchodilator inhalation via HFNC is 15-35 L/min for adults and 1 L/kg/min for children, and the clinical effect produced at this time is similar to that of traditional nebulizer devices. The efficiency of nebulized inhalation in critically ill patients needs further study.


Breathing medication - nebulizer inhalation therapy
2024-05-31

Pneumonia is a common systemic disease and has become the third most lethal disease in the world. It is more common in autumn and winter because the weather is dry and changeable. November 12 is World Pneumonia Day. According to the World Health Organization, pneumonia is the number one killer of children under 5 years old worldwide.


01

STEPS Why are infants and young children prone to pneumonia

Infants and young children are prone to pneumonia due to their physiological characteristics, such as narrow trachea and bronchial lumens, less mucus secretion, poor development of lung elastic tissue, rich blood vessels that are easy to congest, less air in the lungs, etc., coupled with poor immunity, which makes infants and young children not only prone to pneumonia caused by Streptococcus pneumoniae, but also more serious once it occurs. After the age of 5, the throat of children will gradually develop soundly, and respiratory diseases and deaths caused by Streptococcus pneumoniae will drop significantly.


02

What are the more obvious manifestations of STEPS pneumonia?

1. Respiratory system symptoms

(1) Cough: It starts with frequent irritating dry cough, followed by phlegm sound in the throat. Severe coughing may be accompanied by vomiting and choking.

(2) Respiratory symptoms and signs: Shallow and rapid breathing, flaring of the nasal wings, and mild cyanosis around the mouth and nails of some children. Lung signs may not be obvious in the early stage, but small and medium-sized bubbling sounds may be heard later. When combined with pleural effusion, there may be percussion sound and/or disappearance of breath sounds.

2. Symptoms and signs of other systems

  • Circulatory system symptoms: Infant pneumonia is often accompanied by heart failure. If the child's heart rate increases to 160-200 beats/min, the liver enlarges in a short period of time or significantly enlarges, the face is pale, there is cyanosis around the mouth, edema of the limbs, and oliguria, congestive heart failure should be considered.

  • Neurological symptoms: irritability, drowsiness, staring, squinting, eyeballs rolling up. Drowsiness, even coma, convulsions. Conjunctival edema. Pupillary changes, slow or absent response to light. Irregular breathing rhythm. Anterior fontanelle expansion, signs of meningeal irritation. Except for increased cerebrospinal fluid pressure, everything else is normal, which is called toxic encephalopathy.

  • Digestive system symptoms: Children with pneumonia have decreased appetite, vomiting, diarrhea, abdominal distension. In severe cases, the vomitus is coffee-colored or bloody, bowel sounds disappear, and toxic intestinal paralysis and toxic hepatitis may occur.

    Breathing medication - nebulizer inhalation therapy


03

STEPS Nebulization Treatment for Pediatric Pneumonia

We all know that antibiotics are targeted at microorganisms such as bacteria, mycoplasma, and chlamydia, and are ineffective against viruses. According to statistics, 30%-67% of childhood pneumonia is viral; in children under 2 years old, about 50% of pneumonia is caused by viruses. The use of antibiotics for simple viral pneumonia is ineffective, and it is easy to cause adverse reactions such as allergies, diarrhea, and rashes, and may also lead to the production of drug-resistant bacteria.


Pneumonia is generally a disease caused by viral and bacterial infections. While using antibiotics and antiviral drugs, nebulization is used as an auxiliary treatment, which is very helpful for children's pneumonia. Because nebulization inhalation can humidify the respiratory tract, reduce inflammation, relieve cough, and reduce phlegm, it can also promote the absorption and discharge of inflammatory secretions, and has few side effects, shortens the course of the disease, and has a better treatment effect. Therefore, the use of nebulization treatment is helpful for the cure of pediatric pneumonia.


Experience has shown that passive treatment is not as good as active prevention!


04

STEPS How to prevent pneumonia for babies

1. Avoid contact with pneumonia patients

If there are family members of patients with colds and pneumonia at home, the baby should not come into contact with them, because the baby's body resistance is poor and it is very likely that the baby will get sick after contact.

2. Enhance the baby's resistance

Parents must not stay at home for a long time. Take the baby outdoors more often, such as sunbathing or exercising, so as to enhance the baby's body resistance.

3. Keep the indoor air circulating

The baby's living environment must be clean and ventilated, especially in winter. Many parents are afraid that opening the window will cause the baby to catch a cold, but the baby lives in a closed environment for a long time, and once it gets cold, it is easy to catch a cold. If the window can be opened for ventilation, the baby will have the ability to resist the cold and improve the ability to resist disease.


Analysis of factors affecting the effect of nebulized inhalation via HFNC
2024-05-30

Nebulizer selection: VMN vs JN

When JN is used in combination with HFNC, the total gas flow in the HFNC system is greater than 6 L/min, which is also the minimum flow rate for running JN. This flow requirement limits the application of HFNC combined with JN nebulization inhalation in pediatric patients. Infants and young children often need HFNC gas flow less than 6 L/min. In addition, since the combination of HFNC and JN can cause changes in the oxygen concentration, total gas flow and pressure in the system, the integration of HFNC and JN is not necessarily appropriate.

Analysis of factors affecting the effect of nebulized inhalation via HFNC

In contrast, VMN is powered by electricity and does not require additional gas flow. In addition, the amount of drug residue in the JN nebulizer is higher than that in the VMN, with a JN residue of 45% and a VMN residue of only 3%. For children and adult patients, the inhaled drug dose produced by HFNC combined with VMN nebulization is generally 2 to 3 times higher than that of JN (Table 2). Therefore, compared with JN, VMN is more suitable for nebulized inhalation therapy in combination with HFNC.

 

Aerosol carrier

HFNC gas is the "carrier" of aerosol. The gas flow, gas density and humidity of HFNC will affect the effect of nebulized inhalation.

 

HFNC airflow and patient inspiratory flow rate

For patients receiving HFNC, the total inhaled flow rate is a combination of the patient's inspiratory flow rate and the HFNC airflow rate. Any change in flow rate (flow rate) will affect the efficiency of nebulized inhalation. During quiet breathing, the amount of aerosol inhaled by HFNC combined with VMN is negatively correlated with the airflow of HFNC (Table 3). As the airflow rate increases, high-speed inhaled aerosol particles tend to form turbulence, and the aerosol will attenuate when passing through the trachea, bifurcation, and upper respiratory tract, and the amount of aerosol reaching the lower respiratory tract will continue to decrease. Therefore, there are guidelines that the flow rate should not be greater than 4 L/min when nebulizing children.

Analysis of factors affecting the effect of nebulized inhalation via HFNC 

Two in vitro studies showed that in adults with dyspnea, the amount of aerosol inhaled increased when the HFNC airflow was reduced from 50 to 30 L/min, but decreased when the airflow was reduced to 10 L/min. When the HFNC airflow was 30 to 50 L/min, the amount of aerosol inhaled was greater than that of patients breathing quietly, but this was not the case when the airflow was 10 L/min. Subsequently, Li et al reported that the patient's inspiratory flow rate was more important than the set HFNC airflow rate. When the HFNC airflow was set to a lower than the patient's inspiratory flow rate, the amount of aerosol inhaled was greater than that set to a higher flow rate; when the HFNC airflow was set to 50% of the patient's inspiratory flow rate, the amount of aerosol inhaled was relatively constant. This result is consistent with the data for infants and children (Figure 2).

 

Currently, there is no commercially available device that can accurately measure a patient’s inspiratory flow rate during HFNC application. However, when clinicians administer nebulized therapy to a patient, monitoring the ratio of the patient’s inspiratory flow rate to the HFNC airflow can be used to titrate the HFNC airflow to produce the best clinical effect. A retrospective study of patients with pulmonary hypertension and hypoxemia found that bedside titration of airflow during nebulized prostacyclin via HFNC produced a better clinical effect than the use of a constant airflow.

 

Gas Density: Oxygen vs. Heliox

Helium-oxygen (a mixture of helium and oxygen) has a lower density than oxygen or air and produces less turbulence when passing through narrow circuits/airways. For patients with severe airway obstruction, nebulized helium-oxygen can effectively reduce airway pressure and reduce gas trapping. A meta-analysis found that nebulized helium-oxygen can provide potential short-term benefits for children with moderate to severe pharyngitis. During HFNC, nebulized therapy with helium-oxygen as a carrier can reduce turbulence formation, thereby increasing aerosol dose.

For children and adults, nebulized helium-oxygen aerosol inhalation only shows a certain advantage when the airflow rate of HFNC exceeds the patient's inspiratory flow rate. Using helium-oxygen as an aerosol carrier just to improve the nebulization effect is not cost-effective, except for patients with severe airway obstruction, because helium-oxygen can effectively relieve dyspnea in such patients.

 

Dry and heated humidified gases

In vitro and in vivo studies in mechanically ventilated patients have shown that humidification reduces the amount of aerosol entering the lungs. Interestingly, during nasal nebulization at a flow rate of 30 L/min, Alcoforado et al. found that the inhaled dose of dry aerosol was 1-1.5 times that of humidified gas. Clinically, patient discomfort and potential adverse effects of dry aerosol inhalation at >6-10 L/min should be considered. In addition, during mechanical ventilation, turning off the humidifier 30 min before aerosol administration did not improve drug delivery efficiency. For these reasons, long-term delivery of aerosols using dry gases in non-humidified circuits is not recommended in clinical practice.

 

Nebulizer placement: close to the patient vs. humidifier inlet

In vitro studies in pediatrics and adults have reported that aerosol deposition is greater when the VMN is placed at the humidifier inlet than when the nebulizer is placed close to the patient. Only in infants with very low airflow (0.25 L/kg/min) was the nebulizer more effective when placed closer to the patient. Because the VMN is placed farther from the patient, the carrier gas flow (including the delivery gas flow and the patient's inspiratory flow, plus a small tidal volume) may not be sufficient to deliver the aerosol to the patient before aerosol deposition occurs.

 

Open mouth breathing vs closed mouth breathing

When the gas flow rate is higher than the inspiratory flow rate, adult studies have found that open mouth breathing reduces the inhaled dose compared with closed mouth breathing. This observation is consistent with a pediatric study report. Interestingly, when the gas flow rate is lower than the patient's inspiratory flow rate, open mouth breathing results in a higher inhaled dose than closed mouth breathing. Perhaps the aerosol collected in the nasal cavity at low gas flow during oral exhalation is inhaled during the next inhalation. Conversely, the higher gas flow flushes the aerosol out of the nasopharynx, reducing the amount of drug available for the next inhalation.


Research on atomized inhalation and atomized particle size settlement position
2024-05-28

01

Pulmonary aerosol inhalation drug delivery has great potential


Due to the characteristics of the lung tissue itself, the speed of lung absorption is very fast, no less than intravenous injection, such as isoproterenol aerosol can play a role in asthma 1-2min after inhalation.

Research on atomized inhalation and atomized particle size settlement position

1. Huge alveolar surface area

The lungs are composed of trachea, bronchi, bronchioles, alveolar ducts and alveolar sacs. The number of alveolar sacs is estimated to reach 3-400 million, and the total surface area can reach 70-100, which is 25 times the body surface area.

 

2. Alveolar tissue is thin

The alveolar wall is composed of a single layer of epithelial cells.

 

3. Rich capillary network

These alveolar cells are close to a dense capillary network (the total surface area of capillaries is about 90 square meters, and the blood flow is large). The thickness of the cell wall or capillary wall is only 0.5-1m, so the alveolar sacs are where gas and blood rapidly diffuse and exchange. The drug reaches the alveolar sac and is quickly absorbed and effective.


02

Atomized particle size and lung settlement location


Particle size is the main factor affecting lung deposition performance. Particle size significantly affects the location and distribution of inhaled particles deposited in the lungs.

Research on atomized inhalation and atomized particle size settlement position


1. William Glover and others found through radioactive isotope tracing method that the deposition amount and distribution of drug particles in the lungs depend on the particle size.


2. Omars. Usmani et al.’s research on targeting local respiratory tract through inhalation administration found that after inhalation administration, the smaller the particle size, the greater the amount of drug particles deposited in the lungs, the deeper the reach, and the wider the deposition range.

3. Zanen, Rees et al. studied the clinical effects of three different particle size ranges (< 1μm, 2-5μm and 5-10μm), as shown in the figure:

Research on atomized inhalation and atomized particle size settlement position


Through the above research data, we found that for drugs to be atomized into the lungs, the particle size should preferably be 2~5 μm. Particles with a size of 5 to 10 μm are mainly deposited in the oropharynx; particles with a size of 2 to 5 μm are mainly deposited in the lungs and bronchi, and 50% to 60% are deposited in the alveoli; particles that are too small (< 1 μm) are only It can reach the edge of the deep lungs and will be exhaled with breathing, so it has no therapeutic effect.


03

Moderately hydrophilic and lipophilic, atomized for better absorption


1. It must have a certain degree of hydrophilicity

It is best to dissolve in the secretions of the respiratory tract, otherwise it will become a foreign body and cause irritation to the respiratory tract.

 

2. It must have a certain lipophilicity

Substances are absorbed from the lungs by passive diffusion, and the absorption rate is related to the molecular weight and lipid solubility of the drug. Fat-soluble drugs are diffusely absorbed through the lipid bimolecular membrane, and a small part is absorbed through the small pores. Therefore, drugs with a large oil/water distribution coefficient are also absorbed quickly.


04

Common misunderstandings about aerosol inhalation medication


1. Non-atomized dosage forms can be used as atomized preparations

 

Drugs in non-aerosolized preparations cannot meet the requirements of aerosolized particles and cannot be cleared through the respiratory tract. They may be deposited in the lungs, thereby increasing the incidence of pulmonary infection. Atomized use is not recommended.

 

Common intravenous preparations contain preservatives (such as phenols, nitrites, etc.), which can induce asthma attacks after inhalation (excipients contained in non-inhaled drugs can irritate the respiratory tract).



2. Common injections that are not suitable for aerosol treatment

 

Dexamethasone injection: low fat solubility, high water solubility, little combination with airway mucosal tissue; large particle size, low lung deposition rate;

 

Gentamicin injection: The concentration of airway drugs is too low to achieve the purpose of anti-infection. The bacteria are in a sub-bacteriostatic state for a long time and develop drug resistance. At the same time, it can stimulate the airway epithelium and aggravate the epithelial inflammatory reaction;

 

Alpha-chymotrypsin injection: highly toxic to the retina, and can easily cause damage when in contact with the eyes when atomized; it is rapidly inactivated when exposed to blood and cannot be used for patients undergoing pharyngeal or lung surgery; it has been reported that this drug can damage lung tissue and inhale people's breath. It can aggravate inflammation and induce asthma in the tract;

 

Ambroxol Injection: Contains preservatives, which may induce bronchial asthma attacks after inhalation.



References:

"Expert Consensus on the Application of Nebulized Inhalation Therapy in Respiratory Diseases" Respiratory Disease Branch of the Chinese Medical Association

"Expert Consensus on Rational Use of Drugs in Nebulized Inhalation Therapy (2019 Edition)" Clinical Pharmacy Branch of the Chinese Medical Association

Rau JL. Respir Care, 2005, 50(3):,367-82.

Pitcairn G, et al. J Aerosol Med. 2005;18:264-272

Clover W, Chan HK Effect of particle size of dry powder mannitol on the lung deposition in health 2008,349(1/2):314-322



About chronic respiratory diseases - Nebulizer Medication Guide
2024-05-24

Nebulizer Medication Guide


1.  asthma


Long-term asthma treatment drugs are divided into 3 categories: controller drugs, reliever drugs, and add-on drugs for severe asthma.

For long-term maintenance treatment, metered dose inhaler or dry powder inhaler treatment is first recommended;

Some patients with severe illness who require larger doses of medication and those who cannot use inhalation devices correctly, such as infants and young children, may consider aerosol inhalation.

Initial treatment for acute asthma exacerbations includes repeated inhalation of short-acting bronchodilators, inhaled or systemic glucocorticoids, etc.

Recommendations for commonly used atomized inhalation drugs.


(1) Bronchodilators: necessary for asthma patients to prevent or relieve symptoms.

For mild to moderate asthma exacerbations, repeated inhaled short-acting beta2-agonists (SABAs) are often the most effective treatment, rapidly reversing airflow limitation.


"Level of evidence A, it is recommended to administer intermittently (every 20 minutes) or continuous aerosol administration in the first hour of initial treatment, and then intermittently (once every 4 hours) as needed; when the treatment effect is not good, consider adding short-acting bile. Alkaline receptor antagonist (SAMA) combined with aerosol inhalation treatment."


For severe asthma exacerbations, combined SABA and SAMA treatment can better improve lung function and reduce hospitalization rates.



(2) Inhaled corticosteroids (ICS): It is currently the most effective anti-inflammatory drug for the treatment of asthma.

In the early stages of an asthma attack or symptom exacerbation, nebulized bronchodilators combined with high-dose ICS (2 to 4 times the basic dose) can replace or partially replace systemic corticosteroids.

Patients who have contraindications for systemic corticosteroids, such as those with gastroduodenal ulcers and diabetes, can use ICS aerosol administration.

Budesonide (BUD) suspension is the earliest and most widely used ICS in clinical practice. Many studies have shown that nebulized BUD can be used as an alternative or partial replacement therapy for systemic glucocorticoids in the treatment of acute asthma exacerbations.


About Nebulizer Medication Guide


2. chronic obstructive pulmonary disease


Commonly recommended drug treatments for stable patients include bronchodilators, ICS, and expectorants.

Nebulized inhalation administration may be a better choice for some patients who are elderly and frail, have low inspiratory flow rates, have severe diseases, and have difficulty using dry powder inhalers.

✦Patients with mild illness can be treated with nebulized bronchodilators, oral or nebulized ICS, and antibacterial drugs in outpatient clinics.

✦Patients with severe illness who need to be hospitalized are treated with oxygen therapy, antibiotics, expectorants, nutritional symptomatic support, mechanical ventilation, atomized bronchodilators, oral and intravenous glucocorticoids or atomized ICS.


Recommended commonly used aerosol inhalation drugs



(1) Bronchodilators:

Repeated administration of nebulized short-acting bronchodilators is an effective treatment for acute exacerbations of COPD. Generally, SABA is more suitable for the treatment of acute exacerbations of COPD. If the effect is not significant, it is recommended to add SAMA.

 

(2)ICS:

Aerosol inhalation of high-dose ICS can reduce inflammation levels in acute exacerbations of COPD, relieve symptoms of acute exacerbations, and improve lung function. Its efficacy is equivalent to systemic hormone application, and the incidence of adverse reactions is relatively low.

 

Nebulized BUD alone can replace oral corticosteroids in the treatment of COPD exacerbations. Nebulizing 6 to 8 mg of BUD per day (3 mg, 2 times/d or 2 mg, 1 time/6 hours) can achieve the same efficacy as intravenous methylprednisolone (40 mg), but the dosage and duration of treatment have not yet been determined. A consensus has been reached that the treatment course in existing clinical studies is usually 10 to 14 days, and the dose and treatment course are adjusted according to the severity of acute exacerbation.


 About Nebulizer Medication Guide


(3) Expectorants:

For patients with acute exacerbations of COPD who have thick, sticky phlegm that is difficult to cough up, aerosol inhalation of SABA and expectorants can synergize sputum elimination, but it is not recommended as a routine medication in the Global Initiative for COPD (GOLD) 2016.


3. bronchiectasis

 

Due to the destruction of bronchial structure, poor sputum drainage, repeated acute exacerbations, frequent use of antibacterial drugs and other factors, Pseudomonas aeruginosa, a common multi-drug resistant bacteria, persists in the airways for a long time.

 

Once the infection becomes acutely severe, treatment is very difficult. In addition to systemic use of antibacterial drugs, atomized inhalation of antibacterial drugs can be used as local treatment to increase the effect of antibacterial treatment.


Recommended commonly used aerosol inhalation drugs

 

(1) Antibacterial drugs:

The U.S. FDA has approved tobramycin for the treatment of cystic fibrosis by aerosol inhalation.

Some studies have reported that in the acute exacerbation of bronchiectasis, the use of tobramycin, gentamicin, amikacin or polymyxin E aerosol inhalation, 2 times/d, for a course of 7 to 14 days, can achieve better results. Efficacy.

In recent years, some foreign authors have also reported long-term aerosol inhalation of the above-mentioned antibacterial drugs during the stable stage of bronchiectasis, with the course of treatment ranging from 4 weeks to 12 months.


(2) Bronchodilators and ICS:

Since patients with bronchiectasis often suffer from airflow obstruction and airway hyperresponsiveness, aerosol treatment with bronchodilators and ICS can be used as needed. The drugs and doses used can be referred to the section on acute exacerbations of COPD.