Mechanically ventilated patients should be in a sitting or semi-sitting position during nebulization inhalation therapy. Domestic and foreign research and expert consensus recommend this position. When in a sitting or semi-sitting position, the patient's diaphragm moves downward and the chest cavity expands, which can increase the amount of bronchial gas exchange and improve the effect of nebulization therapy. For mechanically ventilated patients, the healthy side should be in a lying position and the head of the bed should be raised to 30~50° during nebulization therapy, which is conducive to the deposition of nebulized drugs. In addition, raising the head of the bed by 45° can reduce the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients.

Any obstruction in the ventilator circuit or tracheal tube, whether due to the accumulation of condensed water, tubing bends or kinks, may cause the aerosol to hit the narrow part of the tubing; the angle of the airway outlet will also affect the flow characteristics of the aerosol and increase the possibility of impact, resulting in aerosol waste and affecting the efficiency of atomization. It can be seen that before the ventilator atomization inhalation treatment, it is important to organize the ventilator pipeline and clean the condensed water.

The retention of airway secretions in patients will increase airway resistance, resulting in uneven distribution of aerosol in the airway and reduced drug deposition rate, thus affecting the effect of atomization treatment. Therefore, before atomization inhalation treatment, the sputum blocking the artificial airway should be fully aspirated.

In order to reduce the need to disconnect the ventilator circuit and avoid the escape of aerosols to contaminate the environment, it is recommended that mechanically ventilated patients use a closed suction device during aerosol inhalation therapy. The use of a closed suction device can reduce the risk of medical staff being exposed to contaminated condensed water and airway secretions. Compared with an open suction device, a closed suction device can prevent the occurrence of VAP, shorten the length of ICU stay, and reduce the rate of respiratory microbial colonization. Therefore, there is no need to remove the closed suction device during ventilator aerosol inhalation therapy.

Reference

[1] DHAND R.How should aerosols be delivered during invasive mechanical ventilation?［J］.Respir Care，2017，62（10）：1343-1367.

[2] WILLIAMS J P，ARI A，SHANMUGAM R，et al.The effect of different closed suction catheter designs and pmdiadapters on aerosol delivery in simulated adult mechanical ventilation with and without exhaled humidity ［J］.Respir Care，2018，63（9）：1154-1161.

[3] HESS D.The ventilator circuit ［ED/OL］. （2021 -10 -14）［2021-10-15］

Aerosol inhalation is used to treat respiratory diseases such as asthma, chronic obstructive pulmonary disease, bronchitis and pneumonia[1].It has the advantages of simple operation, high local drug concentration and few side effects,and is therefore very popular among clinicians and patients.However,not all drugs are suitable for nebulization inhalation.

The most commonly used nebulization preparations includeβ2 receptor agonists and steroids. The main nebulization products on the domestic and foreign markets include salbutamol, ipratropium bromide, budesonide, isoproterenol, etc.[2]. Ambroxol is an expectorant widely used in clinical practice. It has the effect of dissolving sticky sputum and making sputum easier to cough up. Because ambroxol has a rapid and effective effect, good tolerance, and can be used for a long time, it is considered to be an ideal expectorant[3].

The method of administration in its instructions and relevant pharmacopoeias is oral or intravenous administration. No nebulizer inhalation has been launched on the market so far. However, many domestic clinicians use ambroxol injection for nebulization inhalation to treat respiratory diseases.

There is currently a lack of systematic evaluation of relevant evidence on its effectiveness and safety. This study systematically evaluated the effect of ambroxol injection nebulization inhalation in the treatment of pneumonia, and analyzed the application value of ambroxol nebulization inhalation in the treatment of respiratory diseases in combination with clinical practice.

Reference: 

1. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest, 2005; 127(1): 335-371.

2. Labiris NR, Dolovich MB. Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications. Br J Clin Pharmacol, 2003; 56(6):600-612.

3. Yang HD, Xu B. Mechanism and clinical application of ambroxol. Chinese Journal of Hospital Pharmacy, 2002; 22(1): 44.

Objective： To assess the effectiveness and safety of an aerosol inhalation of ambroxol in accessory treatment of pneumonia.

Methods： Biomedical databases, including MEDLINE, EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), CBM-disk and CNKI were searched. Randomized controlled trials (RCTs) and quasi-RCTs that compare aerosol inhalation of ambroxol with placebo or other aerosol inhalation regimens were collected. A critical quality assessment and Meta-analysis were performed for included studies.

Results： Thirteen RCTs were included and all of them were carried out in China. None of the trials described the method of randomization, allocation concealment, blind, and follow-up. With Juni scales, 13 trials scored C degree. Compared with the control group, aerosol inhalation of ambroxol improved total improvement rate and symptoms, and shortened hospital stay. Although statistical difference was not found in some comparisons, all trials showed beneficial tendency. We didn't find any RCTs describing the safety of ambroxol aerosol inhalation.

Conclusion： Because of the low quality of RCTs on ambroxol aerosol inhalation for pneumonia, no reliable conclusion can be drawn from our Meta-analysis. Well-designed RCTs and economic evaluation are urgently needed to evaluate the value and safety of aerosol inhalation of ambroxol in treating pneumonia.

No matter where I go recently, I hear coughs one after another. Winter has arrived in various places, and respiratory diseases have entered a high incidence period.

Based on the symptoms of mycoplasma pneumonia, common cold, influenza, and new crown, we can make a rough preliminary judgment

In general: influenza has more severe systemic symptoms, mycoplasma pneumonia has more severe coughs, and colds have lower fevers

If the following situations occur, seek medical attention in time:

High fever does not subside

Chest tightness, chest pain, difficulty breathing, severe headache, talking nonsense, unconsciousness

Chronic disease worsens

Can Mycoplasma pneumonia be treated at home?

In most cases, whether it is a virus or mycoplasma, if it is confined to the upper respiratory tract, most of them can heal on their own, and a small part may develop into pneumonia. Generally speaking, mycoplasma pneumonia can be improved at home with some symptomatic drugs, but it is necessary to pay attention to whether it develops into a serious condition. For example, if the child's condition improves after taking the medicine, you can observe at home; if the child still has a high fever after taking antipyretics, is listless and unwilling to eat, you should seek medical attention as soon as possible.

If you have Mycoplasma pneumonia, what can you do at home?

1. Closely observe changes in the condition, get enough rest and energy intake, and ensure water and electrolyte balance.

2. Take antipyretics correctly.

3. For those whose dry cough obviously affects rest, antitussive drugs can be used as appropriate. Expectorants include oral and nebulized drugs, and can also assist in mechanical expectoration, percussion expectoration and other physical therapies.

4. You can take the following treatment measures at home under the guidance of a doctor

for example:

Nebulized corticosteroids (such as budesonide)

For children in the acute stage of MPP, if they have obvious coughing and wheezing, and chest X-ray shows obvious inflammatory reaction and atelectasis in the lungs, inhaled glucocorticoids can be used for 1 to 3 weeks.

Nebulized albuterol inhalation

Studies have shown that children with mycoplasma pneumonia combined aerosol inhalation of budesonide and salbutamol on the basis of azithromycin, with a total effective rate of 98.00%, effectively shortening the course of the disease, significantly improving respiratory function, significantly reducing the level of inflammatory response, improving immune function and oxidation Stress-free and with certain safety.

Nebulized acetylcysteine

Acetylcysteine aerosol inhalation combined with azithromycin has a significant effect in treating children with mycoplasma pneumonia. It can suppress the inflammatory response of the children's body, reduce damage to the myocardium, and can quickly relieve the clinical symptoms of the children without significantly increasing adverse reactions.

Nebulized inhalation of ambroxol

In the clinical treatment of mycoplasma pneumonia in infants and young children, the clinical efficacy of ambroxol combined with budesonide aerosol inhalation treatment is accurate. It can control the infection in a short time, reduce the smooth muscle contraction reaction, improve the prognosis of children, and improve their quality of life.

In addition, it is recommended to gently clean the nasal cavity with normal saline regularly, which can reduce the colonization of harmful bacteria such as Mycoplasma pneumoniae in the nasal cavity and reduce the risk of infection.

A total of 70 children with wheezing pneumonia admitted to our hospital from October 2013 to December 2014 were randomly divided into an observation group (35 cases) and a control group (35 cases). The children in the control group received conventional treatment measures, while the children in the observation group received ventolin and pulmicort combined with nebulization inhalation treatment. The disappearance time of the main clinical symptoms and the occurrence of adverse reactions in the two groups were compared and observed. Results The disappearance time of the main clinical symptoms such as cough, wheezing, moist rales, and wheezing in the observation group was significantly shorter than that in the control group (P < 0.05), and the hospitalization time of the observation group was significantly shorter than that in the control group (P < 0.05). Two patients in the observation group had adverse reactions such as nausea, diarrhea, headache, and tremor, while 9 patients in the control group had adverse reactions. The incidence of adverse reactions in the observation group (5.7%) was significantly lower than that in the control group (25.7%) (P < 0.05).

1. Comparison of the disappearance time of the main clinical symptoms and hospitalization time between the two groups of patients The disappearance time of the main clinical symptoms such as cough, wheezing, moist rales and wheezing in the observation group was significantly shorter than that in the control group (P<0.05), and the hospitalization time of the observation group was significantly shorter than that in the control group (P<0.05) (see Table 1).

2. Comparison of adverse reactions between the two groups of patients Two patients in the observation group experienced adverse reactions such as nausea, diarrhea, headache and tremor, while 9 patients in the control group experienced adverse reactions. The incidence of adverse reactions in the observation group (5.7%) was significantly lower than that in the control group (25.7%) (P<0.05) (see Table 2).

  3. The results of this study showed that after the children in the observation group were treated with ventolin and Pulmicort Respules combined with nebulized inhalation on the basis of conventional comprehensive symptomatic treatment, the disappearance time of the main clinical symptoms such as cough, wheezing, moist rales, and wheezing, as well as the length of hospital stay were significantly shortened (P<0.05), and the adverse reactions such as nausea, diarrhea, headache, and tremor in the children in the observation group during treatment were reduced by 20%. This result is basically consistent with the results of Li Ru et al. [4]. It can be seen that the effect of nebulized inhalation of Pulmicort Respules combined with ventolin in children with wheezing pneumonia is good, which is beneficial to improve the clinical symptoms and signs of children.

  Pulmicort Respules is a kind of adrenocortical hormone drug, which has no halogens and has a significant inhibitory effect on respiratory tract inflammatory response. It is also beneficial to relieve respiratory hyperresponsiveness and bronchospasm symptoms [5]. The main ingredient in Pulmicort Respules is budesonide, which can strongly bind to glucocorticoid receptors. The clinical effect of subcutaneous administration is better, which is significantly higher than the treatment effect of general corticosteroid drugs. At the same time, most clinical experimental studies have shown that budesonide can effectively inhibit non-allergic inflammation and allergic inflammation induced by lymphocytes, histamine, neutrophils, mast cells, macrophages, cytokines, mediators, etc., and can also effectively improve clinical symptoms such as cough and wheezing caused by inflammatory reactions.

  The main active ingredient in ventolin is salbutamol, which is a selective β2 receptor agonist that selectively stimulates β2 receptors on bronchial smooth muscle and can also effectively dilate the bronchi [7]. The combined use of pulmicort and ventolin for aerosol inhalation can effectively increase the drug concentration in the patient's body, promote the regeneration of airway epithelial cells, repair the damaged airway as soon as possible, better improve the clinical symptoms of children, and minimize the pain and discomfort of children. Moreover, during the entire medication process, it will not cause adverse effects on the patient's physiological functions, and the treatment safety is relatively high. In summary, the clinical effect of Ventolin and Pulmicort Respules combined with nebulized inhalation in the treatment of children with wheezing pneumonia is good, which can effectively improve the clinical symptoms of children and help them to be discharged from the hospital as soon as possible, and the children have relatively few adverse reactions. It is a safe and effective treatment plan with high value for clinical promotion and reference.

Reference:

[1] Jiang Wenli. Study on the efficacy of Pulmicort Respules combined with Ventolin nebulization in the treatment of acute exacerbation of bronchial asthma in children [J]. Chinese and Foreign Medical Treatment, 2013, 1(3): 122-123.

[2] Gao Zhouli. Application value of oxygen-driven nebulization inhalation of Pulmicort Respules in the treatment of infantile asthmatic pneumonia (J). Modern Diagnosis and Treatment, 2013, 7(16): 74-75.

[3] Gu Jiachang. Observation on the efficacy of nebulization inhalation of Pulmicort Respules combined with Ventolin in the treatment of asthmatic pneumonia in children [J]. Medical Review, 2013, 19(19): 3624-3625.

[4] Li Ru. Observation on the efficacy of triple nebulization inhalation of Pulmicort Respules, Atrovent and Ventolin in the treatment of acute exacerbation of severe asthma in adults [J]. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 291-294.

[5] Zheng Rong. Observation on the efficacy of Pulmicort Respules combined with Ventolin in the treatment of asthmatic children [J]. Chinese General Practice, 2014, 12(1): 162-163.

[6] Zhang Minjie ． Analysis of the efficacy of nebulized inhalation of Pulmicort and Respules in the treatment of asthmatic pneumonia in children [J]. China Medical Guide, 2013, 11(1): 42-43.

[7] Huang Jinzhen. Observation on the efficacy of nebulized inhalation of Pulmicort and Respules combined with Wanhua in the treatment of bronchiolitis [J]. China Modern Doctor, 2013, 51(24): 43-44

Pediatric wheezing pneumonia is a common respiratory infection in clinical pediatrics. It is more common in infants and young children aged between 3 months and 4 years. The main clinical symptoms of children are coughing and wheezing [1]. At present, the main clinical treatments are β-receptor agonists, M receptor antagonists, glucocorticoids and other drugs, and the clinical treatment effect is definite [2]. In recent years, our hospital has used ventolin and pulmicort combined with nebulization inhalation to treat children with wheezing pneumonia, and the results have achieved ideal results [3]. This article compares and analyzes the clinical efficacy of conventional treatment measures and ventolin and pulmicort combined with nebulization inhalation in 70 children with wheezing pneumonia in our hospital.

1 Materials and methods

1.1 General information 70 children with wheezing pneumonia admitted to our hospital from October 2013 to December 2014 were selected as the subjects of this study. All the selected subjects were diagnosed by bilateral lung X-ray examination, and the consent of the family members of the children was obtained. At the same time, children with bronchial foreign body disease and infantile asthma were excluded. The 70 children were randomly divided into an observation group (35 cases) and a control group (35 cases). There were 24 males and 11 females in the observation group. The oldest child was 6 years old and the youngest was 6 months old, with an average age of (2.7±0.7) years old. The longest course of the children was 9 days, the shortest was 3 days, and the average was (5.5±0.3) days. There were 22 males and 13 females in the control group. The oldest patient was 5.7 years old, the youngest was 5 months old, and the average age was (2.3±0.8) years old. The longest course of the disease was 10 days, the shortest was 2 days, and the average was (5.6±0.5) days. The statistical analysis of the age, gender, and course of disease of the two groups showed that there was no statistical significance (P> 0.05), the difference was small, and the comparability was high.

1.2 Methods Both groups of children received routine comprehensive symptomatic treatment such as cough and asthma, oxygen inhalation, sputum suction, fluid infusion, and anti-infection. Children in the observation group received ventolin (trade name: salbutamol sulfate aerosol, manufacturer: produced by GlaxoSmithKline Group of Spain, national medicine standard: J20110040) and Pulmicort Respules (trade name: budesonide suspension for inhalation, manufacturer: produced by AstraZeneca Limited of Australia, national medicine standard: H20090902) atomization inhalation treatment on the basis of conventional comprehensive symptomatic treatment. 2mL of Pulmicort Respules and 0.25mL of ventolin were injected into the micro-atomizer pump at the same time for micro-net atomizer inhalation. The inhalation lasted for 7-15min, twice a day, and the continuous treatment lasted for 4-7d as a course of treatment.

1.3 Observation indicators The disappearance time of the main clinical symptoms such as cough, wheezing, moist rales, wheezing, and hospitalization time of the two groups of patients were observed and counted, and the incidence of adverse reactions of the two groups of patients should be counted.

1.4 Statistical analysis SPSS 20.0 data processing software was used to process the two groups of relevant data. The measurement data were expressed as (x±s), and the counting data were expressed as %. The t-test was used to test the difference between the two groups. P<0.05 indicated that the difference between the two groups was statistically significant.

Objective： To observe and analyze the clinical effect of ventolin and pulmicort combined with nebulized inhalation in children with wheezing pneumonia.

Pic 1: Childhood Pneumonia | Asthma Foundation NZ

Methods： A total of 70 children with wheezing pneumonia admitted to our hospital from October 2013 to December 2014 were randomly divided into an observation group (35 cases) and a control group (35 cases). The children in the control group received conventional treatment measures, and the children in the observation group received ventolin and pulmicort combined with nebulized inhalation treatment on this basis. The disappearance time of the main clinical symptoms and the occurrence of adverse reactions in the two groups were compared and observed. Results The disappearance time of the main clinical symptoms such as cough, wheezing, wet rales, and wheezing in the observation group was significantly shorter than that in the control group (P < 0.05), and the hospitalization time of the observation group was significantly shorter than that of the control group (P < 0.05). Two patients in the observation group had adverse reactions such as nausea, diarrhea, headache and tremor, while 9 patients in the control group had adverse reactions. The incidence of adverse reactions in the observation group (5.7%) was significantly lower than that in the control group (25.7%) (P < 0.05).

Conclusion The clinical effect of ventolin and pulmicort combined with nebulization inhalation in children with wheezing pneumonia is good, which can effectively improve the clinical symptoms of children and help them to be discharged as soon as possible. The adverse reactions of children are relatively few. It is a safe and effective treatment plan with high clinical promotion and reference value.

Keywords: wheezing pneumonia in children; ventolin; pulmicort combined with nebulization inhalation; clinical efficacy