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.

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.

(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.