Abstract
The administration of aerosolized medication is a basic therapy for patients with numerous respiratory tract diseases, including obstructive airway diseases (OADs), cystic fibrosis (CF), and infectious airway diseases. The management and care for patients requiring mechanical ventilation remains one of the greatest challenges for medical practitioners, both in intensive care units (ICUs) and pulmonology wards. Aerosol therapy is often necessary for patients receiving noninvasive ventilation (NIV), which may be stopped for the time of drug delivery and administered through a metered-dose inhaler or nebulizer in the traditional way. However, in most severe cases, this may result in rapid deterioration of the patient's clinical condition. Unfortunately, only limited number of original well-planned studies addressed this problem. Due to inconsistent information coming from small studies, there is a need for more precise data coming from large prospective real life studies on inhalation techniques in patients receiving NIV.
Highlights
Inhalation therapy remains a basic treatment option for chronic airway diseases, including chronic obstructive lung disease (COPD), asthma, and in selected cases of cystic fibrosis (CF)
A patient group treated for severe asthma attack with bronchodilators was randomized to noninvasive mechanical ventilation (NIV) administered through a nasal mask with settings as follows: spontaneous over time mode (ST), inspiratory positive airway pressure (IPAP) 8–15 cm H2O, expiratory positive airway pressure (EPAP) 3 to 5 cm H2O 3 h/day, or sham NIV therapy. e patients were encouraged to breathe only through the nasal mask. 80% of NIV group achieved a ca. 50% increase in FEV1 compared to baseline values versus 20% in sham NIV group
A study was conducted on the effect of connecting temperature, nebulizer tubing, and breathing patterns, on massweighted aerodynamic particle size drug distribution. e data obtained from this study suggested that when inhaled, modifications of particle distribution occur that are related to conditions in the device tubing and may reduce the diameters of particles entering the airways [24]
Summary
Inhalation therapy remains a basic treatment option for chronic airway diseases, including chronic obstructive lung disease (COPD), asthma, and in selected cases of CF. It may be used daily, as a method of symptom control or, in case of an acute exacerbation (AE), as a life-saving therapy. As noninvasive mechanical ventilation (NIV) has recently become a treatment standard in COPD [3] and a popular treatment option for patients with respiratory insufficiency in the course of CF [4] or asthma [5], attempts are made to couple it with aerosol therapy for patients’ benefit [6, 7]. Data on aerosol therapy coupled with NIV in this special patient population is scarce, and there is a need for prospective randomized trials; the aim of this review of the available literature on this topic is to help medical practitioners make optimal decisions while caring for this patient population
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