Nebulizer Therapy Research Articles

Nebulizer Therapy in Children and Recommendations for Nurses

Solunum sistemi hastalıklarının tedavisinde, nebülizatör ile ilaç uygulamaları yaygın olarak kullanılmaktadır. Nebülizatörler inhaler tedavi uygulanması endike olan astım, obstrüktif akciğer hastalığı, pnömoni, kistik fibrozis, bronşiyolit, bronkospazm, krup gibi birçok hastalıkta ilk seçenek olmaktadır. Hızlı etki gösteren noninvaziv bir tedavi yöntemi olması, yan etkilerin ve ilaç etkileşimlerinin az olması, diğer inhaler tedavi yöntemlerine oranla daha az koordinasyon gerektirmesi önemli avantajları arasındadır. Diğer yandan oldukça dikkat edilmesi gereken, dikkat edilmediğinde işlemin etkisini azaltan ya da değiştiren dezavantajları da vardır. Bunlar; uygulama zamanı, hastanın/maskenin pozisyonu, hazneye konulması gereken ilaç miktarı, uygulama süresi, uygun basınca ayarlanması, uygulayan sağlık personelinin/ailenin uygulama hakkında yanlış/yetersiz bilgi sahibi olması gibi faktörlerdir. Yapılan çalışmalar incelendiğinde nebülizatörle ilaç uygulama konusunda hastaların ve sağlık profesyonellerinin bilgi ve becerilerinin yetersiz olduğu dikkat çekmektedir. Özellikle acil birimlerde, yoğun bakımlarda, çocuk servislerinde ve evlerde sıkça kullanılan nebülizatörlerin doğru kullanımı, uygulayıcılar tarafından iyi bilinmelidir. Doğru yapılmayan uygulamalar tedavinin etkin olmamasına ve böylece hastanede kalış süresinin uzamasına, tedavi masraflarında gereksiz artışa ve ülke ekonomisinin olumsuz etkilenmesine neden olmaktadır. Bu derlemede çocuklarda nebülizatör ile ilaç uygulamada karşılaşılan durumlar ile hemşirelik yaklaşımları irdelenmiştir.

The effect of nebulized antibiotics in children with tracheostomy

The effect of nebulized antibiotics in children with tracheostomy

The emerging role of nebulization for maintenance treatment of chronic obstructive pulmonary disease at home.

Inhalation therapy is the cornerstone of chronic obstructive pulmonary disease (COPD) management. However, for many COPD patients who are managed at home, nebulization therapy offers an effective alternative treatment and fulfills the gap of catering to the specific population of patients who are unable to use handheld inhaler devices appropriately. The present review highlights key aspects, namely selection of the right beneficiaries for home nebulization, available drugs in nebulized formulations for the treatment of COPD, and the importance of care, cleaning, and maintenance, which are prerequisites for ensuring successful nebulization therapy.

Современные возможности небулайзерной терапии в лечении респираторной патологии у детей

Современные возможности небулайзерной терапии в лечении респираторной патологии у детей

Knowledge and practices of nurses regarding nebulization therapy in Kirkuk city hospitals

Background: Inhaler is an important device used to inhalant the drugs to treat some pulmonary diseases. Aims of study: Assess the knowledge and practices of nurses about nebulization therapy and determine the relationship between demographic characteristic with nurse's knowledge and practices. Methodology: A purposive study design was conducted in the period from 1st June 2018 to 15th November 2018.the sample include (50) nurses who were working at intensive care unit, at Azadi teaching hospital and Kirkuk general hospital.

Effectiveness of nebuliserotherapy in reflux-associated asthma

In order to study the effectiveness of the combined use of ultrasonic inhalation (nebulizer therapy) in the complex treatment of patients with reflux-induced asthma (RIA), depending on the composition of the refluxate, 39 patients were studied. Conducted clinical, functional, cytological studies and ph metrics. In the main group, 27 patients were prescribed ultrasonic alkaline inhalation. After treatment, in patients with RIA with acid refluxate, clinical indicators improved, and the function of external respiration returned to normal. Stimulation of the body's cellular defense was also observed, and the microbial contamination of the pharynx decreased.

ТОНКОЩІ ВИКОРИСТАННЯ ІНГАЛЯЦІЙНИХ ПРИСТРОЇВ В ДИТЯЧІЙ ПРАКТИЦІ

SUBTLETIES OF USING INHALATION DEVICES IN PEDIATRIC PRACTICE O. Katilov National Pirogov Memorial Medical University, Vinnytsya, Ukraine Abstract. Inhalation therapy plays an important role in the treatment of a number of respiratory diseases. Due to the direct delivery of drugs to the respiratory tract, the development of systemic side effects is minimized, which is extremely important for pediatric patients. Today, inhalation therapy is the basic method of treating bronchial asthma. But about 1/3 of patients with bronchoobstructive diseases perform inhalations with serious technical errors. As a result of improper inhalation technique, the drug enters the respiratory tract in insufficient quantities, which leads to poor disease control and frequent exacerbations. Particular difficulties in the use of inhalation devices arise in pediatric practice. Children under 3 years of age are usually unable to perform specific breathing maneuvers. Therefore, for children under 5 years of age, the best choice among delivery devices is metered-dose inhaler (MDI) with a valve spacer. An alternative method of drug delivery is nebulizer therapy. Children older than 5 years can already use dry powder inhalers (DPI). This literature review presents the classification and types of DPI, considers their main technical characteristics, the criteria of the “ideal” delivery device. Based on the literature, it is established that the most optimal inhalation device for children older than 5 years is Easyhaler, which has a number of advantages. It is easy to use. The MDI-like design contributes to the commitment and correct, without technical errors, use of the inhaler. Easyhaler has the appropriate aerodynamic characteristics of the released dose, safe and efficient delivery of the drug. Key words: inhalation therapy, delivery devices, dry powder inhalers, children, bronchial asthma.

EFFICIENT COMPREHENSIVE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION AND POSTCOVIDAL SYNDROME IN ELDERLY PATIENTS.

The aim: The purpose of the study is to increase the efficacy of сomprehensive treatment in elderly patients with COPD , who have suffered of coronavirus disease-COVID-19 in the last 3-6 months, by using nebulizer therapy with N-acetylcysteine and 3% hypertonic sodium chloride solution (Flu-Acyl broncho) and the drug glycine, to correct psychosomatic disorders. Materials and methods: Under our supervision there were 60 elderly patients with COPD gr D, who underwent Covid 19 in the last 3-6 months, were under observation. The average age was 66.3±2.1 years. Рatients of the main and control groups were prescribed complex basic therapy. However, mucolytic therapy was administered to patients in the main group using combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution through a 5.0 №10 nebulizer. For the treatment of astheno-neurotic disorders of postcovidal syndrome was prescribed glycine 100 mg 2 times a day for 10 days. Subsequently, Flu-Acyl broncho through a nebulizer at 5.0 No.10, and glycised was used in courses once a day for 10 days per month. Patients in the control group were prescribed acetylcysteine 200 mg 3 times a day N10. Results: The results of observation for 6 months showed that in patients of the main group, recurrence of the disease was not observed. whereas in patients of the control group in 6 patients (20%). Conclusions: Comprehensive treatment of elderly patients with comorbid pathology - COPD group D and postcovidal syndrome, with the additional use of nebulizer delivery of the combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution in combination with the sedative drug glycine, promotes improving the quality of life in patients, reducing the duration of treatment, prevents recurrence and progression of COPD.

The benefit of nebulized magnesium sulphate therapy in patients with acute severe asthma: a scoping review

OBJECTIVE It is known that magnesium sulfate (MgSO4) administered intravenously as an adjunct treatment is effective in treating asthma exacerbations. However, there is limited data available on the use and benefit of nebulized magnesium sulfate. METHODS We conducted a scoping review on four databases i.e., Medline, Embase, PubMed, and Cochrane to determine the benefit of using nebulized magnesium sulphate therapy in addition to salbutamol and/or ipratropium in the treatment of patients with severe acute asthma. RESULTS A total of 16 articles were included in the study. Based on the literature review, combined nebulized MgSO4 and salbutamol therapy was found to be superior to salbutamol alone in adult patients. There was also a significant reduction in hospital admissions in adult patients with severe asthma exacerbations if they receive nebulized MgSO4. Although some small studies have shown benefit in using it in children and pregnant patients, further studies are needed to address the role of nebulised MgSO4 in such populations. CONCLUSION Within the study limitations, magnesium sulfate was found to be beneficial when used in nebulized form in acute asthma exacerbation. Further studies are warranted to establish its role in practice guidelines.

CARE: an observational study of adherence to home nebulizer therapy among children with asthma.

Background:The prevalence of pediatric asthma in China is approximately 3%, and asthma remains poorly controlled in many of these patients. This study assessed the rate of adherence to home nebulizer treatment in paediatric patients in China.Methods:The CARE study was a 12-week, multicentre, prospective, observational study across 12 tertiary hospitals in China. Patients were aged 0–14 years, clinically diagnosed with asthma and prescribed home nebulizer inhaled corticosteroid (ICS) therapy for ⩾3 months. The primary endpoint was electronically monitored treatment adherence. Patients attended onsite visits at 0, 4, 8 and 12 weeks to assess asthma control, severity and treatment adherence (recorded by electronic monitoring devices and caregivers).Results:The full analysis set included 510 patients. Median treatment adherence reported by electronic monitoring devices was 69.9%, and median caregiver-reported adherence was 77.9%. The proportion of patients with well-controlled asthma increased from 12.0% at baseline to 77.5% at visit 4. Increased time between asthma diagnosis and study enrolment was a significant predictor for better adherence [coefficient: 0.01, p = 0.0138; 95% confidence interval (CI): 0.00, 0.01] and asthma control (odds ratio = 1.001, p = 0.0498; 95% CI: 1.000, 1.002). Negative attitude to treatment by the caregiver was associated with poorer asthma control.Conclusions:Adherence to home nebulization, a widely used treatment for asthma, was high among Chinese pediatric patients. Asthma control improved with increasing treatment duration. These results suggest that home nebulization of ICS is an effective and recommendable long-term treatment for paediatric patients with asthma. Trial registration ClinicalTrials.gov identifier: NCT03156998 The reviews of this paper are available via the supplemental material section.

P141 Has the COVID-19 pandemic affected medication adherence to inhaled nebulised therapy for patients at a large adult cystic fibrosis centre?

P141 Has the COVID-19 pandemic affected medication adherence to inhaled nebulised therapy for patients at a large adult cystic fibrosis centre?

Cross-risks of development of bronchopulmonary dysplasia and necrotizing enterocolitis of premature neonates

Annotation. Bronchopulmonary dysplasia and necrotizing enterocolitis have become modern problems of effective care of premature neonates. These two pathologies significantly delay the discharge of a premature baby from the hospital, lead to significant economic costs and worsen the quality of life of these patients. The aim of the study was to identify controlled predictors of bronchopulmonary dysplasia, however, in the analysis of the initial status of patients obtained useful results for the parallel treatment of necrotizing enterocolitis. The study recruited 133 neonates with a gestational age of 28–32 weeks with a diagnosis of respiratory distress syndrome on the basis of two NICU in Dnipro in the period from 2016 to 2020. According to the results of the study in the structure of treatment of premature neonates there were significant risks of bronchopulmonary dysplasia: the duration of respiratory support by mechanical ventilation, non-invasive ventilation, additional oxygenation, nebulizer therapy, and for necrotizing enterocolitis – lower fluid intake, hemoglobin level in 1, 3, 7 days of life, moderate and severe asphyxia. Some of the approaches in therapy are cross-cutting, such as the prevention of anemia in respiratory distress syndrome, fluid intake differences and intensive care methods reducing the duration of respiratory support for the prevention of late neonatal sepsis, we can create an algorithm that takes into account all the risks and enhance outcome for these patients. The perspectives for future work – research of neurological status of former premature neonates and finding out predictors of cerebral palsy.

Estimating the burden of nosocomial exposure to tuberculosis in South Korea, a nationwide population based cross-sectional study

Background/AimsThe aim of the study was to investigate the current nationwide burden of nosocomial exposure to tuberculosis (TB) using national health insurance claims data.MethodsAll patients who had claims for drug susceptibility testing for TB from 2012 to 2016, which indicated culture-proven TB, were included. The first day of the infectious period was defined as 3 months before a doctor’s suspicion of TB in patients with respiratory symptoms and 1 month before in patients without symptoms. The last day of the infectious period was defined as one day before the prescription of anti-TB medications. Patients hospitalized during infectious periods were investigated and their hospitalization days were calculated. Records of medical procedures which increased the risk of nosocomial transmission by generating aerosols were also investigated.ResultsA total of 7,186 cases with 94,636 person-days of hospitalization with unrecognized active TB were found. Patients above 60 years of age accounted for 63.99% of the total number and 69.70% of the total duration of hospitalization. TB patients in the older age group showed a trend toward higher risks for hospitalization with unrecognized active TB. Patients in their 80s showed the highest risk (12.65%). Bronchoscopy (28.86%), nebulizer therapy (28.48%), and endotracheal intubation (13.02%) were common procedures performed in these patients during hospitalization.ConclusionsThe burden of nosocomial exposure to TB in South Korea is still substantial. Hospitalization with unrecognized active TB, especially among the elderly TB patients could be a serious public health issue in South Korea.

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

Implementation Of Pursed Lip Breathing And Semi Fowler Position in COPD Patients Which Get Nebulizer in IGD: A Literature Review

Background: Chronic obstruction of pulmonary disease (COPD) is a pulmonary disease caused by the blockage of the air flow channel that occurs much in Indonesia due to the high exposure to the risk factors causing COPD such as the habit of smoking and unhealthy environment. The obstruction of the respiratory tract that occurs in COPD patients is usually characterized by shortness of breath. Various ways can be done to overcome shortness of breath is with pharmacological therapy in the form of nebulizer therapy. One of the effective non-pharmacological therapies to reduce shortness of breath with pursed lip breathing therapy and the giving of semi Fowler position.
 Objectives: Identify the research articles that display the results of analysis of the introduction of pursed lip breathing and the provision of semi Fowler in COPD patients who get therapy nebulizer in IGD space
 Research Method: The search for articles is done electronically using a Sience Direct, NCBI and Google Scholar databases. The search for the article used is the last 5 years. Keyword in search "pursed lip breathing, position semi-Fowler and chronic obstructive pulmonary disease" so obtained 5 research articles in review.
 Results: The feeding of pursed lip breathing and the giving of semi Fowler can effectively lower the shortness of breath in COPD patients. Step in the intervention of this combination by encouraging the patient to inhale the breath from the nose and the patient bent forward 30 to 40 degrees with the head lifted 16 to 18 degrees breathed slowly through the lips as much as 7 counts later afterwards the patient positions the Head 45
 Conclusion: The feeding of pursed lip breathing and the giving of semi Fowler is proven to decrease the shortness of breath in COPD patients
 Keyword: pursed lip breathing, position semi-fowler dan chronic obstructive pulmonary disease

Рossibilities of clinical application of modern nebulizers

The simplicity of converting medicinal solutions and suspensions into aerosols using mechanical and thermal energy, convenient delivery to the airways allows nebulizers to take a worthy place in the treatment of hospitalized and outpatient patients. Different types of nebulizers are available for use in the home and in medical settings (jet, ultrasound, membrane), and researches show that the performance and characteristics of the aerosol vary between different devices and manufacturers. Jet nebulizers are still the most used devices that do not require coordination of inhale and delivery of aerosol to the respiratory tract. To reduce the consumption of medicinal aerosol and optimize the air flow, virtual valve technology (V.V.T.) is being improved, and breath-actuated nebulizers are being created. The advantage of nebulizer therapy is the ability to apply large doses of medications, use substances that exist only in inhaled form. The choice falls on the nebulizer in cases where the patient can not use other delivery devices, for example, if the patient is unable to coordinate the inhalation and intake of the drug into the respiratory tract, with a severe exacerbation of obstructive disease, in the presence of motor disorders. The optimal delivery device for children of any age, including newborns, is a nebulizer. The most common indication for nebulizer therapy is the delivery of bronchodilators and inhaled corticosteroids for asthma or chronic obstructive pulmonary disease, as well as the treatment of upper respiratory tract diseases, in particular croup in children. An important place is given to nebulizers when it is necessary to prescribe certain mucolytics and antibiotics. In the treatment of emergency conditions, inhalation administration of drugs may be required, including situations when the patient is on mechanical ventilation or has a tracheostomy installed. The significance of nebulizers in the treatment of cystic fibrosis, pulmonary arterial hypertension, and alpha-1-antitrypsin deficiency is being studied. The possibilities of endobronchial delivery of heparin, insulin, and monoclonal antibodies are evaluated.

Bronchiectasis with accompanying bronchoobstruction: efficacy of nebulizer therapy

Objective. To investigate the efficacy and safety of the combination of salbutamol (Nebutamol®, “Yuria-Pharm”) and hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) in complex nebulizer therapy of bronchiectasis with concomitant bronchoobstruction.
 Materials and methods. As a result of initial screening, 74 patients with confirmed bronchiectasis using high-resolution computed tomography of thoracic organs were selected for further study of 45 patients who had <90 % postbronchodilation forced expiratory volume in 1 sec (FEV1) at the first visit. Patients on the second visit (V2) were prescribed 14-day nebulizer therapy with the bronchodilator salbutamol at a dosage of 2 mg / 2 ml and mucolytic sodium chloride solution 3 % with sodium hyaluronate 30 mg and respiratory gymnastics. Inhalation of mucolytic was prescribed 20 min after inhalation of bronchodilators. Subjective assessment of the severity of cough and sputum was performed using the scales of V.M. Savchenko (2001), assessment of the severity of dyspnea – on a modified scale of dyspnea of the Medical Research Council (mMRC). The daily amount of sputum (DAS) was measured by laboratory scales of high accuracy (MOMERT Model 6000). The respiratory function (RF) was measured using computer spirometry MasterLab (Viasis, Germany). Indicators were evaluated before and 15 min after inhalation of 400 μg salbutamol using a metered aerosol inhaler through a spacer. Indicators such as DAS, the severity of cough and sputum according to the Savchenko questionnaire, the severity of shortness of breath according to the mMRC and RF were determined at the first (screening – V1), the third (day 14 – V3), the fourth (day 28 – V4) and the fifth (day 42 – V5) visits. The safety of this therapy was assessed by recording all adverse events and further processing of the data.
 Results and discussion. The average age of patients was 58 (43; 66) years, 14 of them (31.1 %) were men. A comparison of all clinical and laboratory characteristics of patients on four visits was performed using Friedman’s rank analysis of variance (ANOVA). Among patients, no statistically significant differences were found between visits in the severity of dyspnea on the mMRC scale (p=0.05), FEV1 (p=0.22) and the ratio of FEV1/FVCpost (p=0.61). However, there were statistically significant differences in such indicators: subjective assessment of the severity of cough on the scale of Savchenko (F29.3=22.5; p=0.00005) was statistically significantly lower by V3 compared with V1 (p=0.0003), on V4 in comparison with V1 (p=0.006), on V5 in comparison with V1 (p=0.008). Subjective assessment of the amount of sputum on the scale of Savchenko (F29,3=22,2; p=0,00009) was significantly higher before treatment than after: on V1 in comparison with V3 (p=0,0005), on V1 in comparison with V4 (p=0.0005) and on V1 in comparison with V5 (p=0.002). DAS was also lower after treatment (F29.3=26.4; p=0.00001): V3 compared to V1 (p=0.000013), V4 compared to V1 (p=0.000006) and on V5 in comparison with V1 (p=0,00005). The following side effects were identified during therapy: tachycardia – in 4 patients (8.9 %), throat irritation after inhalation – in 2 patients (4.4 %), heartburn – in 1 patient (2.2 %).
 Conclusions. The use of salbutamol in a dosage of 2 mg / 2 ml and a solution of sodium chloride 3 % with sodium hyaluronate 30 mg by inhalation for 14 days had statistically and clinically significant effectiveness in reducing DAS, subjective feelings of the patient regarding the severity of cough and sputum in patients with bronchial obstruction. The use of Nebutamol® and Lorde® gial in complex nebulizer therapy of bronchiectasis has shown its effectiveness and safety, which is confirmed by the results of the study.

Bronchodilator Nebulization – A Rare Presentation of Bilateral Acute Angle Closure Glaucoma

Bronchodilator nebulization is one of the most commonly administered treatment for an acute attack of reactive airway disease. Development of acute angle closure glaucoma following nebulization therapy is a rare occurrence. We report a case of acute angle closure of both eyes in a 54 year old gentleman shortly after receiving therapy with inhaled salbutamol and ipratropium. This patient presented to our tertiary care eye hospital and was immediately treated with medical management and laser iridotomy. This case report highlights this rare but possible side effect of inhaled bronchodilator therapy. Health care providers need to be aware of this uncommon adverse effect and appropriate preventive measures such as identifying at risk individuals, usage of protective eye-wear, etc should be practiced.

PENERAPAN PEMBERIAN KOMBINASI MINT (PAPPERMINT OIL) DAN CAIRAN DENGAN NEBULIZER PADA PASIEN DENGAN BATUK ASMA BRONCHIALE DI RSUD UNGARAN

Asthma Bronchiale is inflammation in the airways (bronchi) where excessive lung mucus production makes breathing difficult. One treatment that can be given is by giving nebulizer therapy to ease the cough response to the presence of mucus in the respiratory tract with the addition of mint oil. The purpose of the case study is to illustrate the effect of adding mint (pappermint oil) and liquid with a nebulizer on the handling of asthma bronchiale cough in Ungaran District Hospital. The subject of this case study used two patients with asthma bronchiale, willing to be investigated, cooperative and more than 5 years old. Data was collected by observation and administration of nebulizer therapy by adding pappermint oil and liquid using a nebulizer. The results of the case study found that subject I had a cough frequency of 25 (moderate), no inflammation, no wheezing and easy sputum discharge, whereas in subject II the frequency of cough became 24 (moderate), no inflammation, no wheezing, and easy phlegm Exit. This study is recommended to apply pappermint oil therapy to reduce the frequency of cough bronchial asthma patients

Pharmacokinetics and tolerability of LIQ861, a novel dry-powder formulation of treprostinil.

A dry-powder inhaled formulation of treprostinil (LIQ861) produced using PRINT® technology offers a substantial advantage over current nebulized therapy. Treprostinil is a synthetic prostacyclin analogue that is currently approved for inhalation administration to patients with pulmonary arterial hypertension via nebulized Tyvaso® inhalation solution. LTI-101 was a phase 1, placebo-controlled, double-blind, randomized, single-center study that evaluated the ascending single-dose pharmacokinetics of LIQ861 in healthy subjects. Six sequential, escalating doses (25, 50, 75, 100, 125, and 150 mcg) were studied to investigate treprostinil exposure from LIQ861 inhalation. Subjects (n = 57) were randomly assigned in a 3:1 ratio to receive a single dose of either LIQ861 (n = 43) or placebo (n = 14); 56 subjects completed all protocol-defined assessments. Following single-dose administration, treprostinil exposure from LIQ861 increased proportionally across the dose range studied, and the pharmacokinetics profile of treprostinil administered as LIQ861 was similar to prior reports of inhaled treprostinil. All doses of LIQ861 were generally well-tolerated with no deaths, serious adverse events, or dose-limiting toxicities. The most frequently reported treatment-emergent adverse events related to study drug administration were coughing and throat irritation, which are common to dry-powder formulations. Treatment-related treatment-emergent adverse events were reported more frequently at higher dose levels; however, all were assessed as mild in severity. We conclude that the pharmacokinetics profile of treprostinil using a dry-powder inhaled formulation increased in proportion to dose as anticipated and was similar to earlier reports of inhaled, nebulized treprostinil (Tyvaso®). Based on these results, a phase 3 study (INSPIRE; Clinicaltrials.gov Identifier NCT03399604) evaluating the long-term safety and tolerability of LIQ861 in patients with pulmonary arterial hypertension was initiated.