Nebulizer therapy for bronchial asthma exacerbation. Nebulizers and nebulizer therapy

Nebulizer therapy- is one of the types of inhalation therapy used for respiratory diseases. Nebulizer therapy is most widely used in the treatment of bronchial asthma and COPD, as a highly effective method of delivering drugs directly to the bronchi.
To carry out nebulizer therapy, special devices are used - nebulizers. The word “nebulizer” comes from the Latin “nebula” (fog, cloud), and was first used in 1874 to mean “an instrument that converts a liquid substance into an aerosol for medical purposes.” One of the first portable “aerosol devices” was created by J. Sales-Girons in Paris in 1859. The first nebulizers used a stream of steam as an energy source and were used to inhale vapors of resins and antiseptics in patients with tuberculosis. Modern nebulizers bear little resemblance to these ancient devices, but they fully meet the old definition of producing an aerosol from a liquid drug.
Content:

Goals of nebulizer therapy

The main goal of inhalation (nebulizer) therapy is to achieve maximum local therapeutic effect in the respiratory tract with minor manifestations or absence side effects. The dispersion of the drug, which occurs during the formation of an aerosol, increases the total volume of the drug suspension and the surface of its contact with the affected areas of tissue, which significantly increases the effectiveness of the effect. Some medications are poorly absorbed from gastrointestinal tract or undergo a significant first-pass effect through the liver. In such cases, local administration, and in this case, the inhalation route is the only possible one.

Objectives of nebulizer therapy

The main objectives of nebulizer therapy are:



1. Reducing bronchospasm



2. Improving the drainage function of the respiratory tract


3. Sanitation of the upper respiratory tract and bronchial tree


4. Reducing swelling of the mucous membrane


5. Reduce activity inflammatory process


6. Impact on local immune responses
7. Improved microcirculation
8. Protection of the mucous membrane from the action of allergens and industrial aerosols

Benefits of nebulizer therapy

1. Possibility of use starting from the very beginning early age, in any physical condition of the patient and regardless of the severity of the disease, due to the absence of the need to synchronize the inhalation with the aerosol flow (does not require forced breathing maneuvers).


2. Delivery of a larger dose of the drug and obtaining the effect in a shorter period of time


3. The ability to easily, correctly and accurately dose medications
4. Simple inhalation technique, including at home
5. Possibility of using a wide range of medicines (all standard solutions for inhalation can be used) and their combinations (possibility of simultaneous use of two or more medicines), as well as infusions and decoctions of herbal teas.


6. Nebulizers are the only means of delivering the drug to the alveoli
7. Possibility of connection to the oxygen supply circuit


8. Possibility of inclusion in the ventilator circuit
9. Environmental safety, since there is no release of freon into the atmosphere

Types of nebulizers

There are two main types of nebulizers:



1. Compressor
In compressor nebulizers, aerosol formation occurs when air is supplied to the atomization chamber through a compressor.
More details (principles of operation of compressor nebulizers)
The principle of a compressor (jet) nebulizer is based on the Bernoulli effect (1732) and can be represented as follows. Air or oxygen (working gas) enters the nebulizer chamber through a narrow Venturi orifice. At the exit from this hole, the pressure drops and the gas velocity increases significantly, which leads to the suction of liquid into this area of ​​​​low pressure through narrow channels from the chamber reservoir. When the liquid meets the air flow, it breaks down into small particles measuring 15-500 microns (“primary” aerosol). Subsequently, these particles collide with a “damper” (plate, ball, etc.), resulting in the formation of a “secondary” aerosol - ultrafine particles 0.5-10 microns in size (about 0.5% of the primary aerosol), which it is then inhaled, and a large proportion of the primary aerosol particles (99.5%) are deposited on the inner walls of the nebulizer chamber and are again involved in the process of aerosol formation (Fig. 1).




Fig.1. Diagram of a jet nebulizer (O" Callaghan & Barry).

Convection (general type)

This nebulizer with a constant aerosol output is the most common. During inhalation, air is drawn in through the tube and the aerosol is diluted. The aerosol enters Airways only during inhalation, and during exhalation, most of it is lost (55-70%). Conventional nebulizers require relatively high working gas flows (more than 6 l/min) to achieve adequate aerosol output.



Fig.2. Diagram and aerosol output of a convection nebulizer




Breath-activated (controlled) (Venturi nebulizers)
They also produce an aerosol continuously throughout the respiratory cycle, but the release of aerosol increases during inhalation. This effect is achieved by the entry of additional air flow during inhalation through a special valve into the area of ​​aerosol production, the total flow increases, which leads to an increase in aerosol formation. During exhalation, the valve closes and the patient's exhalation follows a separate path, bypassing the area of ​​aerosol production.
Thus, the ratio of aerosol output during inhalation and inhalation increases, the amount of inhaled drug increases, the loss of drug decreases (up to 30%), and the nebulization time is reduced. Venturi nebulizers do not require a powerful compressor (a flow of 4-6 l/min is sufficient).
Their disadvantages are their dependence on the patient's inspiratory flow and the slow rate of aerosol production when using viscous solutions.
In patients with cystic fibrosis, it was shown that Venturi nebulizers, compared with conventional nebulizers, allowed for twice as much drug deposition in the respiratory tract: 19% versus 9%.


Fig.3. Diagram and aerosol output of a breath-activated nebulizer (Venturi type)



Synchronized with breathing (dosimetric nebulizers)

The aerosol is produced only during the inhalation phase. The generation of aerosol during inhalation is ensured using electronic flow or pressure sensors, and theoretically the ratio of aerosol output during inhalation and exhalation reaches 100: 0. The main advantage of a dosimetric nebulizer is the reduction of drug loss during exhalation.
In practice, however, loss of drug to the atmosphere may occur during exhalation, since not all of the drug is deposited in the lungs. Dosimetric nebulizers have undeniable advantages when inhaling expensive drugs, because reduce their loss to a minimum. Some dosimetric nebulizers were created specifically for the delivery of expensive drugs, for example, the VISAN-9 nebulizer is designed for inhalation of surfactant preparations. The disadvantages of such systems are longer inhalation times and high costs.

Rice. 4. Schemes and aerosol output of a dosimetric nebulizer
Adaptive delivery devices are also a type of dosimetric nebulizer, although some experts consider them to be a new class of inhalation devices.
Their fundamental difference is the adaptation of the production and release of aerosol to the respiratory pattern of the patient. An example of this type of nebulizer is Halolite. The device automatically analyzes the patient's inspiratory time and inspiratory flow (over 3 respiratory cycles), and then provides aerosol production and release during the first half of the subsequent inspiration. Inhalation continues until the output of the precisely prescribed dose is achieved. medicinal substance, after which the device beeps and stops inhalation. Advantages of the device: rapid inhalation of the drug dose (4-5 min), high patient compliance with the therapy, high respirable fraction (80%) and very high aerosol deposition in the respiratory tract - up to 60%.

2. Ultrasonic

In ultrasonic nebulizers, the transformation of liquid into an aerosol is achieved through high-frequency vibration of piezoelectric crystals.

More details (principles of operation of ultrasonic nebulizers)
Ultrasonic nebulizers use the energy of high-frequency vibration of a piezocrystal to produce aerosol. Vibration from the crystal is transmitted to the surface of the solution, where “standing” waves are formed. When the frequency of the ultrasonic signal is sufficient, a “microfountain” is formed at the crossroads of these waves, i.e. aerosol formation (Fig. 3). Particle size is inversely proportional to signal frequency. As in a jet nebulizer, aerosol particles collide with a “damper”, larger ones are returned back to the solution, and smaller ones are inhaled.
Aerosol production in an ultrasonic nebulizer is almost silent and faster compared to compressor nebulizers. However, their disadvantages are:
- inefficiency of aerosol production from suspensions and viscous solutions
- larger residual volume
- increasing the temperature of the solution during nebulization with the possibility of destroying the structure of the drug.





Rice. 5. Diagram of an ultrasonic nebulizer (O" Callaghan & Barry).
Due to its reliability, ease of disinfection, and lack of effect on heat-sensitive drugs and drugs containing complex molecular fractions (hormonal), compressor nebulization is considered the “gold standard” of inhalation therapy.

Basic requirements for nebulizers

- 50% or more of the generated aerosol particles must have a size of less than 5 microns (the so-called respirable fraction)


- The residual volume of the medicinal substance after inhalation is no more than 1 ml;


- Inhalation time no more than 15 minutes, volume 5 ml


- Recommended flow 6-10 liters per minute


- Pressure 2-7 Barr


- Productivity not less than 0.2 ml/min.



The nebulizer must be tested and certified in accordance with the European standards for nebulizer therapy prEN13544-1 (using the low-flow cascade impactor method, at the present stage the most accurate method for studying the aerodynamic sizes of aerosol particles).

Indications for the use of nebulizers

Absolute
1. The drug cannot be delivered to the respiratory tract using other inhalers


2. Delivery of the drug to the alveoli is necessary
3. Inspiratory flow less than 30 liters per minute


4. Decrease in inspiratory vital capacity less than 10.5 ml/kg (for example,< 735 мл у больного массой 70 кг)
5. Inability to hold your breath for more than 4 seconds


6. Impaired consciousness
7. The patient's condition does not allow the correct use of portable inhalers
Relative

Diseases for which nebulizer therapy is used

7. Acute respiratory diseases
8. Pneumonia
9. Bronchiectasis
10. Bronchopulmonary dysplasia in newborns
11. Viral bronchiolitis

12. Respiratory tuberculosis


13. Chronic sinusitis
14. Idiopathic fibrosing alveolitis
15. Post-transplant bronchiolitis obliterans



In palliative therapy, the goals of which are to alleviate the symptoms and suffering of terminally ill patients, inhalation therapy is used to reduce refractory cough (lidocaine), incurable shortness of breath (morphine, fentanyl), retention of bronchial secretions (physiological saline solution), bronchial obstruction (bronchodilators).

Promising areas for the use of nebulizers are such areas of medicine as gene therapy (a gene vector - an adenovirus or liposomes is administered in the form of an aerosol), the introduction of certain vaccines (for example, measles), therapy after transplantation of the heart-lung complex (steroids, antiviral drugs), endocrinology (administration of insulin and growth hormone).

Contraindications

1. Pulmonary hemorrhage and spontaneous pneumothorax against the background of bullous emphysema
2. Cardiac arrhythmia and heart failure
3. Individual intolerance inhalation form medicines
Preparation of solution for inhalation
Solutions for inhalation must be prepared on the basis of saline solution (0.9% sodium chloride) in compliance with antiseptic rules. It is prohibited to use tap, boiled, distilled water, as well as hypo- and hypertonic solutions for these purposes. Syringes are ideal for filling nebulizers with inhalation solution; pipettes can also be used. It is recommended to use a nebulizer filling volume of 2-4 ml. The container for preparing the solution is pre-disinfected by boiling. Store the prepared solution in the refrigerator for no more than 1 day, unless otherwise provided in the instructions for use of the drug.

Before starting inhalation, it is recommended to heat the prepared solution in a water bath to a temperature of at least +20C. Decoctions and infusions of herbs can be used only after careful filtration. When using essential oils, it is advisable to use a separate nebulizer chamber.
Carrying out inhalation


- During inhalation, the patient should be in a sitting position, not talk and hold the nebulizer vertically. When performing inhalation, it is not recommended to bend forward, as this position of the body makes it difficult for the aerosol to enter the respiratory tract.
- For diseases of the pharynx, larynx, trachea, bronchi, inhale the aerosol through the mouth, after taking a deep breath through the mouth, hold your breath for 2 seconds, then exhale completely through the nose. It is better to use a mouthpiece or mouthpiece than a mask.


- For diseases of the nose, paranasal sinuses and nasopharynx, it is necessary to use special nasal attachments (nasal cannulas) for inhalation; inhalation and exhalation must be done through the nose, breathing calmly, without strain.



- Since frequent and deep breathing can cause dizziness, it is recommended to take breaks in inhalation for 15-30 seconds
- Continue inhalation as long as liquid remains in the nebulizer chamber (usually about 5-10 minutes), at the end of inhalation - lightly tap the nebulizer for more complete use of the drug.
- After inhalation of steroid drugs and antibiotics, you must rinse your mouth thoroughly. It is recommended to rinse your mouth and throat with boiled water at room temperature.


- After inhalation, rinse the nebulizer with clean, if possible, sterile water, dry using napkins and a stream of gas (hair dryer). Frequent rinsing of the nebulizer is necessary to prevent drug crystallization and bacterial contamination.

Drugs used for nebulizer therapy

Prevalence rate allergic rhinitis(AR) among the Russian population is currently considered high. In Moscow and the Moscow region, AR is detected with a frequency of 20.6 per 1000 examined children and is diagnosed almost 2 times more often among children living in rural areas compared to urban ones. AR is often accompanied by bronchial asthma. varying degrees gravity. On the part of the ENT organs, simultaneously with AR, an inflammatory process can occur in the nasal cavity and paranasal sinuses (infectious rhinitis, sinusitis), in the pharynx (adenoiditis, tonsillitis), and also in the ear (tubo-otitis, chronic otitis media).

For therapeutic purposes, drugs for AR are administered orally, parenterally and inhaled. Heat-moist, steam and oil inhalations are used, and aerosol therapy is also used. If the particles of a substance in aerosols are electrically charged, they are called electroaerosols. The foundations of the scientific and practical use of aerosols were laid by L. Dotreband in 1951.

Aerosol therapy with drugs for respiratory diseases has long been theoretically and experimentally substantiated, pathogenetically justified, clinically tested and highly effective. Indications for the use of aerosol preparations are constantly expanding. Aerosol therapy is simple, accessible, economical and painless method effects on the human body. Drugs of various groups are administered in aerosol form.

It has been proven that the drug, administered by inhalation, is deposited in the body and circulates for a long time in the pulmonary circulation. It is known that the absorption of drugs through the mucous membrane of the respiratory tract occurs 20 times faster than when taking tablet forms. The therapeutic effect of the drug in the form of an aerosol is achieved with a lower dose of the substance due to the large total area of ​​influence, and therefore higher physical activity and action directly on the pathological focus. Thus, medicine with aerosol therapy, it has not only a local, but also a general effect, which is carried out due to simultaneous chemical, mechanical and thermal effects. General action The drug manifests itself both during its absorption (resorptive effect) and due to irritation of the reflexogenic zones of the mucous membrane of the respiratory tract.

The main goal of inhalation therapy is to achieve maximum local therapeutic effect in the respiratory tract with little or no systemic side effects.

The main objectives of inhalation therapy are: sanitation of the upper respiratory tract; reducing swelling of the mucous membrane; reducing the activity of the inflammatory process; impact on local immune responses; improvement of microcirculation; protection of the mucous membrane from the effects of industrial aerosols, aeroallergens and pollutants; oxygenation.

The effectiveness of inhalation therapy depends on the aerosol dose and is determined by a number of factors: the anatomy of the respiratory tract; vital capacity of the patient's lungs; the ratio of inhalation and exhalation; clinical and functional state of the mucous membrane of the respiratory tract; pharmacological, organoleptic, physico-chemical properties of the aerosol; characteristics of aerosol particles; aerosol dispersion (ratio of particles in an aerosol by size); aerosol density (the content of the sprayed substance per liter of aerosol); the amount of aerosol produced; sprayer productivity (the amount of aerosol generated per unit of time); loss of the drug during inhalation; duration of inhalation; regularity of procedures.

However, like every type of effect on the human body, the use of aerosols must have strict indications and contraindications, which are based on data on the etiopathogenesis of the disease, taking into account the peculiarities of its course in this particular patient, as well as general state patient. It is also necessary to take into account the possibility of side effects.

The results of treatment with drug aerosols are assessed based on:

• results of examination of ENT organs;
• determining the state of the main functions of the mucous membrane;
• assessment of external respiratory function;
• achieved therapeutic effect.

Basic rules for taking inhalations

1. Inhalations are carried out no earlier than 1-1.5 hours after meals and physical activity.
2. Smoking is prohibited before and after inhalations.
3. Voice exercises are not recommended before and after inhalations.
4. Clothing should not restrict the neck or make breathing difficult.
5. Inhalations should be carried out in a calm state, without being distracted by conversations or reading.
6. For diseases of the nose, paranasal sinuses and nasopharynx, inhalation and exhalation must be done through the nose, breathing calmly, without tension.
7. For diseases of the pharynx, larynx, trachea, bronchi, it is recommended to inhale the aerosol through the mouth - you need to breathe deeply and evenly; After taking a deep breath through your mouth, you should hold your breath for 2 seconds, and then exhale completely through your nose.
8. Frequent and deep breathing can cause dizziness, so periodically it is necessary to interrupt inhalation for a short time.
9. Before the procedure, you should not take expectorants or gargle with antiseptic solutions.
10. After the procedure, it is recommended to rinse your mouth and throat with boiled water at room temperature.
11. The duration of one inhalation is 5-10 minutes; The course of treatment with aerosol inhalations ranges from 6-8 to 15 procedures.
12. After the procedure, you should rest for 10-15 minutes, and in the cold season - 30-40 minutes.

Inhalations are prescribed after examining the patient by an otorhinolaryngologist and developing tactics for complex treatment of the patient together with an allergist-immunologist, and often with a pulmonologist. The examination of the ENT organs should be repeated after some time, since depending on the results, the nature of the prescriptions may be changed, and the course of inhalations may be lengthened or shortened. At the end of the course, an examination by an ENT doctor is also required.

When using medicinal aerosol therapy, the effect on the mucous membrane of the respiratory tract should be gentle, using drugs that not only improve mucus secretion, but also normalize the composition of nasal and tracheobronchial secretions. For diseases of the respiratory tract and lungs, inhalation therapy is the most logical, since medicinal product directly sent to the place where it should act - in the respiratory tract.

Aerosol therapy in practice is carried out in the form of inhalations, which can be carried out either independently or with the help of various devices: a variety of inhalers and nebulizers. The dispersion of the aerosol depends on the type of inhaler.

Nebulizers are technical devices that allow long-term inhalation therapy aerosols of solutions of medicinal substances. Nebulizers have the longest history of use - they have been used for about 150 years. One of the first nebulizers was created in 1859. The word “nebulizer” comes from the Latin nebula (fog, cloud); it was first used in 1874 to mean “an instrument for converting a liquid substance into an aerosol for medical purposes.”

Currently, depending on the type of energy that converts liquid into an aerosol, there are two main types of nebulizers:

• jet, or compressor, pneumatic, using a gas stream (air or oxygen). These are devices consisting of a nebulizer itself and a compressor that creates a flow of particles 2-5 microns in size at a speed of at least 4 l/min;
• ultrasonic, using the vibration energy of a piezocrystal.

The main types of compressor nebulizers are listed below.

1. Nebulizer operating in continuous mode. Aerosol generation occurs continuously during the inhalation and exhalation phases. As a result, a significant part of the medicinal substance is lost (when using expensive drugs, this quality of the device makes it economically unprofitable).
2. A nebulizer that generates an aerosol continuously and is manually controlled. During the exhalation phase, the patient stops the supply of aerosol from the system by pressing the button. In children, this nebulizer is limited in use due to the difficulty of synchronizing breathing and hand movements. For children preschool age it is hardly acceptable (parents’ “work with the key” is, as a rule, not effective enough).
3. Nebulizer controlled by the patient's inhalation. Operates in variable mode. It has a special valve that closes when the patient exhales. This reduces the loss of aerosol and increases its entry into the lungs (up to 15%).
4. Dosimetric nebulizer. It generates an aerosol strictly during the inhalation phase; the operation of the interrupter valve is controlled by an electronic sensor.

A relatively new method of aerosol therapy is the use of ultrasonic inhalers. They are highly productive, form an aerosol of high density, high dispersion, provide economical consumption of drugs, reduce the time of exposure of the patient to drugs and increase the effectiveness of treatment. Ultrasonic inhalers are compact, silent and reliable, but a number of drugs (for example, some antibiotics and mucolytics) are destroyed by the ultrasonic wave and cannot be used in this type of inhaler. Due to these features, ultrasonic nebulizers are not widely used in practice.

Benefits of nebulizer therapy:

• faster absorption of drugs;
• increase in the active surface of the drug substance;
• the possibility of using medicinal substances in unchanged form, which act more effectively in diseases of the respiratory tract and lungs (bypassing the liver);
• uniform distribution of drugs over the surface of the respiratory tract;
• penetration of drugs with a current of air into all parts of the upper respiratory tract (nasal cavity, pharynx, larynx, etc.);
• atraumatic drug administration. There is no need to coordinate breathing with the intake of aerosol;
• the possibility of using high doses of the drug;
• obtaining a pharmacodynamic response in a short period of time;
• continuous supply of medicinal aerosol with fine particles;
• rapid and significant improvement in condition due to the effective entry of the drug into the bronchi;
• rapid achievement of a therapeutic effect when using smaller doses of the drug. Easy inhalation technique.

Preparations for nebulizer therapy are used in special containers, nebulas, as well as solutions produced in glass bottles. This makes it possible to easily, correctly and accurately dose the drug.

In children, nebulizer therapy occupies a special place due to its ease of implementation, high efficiency and the possibility of use from the first months of life. A children's inhaler must meet the following requirements: be ergonomic and easy to use, equipped with a children's mask, have an attractive appearance (interesting design), which is important for keeping the child interested.

The goal of nebulizer therapy for AR is to deliver a therapeutic dose of the drug in aerosol form directly to the mucous membrane of the nasal cavity and nasopharynx, while high concentrations of the drug should be created, and a pharmacodynamic response should be achieved in a short period of time (5-10 minutes).

Contraindications to the use of nebulizer therapy are cystic fibrosis and bronchiectasis.

Of the types of nebulizers currently existing in our country, we recommend devices from Inter-Eton. For use in complex therapy AR, it is advisable to use the “Boreal” model, which creates a coarse aerosol with a particle size of 5-10 microns, which settle in the nasal cavity and nasopharynx, i.e. exactly in the place where allergic inflammation develops in AR. This nebulizer model is convenient for use both in a doctor’s outpatient practice and at home. It should be noted that the design of the nebulizer and its components does not contain latex.

In children, preference is given to inhalation through the mouth using a mouthpiece. For infants in the first years of life, a tight-fitting mask can be used.

For therapeutic purposes in AR with the help of a nebulizer, it is possible to use various groups of drugs. These are the following:

• thinning nasal secretions;
• mucolytics;
• M-anticholinergics, helping to reduce increased secretion production;
• Cromons;
• anti-inflammatory drugs;
• antibacterial agents.

Drugs that dilute nasal secretions

• Ambroxol is represented by the drugs Lazolvan, AmbroHEXAL, Ambroxol, Ambrobene, etc. Lazolvan: for aerosol therapy can be used using various inhalers, but it is preferable to use a nebulizer in order to more accurately dose and save the drug. The solution for inhalation is produced in 100 ml bottles. Recommended doses: adults and children over 6 years old are initially prescribed 4 ml 2-3 times a day, then 2-3 ml - 1-2 inhalations per day, children under 6 years old - 2 ml - 1-2 inhalations per day. day. The drug is used in pure form or diluted with saline (distilled water cannot be used) in a 1:1 ratio immediately before inhalation. At the end of inhalation, the remaining drug is unsuitable for use.

Ambroxol is available in 40 ml bottles.

AmbroHEXAL: a solution for inhalation is produced in 50 ml dropper bottles containing 7.5 mg of the drug per ml. Recommended doses: adults and children over 5 years old - 40-60 drops (15-22.5 mg) 1-2 times a day; children under 5 years old - 40 drops (15 mg) 1-2 times a day.

Ambrobene is available in bottles of 100 ml and 40 ml (7.5 mg/ml).

• Alkaline solutions. Sodium bicarbonate: use a 2% solution to thin the mucus and create an alkaline environment in the area of ​​inflammation. Recommended doses: 3 ml of solution 3-4 times a day. Ten-minute inhalation increases the efficiency of removing mucopurulent discharge from the nasal cavity by more than 2 times.

• Saline solutions. Physiological solution of sodium chloride (NaCl): 0.9% NaCl solution does not irritate the mucous membrane. It is used to soften it, cleanse and rinse the nasal cavity in case of contact with caustic substances. The recommended dose is 3 ml 1-2 times a day. You can use weakly alkaline mineral water Narzan, Essentuki-4 and Essentuki-17. Before use, it must be degassed by settling in an open container.

It is advisable to use a hypertonic NaCl solution (3% or 4%) when there is a small amount of viscous secretion. It helps cleanse the nasal cavity from mucopurulent contents. Up to 4-5 ml of solution is used for one inhalation. Warning: use with caution in case of concomitant bronchial asthma; bronchospasm may increase.

Zinc sulfate: 0.5% solution, 20 ml per inhalation.

Aqua Maris is an isotonic sterile solution of Adriatic Sea water with natural trace elements. 100 ml of solution contains 30 ml of sea water with natural ions and trace elements. Used for rinsing the nasal cavity, nasopharynx and inhalations. For hygienic and preventive purposes - to moisturize the mucous membranes of the nose.

Mucolytics. Acetylcysteine ​​is represented by the drugs Fluimucil, Mucomist and Acetylcysteine. Used for inhalation through a nebulizer or ultrasonic inhaler in the form of a 20% solution. Available in ampoules of 3 ml. Recommended doses: 2-4 ml per inhalation 3-4 times a day.

Fluimucil is available as a 10% solution for inhalation in 3 ml ampoules (300 mg acetylcysteine). In addition to liquefying viscous purulent nasal secretions that are difficult to separate, it has an antioxidant effect, protecting the mucous membrane from free radicals and toxins. Recommended doses: 300 mg (1 ampoule) 1-2 times a day. When diluting, use glass containers, avoiding contact with metal and rubber products. The ampoule is opened immediately before use. Warning: with concomitant bronchial asthma, bronchospasm may increase (!).

Mucomist: an ampoule of 20% solution is used for inhalation. For nebulizer aerosol therapy, Mucomist is used in pure form or diluted with saline in a ratio of 1:1 per day 2-3 times (not exceeding the daily dose of 300 mg).

M-anticholinergics. Ipratropium bromide (Atrovent) causes a decrease in secretion and prevents the development of bronchospasm, which gives it an advantage when used in patients with a combination of AR and bronchial asthma. It is especially recommended for severe overproduction of nasal secretions - during exacerbation of AR with copious watery discharge. Available in 20 ml bottles, 1 ml of solution contains 250 mcg of ipratropium bromide. The effect when used occurs after 5-10 minutes, with the development of the maximum effect in the 60-90th minute; the duration of action is 5-6 hours. Recommended doses: adults - on average use 8-40 drops per inhalation, children - 8-20 drops (young children under medical supervision). The drug is diluted with physiological solution (do not dilute with distilled water!) to a volume of 3-4 ml immediately before the procedure. It is recommended to use it through the mouthpiece to avoid contact with the eyes. Residues of the drug in the nebulizer are not suitable for reuse.

Cromons. Cromoglyic acid - CromoHEXAL - is available in 2 ml plastic bottles (containing 20 mg of cromoglyic acid). Recommended dose: 20 mg (2 ml) 4 times a day. Dilute with physiological solution to a volume of 3-4 ml (do not use distilled water!) immediately before the procedure. Residues of the drug in the nebulizer and opened ampoules are not suitable for reuse. It can be widely recommended for use in children of the first years of life, in whose treatment topical glucocorticoids are not used.

Anti-inflammatory drugs. Glucocorticosteroids are represented by the drug Pulmicort (budesonide). Available as a ready-made solution for inhalation in plastic containers of 2 ml in dosages of 0.125, 0.25 and 0.5 mg/ml. The drug is indicated for severe AR, when AR is combined with bronchial asthma. Daily dose The doctor determines individually. In this case, doses less than 2 ml are diluted with saline to 2 ml. Aerosol therapy sessions are carried out every 5-6 hours for no more than 5-7 days. After a session of Pulmicort aerosol therapy, you should rinse your mouth thoroughly.

Antibacterial agents. These drugs are indicated for AR complicated by chronic infectious rhinitis or rhinosinusitis. Furacilin - in the form of a 1:5000 solution - affects gram-positive and gram-negative microbes. Its inhalations are effective in acute phases of the disease (during exacerbation of infectious rhinitis or rhinosinusitis). Recommended dose: 2-5 ml 2 times a day.

Immunomodulators. Leukinferon: for inhalation, dilute 1 ml of the drug in 5 ml of distilled water. Recommended when combining AR with viral infection in the nasal cavity, paranasal sinuses and pharynx.

Derinat is a highly purified sodium salt of native deoxyribonucleic acid, partially depolymerized by ultrasound, dissolved in a 0.1% aqueous solution of sodium chloride. Biologically active substance isolated from the milt of sturgeon fish. The drug has immunomodulatory, anti-inflammatory, detoxification and reparative properties. Indicated in combination with ARVI/influenza, acute catarrhal rhinitis, acute catarrhal nasopharyngitis, acute laryngotracheitis, acute bronchitis, community-acquired pneumonia, as well as in the prevention and treatment of relapses and exacerbations of chronic diseases - chronic rhinosinusitis, chronic mucopurulent and obstructive bronchitis, bronchial asthma.

Combined drugs. Fluimucil: the drug contains acetylcysteine ​​(a mucolytic and antioxidant) and thiamphenicol (a broad-spectrum antibiotic). In terms of thiamphenicol, one bottle contains 500 mg of the drug. Before use, the powder contained in the bottle is dissolved in 5 ml of physiological solution. Recommended doses: adults - 250 mg 1-2 times a day, children - 125 mg 1-2 times a day. Contraindicated for bronchial asthma (!).

conclusions

The widespread prevalence of AR determines the urgency of searching for more effective and cost-effective therapy. The use of certain drugs that affect different parts of the pathogenesis of the pathological process, making up the treatment complex, with the help of a nebulizer makes it possible to shorten the duration of the period of exacerbation of AR, reduce the severity of its symptoms, especially rhinorrhea, and also reduce the consumption of the drug used, i.e. gives a pronounced its savings.

Thus, the use of necessary drugs using a nebulizer in complex therapy increases the therapeutic effectiveness and cost-effectiveness of treating patients with AR, which gives grounds to recommend nebulizers for widespread use in the treatment of patients suffering from AR, and even with its complications.

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8. Fujihara K., Sakai A., Hotomi M., Uamanaka N. The effectiveness of nasal nebulizer therapy with cefmenoxime hyrochloride and nasal drops of povidone iodine for acute rhinosinusitis in children // 2004. 97; No. 7: 599-604.
9. Kemp J. P., Skoner D. P., Szefler S. J. et al. Once-daily budesonide inhalation suspension for the treatment of persistent asthma in infants and young children // Ann. Allergy Asthma Immunol. 1999; 83(3): 231-9.
10. Muers M. F. Overoiew of nebulizer treatment // Thorax. 1997. 52; 2: S25-S30.

G. D. Tarasova, Doctor of Medical Sciences, Professor
Scientific and Clinical Center of Otorhinolaryngology, Moscow

For quotation: Avdeev S.N. Modern possibilities of nebulizer therapy: operating principles and new technical solutions // RMJ. Medical Review. 2013. No. 19. P. 945

Introduction The effectiveness of therapy for lung diseases depends not only on the correct choice of the drug, but also on the method of its delivery to the patient’s body. The inhalation route of administration of medical aerosols is the most effective way delivery of drugs for lung diseases: the drug is sent directly to the site of its action - into the patient’s respiratory tract. The key to successful inhalation therapy is not only the properties of the drug (its chemical structure), but also factors such as the choice of the optimal delivery system and patient training in inhalation techniques.

The effectiveness of therapy for lung diseases depends not only on the correct choice of the drug, but also on the method of its delivery to the patient’s body. The inhalation route of administration of medical aerosols is the most effective way of delivering drugs for lung diseases: the drug is sent directly to the site of its action - into the patient’s respiratory tract. The key to successful inhalation therapy is not only the properties of the drug (its chemical structure), but also factors such as the choice of the optimal delivery system and patient training in inhalation techniques.
An ideal delivery device should ensure the deposition of a large fraction of the drug in the lungs, be fairly easy to use, reliable, and accessible for use at any age and in severe stages of the disease. The main types of delivery systems include: metered dose inhalers (MDIs), metered dose powder inhalers (DPIs), soft mist inhalers and nebulizers. Each of these delivery means has its own advantages and disadvantages (Table 1).
Nebulizers have been used in clinical practice for over 100 years. The term “nebulizer” (from Latin nebula - fog, cloud) was first used in 1874 to mean “an instrument that converts a liquid substance into an aerosol for medical purposes.” Nebulizers allow the drug to be inhaled while the patient is breathing quietly, thus solving the problems of patient-inhaler coordination. These devices can be used in the most severely ill patients who are unable to use other types of inhalers, as well as in patients of “extreme” age groups - children and the elderly. With the help of nebulizers, it is possible to deliver a variety of drugs into the patient’s respiratory tract, and, if necessary, their high doses.
As can be seen from Table 2 (recommendations of the European Respiratory Society and International Society for Aerosols in Medicine, 2011), nebulizers can be used in patients with poor and good coordination of inspiration with activation of the inhaler, regardless of the magnitude of the inspiratory flow created.
Indications for use
nebulizers
There are few absolute indications for the use of nebulizers. They should be used when:
1) the drug cannot be delivered to the respiratory tract using other inhalers, because There are quite a lot of medications for which portable inhalers (MDI and DPI) have not been created: antibiotics, mucolytics, surfactant preparations, prostanoids, etc.;
2) delivery of the drug to the alveoli is necessary (for example, surfactant preparations for acute respiratory distress syndrome);
3) the severity of the patient’s condition or his physical condition does not allow the correct use of portable inhalers. This indication is the most important and significant when choosing an inhalation technique. Despite the well-known advantages of metered-dose inhalers (MDIs) - small size, lower cost, speed of use, their use requires precise coordination between the patient's inhalation and the release of the drug, as well as forced maneuver. Elderly age the patient can often be an obstacle to the correct use of all types of inhalation equipment except the nebulizer. A nebulizer is also the only possible means of delivering aerosol drugs to children under 3 years of age.
Objective criteria requiring the appointment of inhalations using nebulizers include: a decrease in inspiratory vital capacity of less than 10.5 ml/kg of weight (for example,< 730 мл у больного массой 70 кг); инспираторный поток больного менее 30 л/мин; неспособность задержки дыхания более 4 с, кроме того, использование небулайзеров показано больным с двигательными расстройствами, нарушением уровня сознания .
All other indications are relative (i.e., in these situations, the nebulizer can be replaced with other inhalation systems):
1) the need to use a large dose of the drug. Drug doses may depend on the functional severity of the disease. The maximum response to inhaled drugs for severe bronchial obstruction can only be achieved when using high doses of drugs. The reasons for such a physiological response in severe bronchial obstruction may be the presence of anatomical obstacles (secretion, spasm, swelling of the mucous membrane and other disorders) for the drug to access the receptors and, possibly, the need for a larger proportion of available receptors to achieve maximum response;
2) patient preference, which is expressed in the fact that many patients, during an exacerbation of the disease, prefer to use therapy and techniques different from those they use in their usual home environment;
3) practical convenience. Despite the fact that the effectiveness of the inhalation technique when using a MDI with a spacer and a nebulizer is approximately the same in many situations, the use of nebulizers is a simpler method of therapy and does not require the patient to be trained in the breathing maneuver and the doctor to monitor the inhalation technique. When using a nebulizer, the doctor can be sure that the patient is receiving the exact dose of the drug.
It is also worth recalling other advantages of a nebulizer compared to other delivery means - if necessary, oxygen can be used during inhalation.
Delivery of the drug to the respiratory tract depends on many factors, the most important of which is the particle size of the drug aerosol. Conventionally, the distribution of aerosol particles in the respiratory tract depending on their size can be represented as follows (Fig. 1):
. more than 10 µm – deposition in the oropharynx;
. 5-10 µm – deposition in the oropharynx, larynx and trachea;
. 2-5 µm – deposition in the lower respiratory tract;
. 0.5-2 µm – deposition in the alveoli;
. less than 0.5 microns - do not settle in the lungs.
The efficiency of aerosol production, its properties and delivery to the respiratory tract depend on the type of nebulizer, its design features, the combination of the compressor - nebulizer system, etc. However, traditional nebulizers are not without disadvantages, such as long inhalation times, relatively low pulmonary deposition of drugs, and the possibility of contamination equipment due to improper maintenance, etc. (Table 1).
How nebulizers work
For many years, depending on the type of energy that converts liquid into an aerosol, 2 main types of nebulizers have been distinguished: 1) jet - using a gas stream (air or oxygen); 2) ultrasonic (US) - using the vibration energy of a piezocrystal. Relatively recently (about 3 years ago) a new, third type of nebulizers appeared - membrane ones, which, thanks to the new operating principle, make it possible to overcome many of the disadvantages associated with the use of traditional nebulizers.
Jet nebulizers
The operating principle of a jet nebulizer is based on the Bernoulli effect. Air or oxygen (working gas) enters the nebulizer chamber through a narrow opening (called a Venturi). At the exit from this hole, the pressure drops, the gas velocity increases significantly, which leads to the suction of liquid into this area of ​​​​low pressure through narrow channels from the chamber reservoir. When a liquid meets an air flow, under the influence of a gas jet, it is broken into small particles, the sizes of which vary from 15 to 500 μm - this is the so-called “primary” aerosol. Subsequently, these particles collide with a “damper”, resulting in the formation of a “secondary” aerosol - ultrafine particles ranging in size from 0.5 to 10 μm (about 0.5% of the “primary” aerosol), which is then inhaled, and a large proportion of particles of the “primary” aerosol (about 99.5%) is deposited on the inner walls of the nebulizer chamber and is again involved in the process of aerosol formation (Fig. 2).
Ultrasonic nebulizers
Ultrasonic nebulizers use the energy of high-frequency vibrations of a piezocrystal to produce aerosol. A high frequency signal (1-4 MHz) deforms the crystal, and vibration from it is transmitted to the surface of the drug solution, where the formation of “standing” waves occurs. With sufficient frequency
At the intersection of these waves, the ultrasonic signal forms a “microfountain” (geyser), i.e. aerosol formation and release. Particle size is inversely proportional to the acoustic frequency of the 2/3 power signal. Larger diameter particles are released at the top of the geyser, and smaller ones at its base. As in a jet nebulizer, aerosol particles collide with a “damper”, larger ones are returned back into the solution, and smaller ones are inhaled (Fig. 3). Aerosol production in an ultrasonic nebulizer is almost silent and faster compared to jet nebulizers. However, their disadvantages are the inefficiency of producing aerosol from suspensions and viscous solutions; as a rule, a larger residual volume; an increase in the temperature of the medicinal solution during nebulization and the possibility of destruction of the structure of the medicinal product.
Membrane nebulizers
The new generation of nebulizers has a fundamentally new operating device: they use a vibrating membrane or plate with multiple microscopic holes (sieve), through which a liquid medicinal substance is passed, which leads to the generation of an aerosol. The new generation of nebulizers has several names: membrane, electronic, vibrating mesh nebulizers (VMN) or mesh nebulizers.
In these devices, the “primary” aerosol particles are the size of respirable particles (slightly larger than the diameter of the holes), so the use of a damper is not required. This type of technology involves the use of small filling volumes and the achievement of higher pulmonary deposition values ​​compared to conventional jet or ultrasonic nebulizers. There are 2 types of membrane nebulizers: those using “passive” membrane vibration and “active” ones.
In nebulizers that use “active” membrane vibration, the membrane itself is vibrated by a piezoelectric crystal. The pores in the membrane are conical in shape, with the widest part of the pores in contact with the drug. In nebulizers of this type, deformation of the membrane towards the liquid drug substance leads to “sucking” of the liquid into the pores of the membrane (Fig. 4). Deformation of the membrane in the other direction leads to the ejection of aerosol particles towards the patient's respiratory tract. The principle of “active” membrane vibration is used in AeroNeb Pro and AeroNeb Go (Aerogen) and eFlow (Pari) nebulizers.
In devices that rely on “passive” membrane vibration, the vibrations of the transducer (horn) affect the liquid drug substance and push it through a sieve, which vibrates at the frequency of the horn (Fig. 5). Unlike traditional jet or ultrasonic nebulizers, the aerosol that is formed when a liquid medicinal substance passes through a sieve membrane is not subject to reverse recirculation and can be immediately delivered into the patient’s respiratory tract. The principle of "passive" vibration of the membrane is used in
nebulizer OMRON Micro AIR U22 (OMRON Healthcare, Japan) is the smallest nebulizer in the world.
Unlike traditional ultrasonic nebulizers, in membrane nebulizers the vibration energy of the piezocrystal is directed not at the solution or suspension, but at the vibrating element, so there is no warming or destruction of the structure of the drug substance. Thanks to this, membrane nebulizers can be used for inhalation of proteins, peptides, insulin and antibiotics. In an in vitro study, Y. Yoshiyama et al. showed that the OMRON U22 membrane nebulizer is capable of efficiently producing an aerosol from a budesonide suspension, with an aerosol yield of 70% of the drug dose.
Potential disadvantages of membrane nebulizers include the possibility of aerosol particles clogging the miniature openings, especially when using suspensions. The risk of clogged orifices depends on the frequency and reprocessing conditions of the inhalers. Thanks to more high efficiency membrane nebulizers, when used, require a reduction in standard doses and volume of filling of drugs.
Detailed instructions for using jet and membrane nebulizers are presented in Table 3.
New technical solutions
nebulizer therapy
Among the new technical solutions in the field of nebulizer technologies, we can note the further development of traditional jet nebulizers. Compressors have been created that, due to their small size, bring nebulizers closer to portable delivery devices (and at the same time are not inferior to their more massive “colleagues” in terms of technical specifications) (Fig. 6). New solutions have emerged in the class of adaptive delivery devices - dosimetric nebulizers, the fundamental difference of which is the adaptation of products and aerosol release to the patient’s respiratory pattern. The device automatically analyzes the patient's inspiratory time and inspiratory flow, and then, based on this analysis, the device provides aerosol production and release during the first 50% of the subsequent inspiration (Fig. 7). Inhalation continues until the exact dose of the drug is delivered, after which the device beeps and stops inhalation. Examples of nebulizers of this type are I-nebTM (Philips Respironics, US) and AKITA Inhalation System (Aktivaero GmbH, Germany).
And finally, the improvement of classic models of jet nebulizers continues. It must be remembered that jet nebulizer systems (i.e., nebulizer-compressor) from different manufacturers are not absolutely identical in their effectiveness, and this must be taken into account when choosing a delivery system for hospital or home inhalation therapy. In practice, efficiency comparison various systems nebulizers poses a very difficult clinical challenge. This requires a clinical trial to evaluate the effectiveness of bronchodilators in patients with obstructive pulmonary disease. Conducting this type of research is much more labor-intensive and responsible compared to bench and laboratory research, for this reason, very little such work is being carried out today. Therefore, the results of a recently presented study comparing the effectiveness of two different jet nebulizer systems are noteworthy.
T. Sukumaran et al. conducted a randomized controlled trial that included 60 patients with bronchial asthma (children aged 7 to 13 years with a peak (maximum) expiratory flow (PEF) less than 70% of the expected values). Patients were randomly divided into 2 groups: the first group of patients (n=30) received therapy with a salbutamol solution (0.15 mg/kg body weight dissolved in 2 ml of saline) using a NE-C900 nebulizer (OMRON Healthcare), and the second group - the same therapy using the Redimist (RE) nebulizer. To obtain acceptable PEF readings, at least three maneuvers were performed to evaluate this indicator before inhalation with salbutamol and after 15 and 30 minutes. after inhalation.
Baseline PEF values ​​were similar in both groups. Differences between the initial PEF indicator and the indicator after 15 minutes. after inhalation, as well as the initial PEF indicator and the indicator after 30 minutes. after inhalation were significant in both groups. The improvement in PEF in the OMRON NE-C900 nebulizer group was more significant than in the RE group at 15 minutes. after inhalation (p=0.005). Differences in PEF between readings after 15 and 30 minutes. after inhalation in both groups were not statistically significant. When comparing repeatedly measured PEF indicators, the ANOVA method showed consistency of data and the absence of significant differences in changes in both groups at the initial stage, after 15 and 30 minutes. after inhalation.
Thus, this study demonstrated that the bronchodilator effect (expressed as an improvement in PEF) after 15 min. after inhalation of salbutamol was more pronounced when using the OMRON NE-C900 nebulizer than when using the Redimist nebulizer. This study not only clearly demonstrated the difference in the effectiveness of various jet nebulizer systems, which is important from the point of view of choosing the optimal technology, but may also have some significance for domestic medical practice, because nebulizer NE-C900 (OMRON Healthcare) (Fig. 8) is now available on our market. The NE-C900 nebulizer is positioned as a device for use, incl. and in stationary conditions. Taking into account the proven high efficiency in a clinical study and the technical features of the device (a powerful compressor with the ability to generate an air flow of up to 7 l/min and a simple nebulizer chamber consisting of only two parts), the OMRON NE-C900 nebulizer may have advantages when choosing reliable and efficient devices delivery.
Principles of processing and disinfection of nebulizers
Nebulizer treatment and disinfection procedures offered by manufacturers can vary significantly depending on the brand of device used. Meanwhile, it seems very important to use unified rules for the processing of nebulizers.
According to the recommendations of the Center for Diseases Control and Prevention (CDC), the procedure for processing medical instruments, incl. and nebulizers, must include 4 consecutive stages: washing, rinsing, disinfection and drying. Personnel or handlers must maintain strict hand hygiene during these procedures. The main recommendations for reprocessing nebulizers given in various documents are presented in Table 4.

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3. Avdeev S.N. Delivery devices inhalation drugs, used in the treatment of respiratory diseases // Russian Medical Journal. 2002. T. 10. No. 5. P. 255-261.
4. Muers M.F. Overview of nebulizer treatment // Thorax. 1997. Vol. 52 (Suppl. 2). R. 25-30.
5. Boe J., Dennis J.H., O"Driscoll B.R. et al. European Respiratory Society Guidelines on the use of nebulizers // Eur Respir J. 2001. Vol. 18. R. 228-242.
6. Laube B.L., Janssens H.M., de Jongh F.H. et al. What the pulmonary specialist should know about the new inhalation therapies // Eur Respir J. 2011. Vol. 37. R. 1308-1331.
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Secrets of nebulizer therapy

Is one of the most effective ways to treat diseases respiratory system.

Not so long ago, due to the high cost and complexity of operating the equipment, it was carried out only in medical organizations. Now there is an opportunity that is characterized by an affordable price and ease of use, thanks to which this therapy has become widely used at home.

What are the indications for nebulizer therapy?

The list of indications for nebulizer therapy is very wide: from rhinitis and ARVI to diseases such as chronic obstructive pulmonary disease (COPD) and bronchial asthma.

What is a nebulizer?

A special device that breaks a liquid medicine into microparticles, thus converting it into an aerosol for inhalation. The average size of microparticles is usually about 5 micrometers (one micrometer is equal to a thousandth of a millimeter).

What is the difference between a nebulizer and an inhaler?

In everyday speech, the names and “inhaler” are often used as equivalent. Strictly speaking, nebulizers do not include steam inhalers, which heat rather than spray a drug solution.

What types of nebulizers are on the market?

Now you can. Compressor inhalers are the most versatile, as well as the best in terms of price and quality ratio. The drug is broken down into microparticles by a jet of compressed air, which is created by a built-in compressor.

The main advantage of compressor inhalers is the ability to use a wide range of medications. This sets them apart from ultrasonic nebulizers. The fact is that under the influence of ultrasound, the molecules of some drugs are destroyed, which leads to the loss of the therapeutic properties of the drug.

Among their disadvantages, one can highlight the relatively significant noise generated, which, however, does not exceed sanitary standards and in most cases does not create discomfort.

The goal of this treatment method is to deliver the required amount of medication into the respiratory system in the form of an aerosol in a short time. The continuous supply of aerosol makes it possible to create a high concentration of the drug in the respiratory system in a few minutes.

The advantages of this method of treating diseases:

• With proper use and prescription of the drug, there is a low risk of side effects.
• Delivery of the drug directly to the site of the disease, therefore ensuring a rapid therapeutic effect.
• When using nebulizers, there is no risk of thermal burns to the mucous membranes. This is achieved due to the fact that the drug is not heated when forming an aerosol (unlike steam inhalers).
• There is no need to coordinate respiratory movements with the control of the device (for example, activating a nebulizer dispenser), so the nebulizer can be used to treat diseases of the respiratory system even in infants.
• Solvents and pressure-producing gases do not enter the respiratory tract (unlike metered aerosol sprays).
• It is possible to set the dose quite accurately and, if necessary, use high dosages of drugs.

What medications can be used with nebulizers?

It is recommended to use solutions specially developed for this purpose. It is not recommended to use any products that contain essential oils, as well as solutions that include suspended particles - for example, decoctions, herbal tinctures and the like.

Before using medications or performing procedures, be sure to consult your doctor. Only a specialist can correctly select the appropriate drug and its dosage.

Familiarize yourself with the doctor’s prescription (type of inhalation, composition of the inhalation mixture, its quantity, duration of the procedure);

Preparing for the patient procedure:

1. Instruct the patient about behavior and breathing during the procedure;

2. Fill the inhaler container with medicine;

3. Seat the patient at the inhaler;

4. Make sure it is ready.

Carrying out the procedure:

1. Turn on the inhaler.

2. Make sure the patient’s behavior and breathing are correct.

3. Monitor the patient.

4. In case allergic reactions(cough, choking) stop the procedure and call a doctor.

End of the procedure:

1. Turn off the inhaler.

2. Remove the tip and sterilize.

3. Invite the patient to rest for 10-15 minutes.

4. Warn the patient about unwanted smoking, loud talking and cooling for 2 hours.

3) The procedure is possible at home. Eucalyptus, rose, lavender, coriander, sage, anise;

4) CN-231 COMPRESSOR INHALER, MAHOLDA INHALER WITH ESSENTIAL OILS, UN-231 ULTRASONIC INHALER. EASY TO USE.

5) Electrosleep, DDT, method No. 124: Inhalation of electroaerosols, inductothermy with a slight sensation of warmth in the area of ​​the adrenal glands, while an inductor-cable in the form of a spiral of 2-3 turns is applied at the level of T 10 - L 4, DVM on the area of ​​the lungs, NMP, UHF using the bitemporal method, phonophoresis, dry carbon dioxide baths. The use of electroacupuncture and electropuncture, as well as the cauterization method (ju), in particular with wormwood cigarettes, is of particular importance.

Given: Patient P., 45 years old.

Ds: Bronchial asthma.

Assigned to: Individual aerosol therapy, medicinal mixtures: aminophylline solution 1% -1 ml, ephedrine hydrochloride solution 1% -1 ml. Duration 5-10 min.

Course of 15 procedures.

Questions:

1) What is the mechanism of the therapeutic effect of this procedure?

2) What is the sequence of actions of the nurse when performing this procedure?

3) Is it possible to use this therapy at home? What medicinal substances or herbal infusions, vegetable oils can you recommend?

4) What devices for inhalation therapy are currently used at home? What is their feature?

5) What other physical procedures can inhalation therapy be combined with for this pathology?

Solution:

1) Inhalers crush particles of a medicinal substance to a given size, spraying it in the air or in some other gas (oxygen), and deliver it to patients for breathing. Spraying is done in the usual mechanical way using spray nozzles. Active deep breathing of the patient promotes deep penetration and uniform distribution of the aerosol in the respiratory tract.