The role of a nurse in carrying out nebulizer therapy. Nebulizer therapy (draft)

According to the WHO, every third inhabitant of the planet suffers from acute respiratory infectious diseases every year. In children under 3 years of age, they account for 65% of all registered diseases. In the group of frequently ill children, which accounts for 25% of the child population, their frequency is 4-12 or more times a year. Diseases of the respiratory system (RES) are the most common pathology of childhood, which can be explained by several main reasons: the strength of the immune system of an actively growing organism, the anatomophysiological features of the respiratory system and its high susceptibility to microbial penetration. The mucous membrane of the respiratory tract constantly experiences the negative influences of various environmental factors and is the area where, under certain conditions, adhesion of pathogenic microorganisms, their reproduction, with the subsequent development of the inflammatory process is possible.
The key to success in treating ZOD in children is not only the correct choice of medication and dosage regimen, but also the method of drug delivery to the lungs.
To date, inhalation methods of drug delivery are recognized as the most optimal for the treatment of children with ZOD in the world, which is quite logical, since when they are used, the drug enters the respiratory tract directly. Aerosols are used to deliver bronchodilators, mucolytics, antiviral drugs, inhaled glucocorticosteroids, antibiotics and other medicines to the bronchi.
Inhalation therapy has been known since ancient times in China, Egypt, India: its first description was given in Ayurvedic texts more than 4000 years ago. In the writings of Hippocrates and Galen, you can find references to inhalation of aromatic fumes of various plants. Aerosols (from the Greek aero - air and Latin solucio - solution) are dispersed systems consisting of a gaseous medium in which solid or liquid particles are suspended. In nature, there are natural aerosols - the air of seaside resorts, phytoncides and terpenes secreted by plants. In medicine, artificial aerosols are often used, which are obtained by creating dispersion mixtures with a liquid or solid phase.
International programs identify the following key success factors for inhaled therapy:

• availability of an effective and safe drug substance
• inhalation device providing a high respirable drug fraction
• correct inhalation technique

Such requirements for inhalation therapy for ZOD deserve attention to the highest degree in pediatric practice due to the exclusion of psychological trauma to the child, possible post-injection complications, ease of treatment and economic feasibility.
Evaluation of various inhalation devices used for therapeutic purposes shows that the most reliable inhalers providing effective drug delivery into the child's respiratory tract include only a nebulizer - an inhalation device designed to spray an aerosol with particularly fine particles.
The term "nebulizer" (from Lat. Nebula - fog, cloud) was first used in 1874 to mean "an instrument that converts a liquid substance into an aerosol for medical purposes." In 1859 J. One of the first portable aerosol machines was created by Sales-Girons in Paris. The first nebulizers used a stream of steam as a source of energy and were used to inhale vapors of tar and antiseptics in patients with tuberculosis. Modern nebulizers bear little resemblance to these old devices, but they fully meet the old definition - they serve to produce an aerosol from a liquid drug.
Due to the fact that nebulizer therapy (NT) in pediatrics is actively used, as a rule, only in specialized pulmonological and allergological clinics, and are just beginning to introduce into practice children's inpatient and outpatient institutions, doctors need to master this modern method of treatment.
The widespread use of NT in both European and other countries has led to the creation of the European Respiratory Society Guidelines for the use of nebulizers (2001), which aims to maximize the effectiveness and safety of this type of treatment in general clinical practice. Here are some of the main points that characterize NT.
There are three main types of nebulizers, depending on the type of energy that converts a liquid into an aerosol:
1. Jet (compressor) - using a gas stream. At the same time, jet nebulizers can be continuous action, as well as controlled by breathing (with inhalation valves and virtual valves - Omron NE-C28 Comp A.I.R., Omron Pro NE-C29 Comp A.I.R., Omron NE-C30 Comp A.I.R. Elite [Japan]).
2. Ultrasonic - using the vibrational energy of a piezoelectric crystal, for example Omron U17.
3. Membrane nebulizers - OMRON MicroAIR U22.
It is known that all common membrane nebulizers comply with the European HT standards (EN 13544-1). Unlike traditional ultrasonic nebulizers in membrane nebulizers, the vibrational energy of a piezoelectric crystal is directed not to a solution or suspension, but to a vibrating element, therefore, the drug does not heat up and its structure is not destroyed. Due to this, membrane nebulizers can be used for inhalation of corticosteroids, antibiotics and other drugs.

Benefits of nebulizer therapy:

faster absorption of drugs;
an increase in the active surface of the drug substance;
the possibility of using medicinal substances unchanged, which act more effectively in diseases of the respiratory tract and lungs (bypassing the liver);
even distribution of drugs over the surface of the respiratory tract;
the penetration of drugs with air flow into all parts of the upper respiratory tract (nasal cavity, pharynx, larynx, etc.);
atraumatic drug administration. No need to coordinate breathing with aerosol intake;
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 the condition due to the effective intake of the medicinal substance into the bronchi;
rapid achievement of a therapeutic effect when using smaller doses of the drug. Easy inhalation technique.

Basic principles of treatment of infectious complications of ENT organs with the use of nebulizer therapy

Otitis.
They develop against the background of acute respiratory infections due to edema of the mucous membrane in the nasal cavity and nasopharynx, which leads to dysfunction of the auditory tube. Treatment of acute otitis media is usually conservative. Includes vasoconstrictor nasal drops, complex inhalations with furacilin through the nose using a nebulizer, ear drops (the choice depends on the type of acute otitis media), heat on the affected ear area. Antibiotics are prescribed for acute otitis media in children under two years of age and in adults with purulent otitis media.

Sinusitis.
These include inflammatory processes in the paranasal sinuses (maxillary, frontal, ethmoidal, basic), which develop when the function of the osteomeatal complex is impaired. Treatment is usually conservative. Prescribed broad-spectrum antibiotics, vasoconstrictor nasal drops, drugs that improve mucociliary clearance through inhalation therapy (0.9% NaCl, 2% Na bicarbonate, rinofluimucil, lazolvan, phyto-collection). Recently, topical corticosteroids (flixonase, nazonex) are increasingly used in the complex therapy of sinusitis.

Adenoiditis.
This is an inflammation of the hypertrophied nasopharyngeal tonsil, mainly in children. Combined drugs are prescribed in the form of nasal sprays (polydex with phenylephrine, isofra, etc.), the local antibiotic bioparox is widely used. An important place in the treatment of adenoiditis is occupied by inhalation therapy through a nebulizer - complex inhalations with furacilin through the nose, 2% Na bicarbonate, dioxidin, miramistin, iodinol.

Pharyngitis.
Treatment of acute pharyngitis includes the appointment of warm non-irritating food, nebulizer inhalations of antiseptics, 2% Na bicarbonate, 0.9% NaCl, antiseptic phytopreparations (rotocan 1:50, elekasol), irrigation with warm alkaline solutions 4-6 times a day for several days ... Local antiseptics of the oral cavity and pharynx are widely used (antiangin, septolete, decatilen, inhalipt, etc.).

Laryngitis.
With the development of an acute inflammatory process in the larynx, a gentle voice mode is required for 5-7 days, warm drink, nebulizer inhalations (with mucolytics, 0.9% NaCl, 2% Na bicarbonate, hydrocortisone suspension, eucalyptus, fir oils, phyto-assemblies (calendula, chamomile, mother-and-stepmother, thyme, etc.)). Also, local antibiotic therapy with bioparox is used, physiotherapy for the larynx area (ultrasound, magnetotherapy, drug phonophoresis), distracting therapy. In severe cases, broad-spectrum antibiotics are prescribed.

Acute stenosing laryngotracheitis (false croup).
It develops more often in preschool children due to inflammation and edema of the fiber in the sub-lining region. In this case, laryngeal stenosis of varying severity develops. In this case, urgent hospitalization is indicated. At the initial stage of therapy, inhalations of adrenaline, glucocorticosteroids, furosemide are used through a compressor nebulizer; in severe cases, parenteral administration of glucocorticosteroids, furosemide, antibiotics is indicated.

For therapeutic purposes, using a nebulizer, it is possible to use various groups of drugs. These are the following tools:
thinning nasal secretions;
mucolytics;
M-anticholinergics, which help to reduce increased secretion production;
cromones;
anti-inflammatory drugs;
antibacterial agents.

Drugs that thin the nasal secretion

Ambroxol is represented by the drugs Lazolvan, AmbroGEXAL, Ambroxol, Ambrobene and others. Lazolvan: for aerosol therapy, you can use various inhalers, but it is preferable to use a nebulizer in order to more accurate dosage and save the drug. The solution for inhalation is produced in bottles of 100 ml. Recommended doses: adults and children over 6 years old are initially prescribed 4 ml 1-2 times a day, then 2-3 ml - 1-2 inhalations a day, children under 6 years old - 2 ml - 1-2 inhalations day. The drug is used in pure form or with dilution with saline (you cannot use distilled water) in a 1: 1 ratio immediately before inhalation. At the end of inhalation, the remains of the drug are unusable for use.
Ambroxol is available in 40 ml vials.
AmbroGEXAL: release a solution for inhalation in dropper bottles of 50 ml each containing 7.5 mg of the drug in 1 ml. Recommended doses: for 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: a 2% solution is used to liquefy mucus and create an alkaline environment in the focus 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 sodium chloride solution (NaCl): 0.9% NaCl solution does not irritate the mucous membrane. It is used to soften, cleanse and rinse the nasal cavity when corrosive substances enter. The recommended dose is 3 ml 1-2 times a day.
A hypertonic solution of NaCl (3% or 4%) is advisable to use with a small amount of viscous secretion. It helps to cleanse the nasal cavity from mucopurulent contents. For one inhalation use up to 4-5 ml of solution. Warning: use with caution in concomitant bronchial asthma, possibly increased bronchospasm.
Zinc sulfate: 0.5% solution, 20 ml per inhalation.
Aqua Maris is an isotonic sterile solution of Adriatic water with natural trace elements. 100 ml of solution contains 30 ml of sea water with natural ions and trace elements. Used for washing the nasal cavity, nasopharynx and inhalation. For hygienic and preventive purposes - to moisturize the nasal mucous membranes.
Mucolytics. Acetylcysteine \u200b\u200bis represented by the drugs Fluimucil, Mukomist and Acetylcysteine. It is used for inhalation through a nebulizer or an ultrasonic inhaler in the form of a 20% solution. Available in ampoules of 3 ml. Recommended doses: 2-4 ml per inhalation 1-2 times a day.
Fluimucil is produced in the form of a 10% solution for inhalation in ampoules of 3 ml (300 mg of 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 glassware, avoiding contact with metal and rubber products. The ampoule is opened immediately before use. Warning: with concomitant bronchial asthma, an increase in bronchospasm is possible (!).
Mukomist: an ampouled 20% solution is used for inhalation. For nebulizer aerosol therapy, Mukomist is used in pure form or in dilution with saline in a ratio of 1: 1 a day 1-2 times (not exceeding a 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 with bronchial asthma. It is especially recommended for severe overproduction of nasal secretions - with exacerbation of AR with abundant watery discharge. Produced in vials of 20 ml, 1 ml of solution contains 250 μg of ipratropium bromide. When used, the effect occurs in 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: for adults - on average 8–40 drops are used for one inhalation, for children - 8–20 drops (for young children under medical supervision). The drug is diluted with saline (do not dilute with distilled water!) To a volume of 3-4 ml immediately before the procedure. Use through a mouthpiece is recommended to avoid eye contact.
Cromones.
Cromoglic acid - KromoHEXAL - is available in 2 ml plastic bottles (contain 20 mg of cromoglic acid). Recommended dose: 20 mg (2 ml) 1-4 times a day. Dilute with saline to a volume of 3-4 ml (do not use distilled water!) Immediately before the procedure. The use in children of the first years of life can be widely recommended, in the treatment of which topical glucocorticoids are not used.
Anti-inflammatory drugs.
Glucocorticosteroids are represented by the drug Pulmicort (budesonide) or flixotide. It is produced in the form of a ready-made solution for inhalation in plastic containers of 2 ml at dosages of 0.125, 0.25, 0.5 mg and 2.0 mg / ml. The drug is indicated for severe AR, when AR is combined with bronchial asthma. The doctor sets the daily dose individually. In this case, doses less than 2 ml are diluted with saline to 2 ml. Aerosol therapy sessions are carried out for no more than 5-7 days.
Antibacterial agents.
These drugs are indicated for AR complicated by chronic infectious rhinitis or rhinosinusitis. Furacilin - in the form of a solution of 1: 5000 - affects gram-positive and gram-negative microbes. Its inhalations are effective in the acute phases of the disease (during the exacerbation of infectious rhinitis or rhinosinusitis). Recommended dose: 2-5 ml 1-2 times a day.
Immunomodulators.
Leukinferon: for inhalation, dilute 1 ml of the drug in 5 ml of distilled water. Recommended for combination of AR with a 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 sturgeon milk. The drug has immunomodulatory, anti-inflammatory, detoxification, reparative properties. It is indicated in combination with ARVI / influenza, acute catarrhal rhinitis, acute catarrhal rhinopharyngitis, 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 asthma and obstructive bronchitis ...
Combined drugs.
Fluimucil: the drug contains acetylcysteine \u200b\u200b(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 vial is dissolved in 5 ml of saline. Recommended doses: adults - 250 mg 1-2 times a day, children - 125 mg 1-2 times a day. Contraindicated in bronchial asthma (!).

There are 4 main areas of NT application in pediatrics:

• Bronchodilator therapy - with exacerbation of asthma and with other types of acute bronchial obstruction.
• Mucolytic therapy - bronchitis, pneumonia, cystic fibrosis.
• Anti-inflammatory therapy - inhaled glucocorticosteroids for broncho-obstructive syndrome, laryngeal stenosis.
• Antibacterial therapy.

It is important to note that for NT it is allowed to use only special solutions containing bronchodilators (salbutamol, ipratropium bromide, Berodual [ipratropium bromide and fenoterol hydrobromide], etc.), anti-inflammatory drugs (cromones, glucocorticosteroids), antibacterial drugs (luikimucil-antibiotic thiamphenicol glycinate acetylcysteine], tobramycin, etc.), mucolytic drugs (Lazolvan [ambroxol], Fluimucil [acetylcysteine], dornase alfa), etc.
It is strictly forbidden to use for NT oil solutions, hypotonic solutions, pure and even distilled water, suspensions and solutions containing suspended particles, including decoctions and herbal infusions, as well as medicines not intended for inhalation (solutions of aminophylline, papaverine, diphenhydramine, prednisolone ).
Due to the fact that most solutions intended for a nebulizer do not have drug interactions, it is possible to carry out inhalation with several drugs at the same time, reducing its time. In one inhalation, you can combine budesonide with bronchodilators, Berodual with Lazolvan.
In acute respiratory viral infections, it is recommended to use preparations of recombinant-2b human interferon (powder in ampoules of 100,000; 1,000,000; 3,000,000 IU) at the rate of 25-30 thousand IU / kg per day in 1-3 doses (dissolve in 3 ml of saline).

The experience of using nebulizers in children with broncho-obstructive diseases indicates the high efficiency of this method of drug delivery. So, when evaluating inhalation therapy in children of different age groups, it was noted that the use of a nebulizer quickly enough contributed to an improvement in well-being, a decrease, and in some patients even relief, of the phenomena of bronchial obstruction. The use of a nebulizer allowed in most cases to refuse infusion therapy. The use of a nebulizer leads to more pronounced bronchodilation, predominantly at the level of small bronchi, compared with the use of metered-dose inhalers, which is reliably confirmed by the dynamics of indicators of external respiration function. Moreover, NT is a safe and convenient means of drug delivery, especially in young children.
Thus, nebulizer therapy currently occupies the main place in the treatment of respiratory diseases in children and adults. This is due to the optimal possibility of delivering the necessary drugs directly to the respiratory tract, which has a higher therapeutic effect, contributes to the early relief of symptoms and a decrease in the severity of the disease. Improving nebulizer therapy and its introduction into the daily work of inpatient and outpatient institutions, as well as in the practice of emergency medical care, will reduce the frequency of hospitalizations, and in many cases, abandon the use of infusion and systemic therapy.

For citation:Kolosova N.G. Inhalation therapy of respiratory diseases in children // BC. 2014. No. 21. S. 1534

At present, in the treatment of most acute and chronic diseases of the respiratory tract in children, inhalation therapy is mainly used. There are many inhalation devices used to deliver drugs to the respiratory tract. The choice of a delivery device for various diseases is often of fundamental importance, since the use of a number of devices has age restrictions, and errors in the use of inhalers lead to an incorrect distribution of the drug in the airways, an unreasonable increase in the volume of treatment, an increase in the number of side effects and the total cost of therapy. ...

The most common and effective method of drug delivery is a nebulizer (from Latin nebula - fog). With its help, the preparation is sprayed in the form of a moist aerosol with particles of 2-5 microns, which are optimal for entering the respiratory tract. Nebulizers are used in children of all ages. Nebulizer therapy is especially effective in young children, as well as in patients during an exacerbation of the disease, when the presence of symptoms (for example, shortness of breath) does not allow an adequate inhalation maneuver to be performed, which, naturally, makes it difficult for them to use other delivery vehicles (metered aerosol inhalers, powder inhalers etc.). Nebulizer therapy is widely used both in hospital and at home by trained parents. The advantages of nebulizer therapy can also include the ability to deliver a larger dose of the drug and obtain an effect in a shorter period of time, a simple inhalation technique, including at home. Nebulizers are the only means of delivering the drug to the alveoli. If necessary, it is possible to connect to the oxygen supply circuit or to be included in the artificial lung ventilation circuit.
The nebulizer consists of a compressor or ultrasonic device, with the help of which the medicinal solution is sprayed, and a special design nebulizer that allows mainly fine particles of the solution (1-5 microns) to pass through. It is the combination of the device and the nebulizer that determines the main characteristics of the aerosol.
Currently, several types of nebulizers are most common: compressor, ultrasonic and mesh nebulizers.
An ultrasonic nebulizer generates an aerosol by vibrating a piezoelectric crystal, causing the ultrasonic waves to produce a primary aerosol with varying particle sizes above the liquid surface. Subsequently, larger particles are separated, and the patient receives only respirable particles. The fragmentation of aerosol particles occurs by increasing the vibration frequency of the piezoelectric crystal. The drug solution heats up as an aerosol is formed, which can change the properties or destroy the drug. The disadvantages are also the ineffectiveness of aerosol formation from viscous solutions (suspensions) and a large residual volume of the drug.

The operation of a compressor nebulizer is based on the Venturi principle - the flow of compressed air passing through a narrow opening creates negative pressure, which in turn leads to the absorption of liquid through special channels in the nebulizer system. The high speed of the air flow interrupts the liquid flow and forms the particles of the so-called "primary generated aerosol". Subsequently, these particles collide with a "shutter" (plate, ball, etc.), resulting in the formation of a "secondary" aerosol - ultrafine particles with a size of 0.5-10 microns (about 0.5% of the primary aerosol). The secondary aerosol is then inhaled, and a large fraction of the primary aerosol particles (99.5%) is deposited on the inner walls of the nebulizer chamber and is again involved in the aerosol formation process.
Nebulizers in nebulizers from different manufacturing companies may have design features. For example, compressor nebulizers OMRON Healthcare, Japan: OMRON C28 and C24 Kids are equipped with modern virtual valve technology (V.V.T.). This technology is based on the unique structure of the nebulizer chamber and mouthpiece with special openings, which during inhalation work as valves (optimal characteristics: average particle size - 3.0 microns, small residual volume of the drug - 0.7 ml and, what is important, high respirable fraction - 70-76%). This allows you to increase the effectiveness of the therapy when using standard doses of drugs. This technology optimizes the air flow, which contributes to the minimum loss of medication during inhalation by children, weakened and elderly people. The absence of silicone valves in the structure of the atomizer chamber makes it possible to carry out a complete disinfection of the entire chamber by boiling, processing by chemical methods, eliminates the loss or deformation of the valves.

The recommended volume of liquid for nebulization is 2-5 ml in most nebulizers. If necessary, to achieve it, a physiological solution must be added to the drug. Water should not be used for these purposes, since a hypotonic solution can provoke bronchospasm.
A feature of modern membrane nebulizers is the presence of an annular ceramic piezoelectric element and a concave movable membrane. At the same time, atomization occurs by transferring the vibration of the piezoelectric element to a thin metal membrane, due to which the inhalation solution passes through micro-holes of a certain size and shape, forming an aerosol. Mesh nebulizers, like conventional ultrasonic nebulizers, are compact, quiet during operation, but unlike the latter, they have a reduced ultrasound frequency, which allows the use of all medicinal solutions intended for inhalation therapy. Also, mesh nebulizers are characterized by the smallest residual volume, therefore, they allow the most economical use of drugs. Thus, membrane nebulizers combine the advantages of compressor and ultrasonic nebulizers.

The OMRON MicroAir U22 membrane nebulizer uses mesh technology. This technology is based on the innovative principle of aerosol formation, in which a liquid medicinal substance is sifted through a metal mesh-membrane, which contains about 6000 round holes, forming a finely dispersed aerosol of high quality. In contrast to traditional ultrasonic nebulizers, the axial vibrations of the built-in horn are very small (117-180 kHz) and do not destroy the structure of high-molecular drugs. The nebulizer itself is very compact (weight - 97 g), quiet, easy to use, since it works at any angle of inclination from batteries (4 hours of inhalations) or a power adapter. This nebulizer is also effective with a small amount of medication (from 0.5 ml). Despite its compact size, the respirable fraction is 60%, which ensures good effectiveness of inhalation therapy when small doses of drugs are prescribed. Clinical studies have demonstrated the possibility of its effective use with various drugs, including inhaled glucocorticosteroids. The listed characteristics make it relevant to use this type of nebulizer in young children, patients both on bed rest and leading an active lifestyle.

Since the choice of nebulizers on the Russian market is wide enough, it is necessary to focus on the following characteristics:
- 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 drug after inhalation - no more than 1 ml;
- the recommended flow is 6-10 l / min;
- productivity - not less than 0.2 ml / min.
The nebulizer must be tested and certified in accordance with the European standard for nebulizer therapy EN13544-1 (using the low-flow cascade impactor method, currently the most accurate method for investigating the aerodynamic size of aerosol particles). OMRON Healthcare nebulizers meet these requirements.
Nebulizer therapy is widely used today to treat most diseases of the respiratory tract, such as stenosing laryngotracheitis, acute and chronic bronchitis, bronchial asthma, cystic fibrosis, etc., and therefore the choice of drugs is quite diverse. For inhalation nebulizer therapy, both standard solutions of drugs (Table 1) and their combinations (Table 2) are used.
Not recommended for use in nebulizers:
- mineral water;
- all solutions containing oils;
- suspensions and solutions containing suspended particles, including decoctions and herbal infusions;
- solutions of aminophylline, papaverine, platifillin, diphenhydramine and similar agents, as they do not have points of application on the mucous membrane of the respiratory tract.
When using nebulizers, you must remember some rules:
1. Never leave a nebulizer containing medication attached to the compressor.
2. Pour out the rest of the medicine after each procedure.
3. If there is moisture in the connecting pipe, turn on the compressor for a few minutes to remove condensation.
4. After each use, disassemble all parts of the nebulizer, rinse in hot soapy water and rinse thoroughly in running hot water.
5. Dry all parts of the nebulizer disassembled.
6. Disinfection at home should be carried out at least 1 r. / Week. Preference is given to boiling for 10 minutes.
When choosing a nebulizer, you need to clearly understand the goals and objectives of its use in the future: take into account the place of operation of the device - in a hospital, at home, on trips. In the conditions of a medical institution, the use of more powerful nebulizers is required. The use of the device dictates the need to purchase additional consumables. To handle replacement parts (nebulizer kit, mouthpiece, mask, etc.), follow the disinfectant manufacturer's instructions.
The choice of a nebulizer depends on many factors and primarily on the individual characteristics of the patient's breathing. The effectiveness of inhalation therapy will be determined by the severity of the action and the speed of the onset of the therapeutic effect, as well as the minimization of systemic side effects.

Literature
1. Avdeev S.N. Nebulizer therapy with Pulmicort suspension: a place in the treatment of respiratory diseases: A manual for doctors. M., 2008.
2. Geppe N.A. Inhalation nebulizer therapy of respiratory diseases in children: A practical guide for doctors. M., 2008.
3. Geppe NA, Kolosova NG, Shatalina SI, Chokroborty G. Use of inhaled budesonide for airway obstruction in infants // Doctor.Ru. 2012. No. 3 (71). S. 14-18.
4. Hess D.R., Myers T.R., Rau J.L. A guide to aerosol delivery devices. Irving TX: AARC, 2007.
5. Newman S. P., Pitcairn G. R., Pickford et al. The MicroAir electronic-mesh nebulizer deposits aerosol in the lungs more efficiently than a conventional jet nebulizer. Drug Delivery to the Lungs XV, The Aerosol Society, London, 2004. P. 228-231.
6. Waldrep J.C., Berlinski A., Dhand R.J. Aerosol. Med. 2007. Vol. 20. No. 3. P. 310-319.
7. Smaldone G.C., Morra L. Stony Brook Health Science Center Stony Brook. New York 11794 # 8172. February 2002.

The prevalence of allergic rhinitis (AR) among the population of Russia 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 than in urban areas. Often, AR is accompanied by bronchial asthma of varying severity. 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), as well as in the ear (tubo-otitis, chronic otitis media).

For therapeutic purposes, drugs for AR are administered orally, parenterally and inhaled. Inhalations use warm-humid, steam and oil, 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. Dotband in 1951.

Aerosol therapy with drugs for respiratory tract diseases has long been theoretically and experimentally substantiated, pathogenetically justified, clinically tested and highly effective. The indications for the use of aerosol preparations are constantly expanding. Aerosol therapy is a simple, affordable, economical and painless method of influencing the human body. In aerosol form, drugs of various groups are administered.

It has been proven that the drug administered by inhalation is deposited in the body and circulates for a long time in the pulmonary and lymph 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 at a lower dose of the substance due to the large total area of \u200b\u200bexposure, and therefore higher physical activity and action directly on the pathological focus. Thus, during aerosol therapy, the drug has not only local, but also a general effect, which is carried out due to the simultaneous chemical, mechanical and thermal effects. The general effect of the drug is manifested 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 the maximum local therapeutic effect in the airways with little or no systemic side effects.

The main objectives of inhalation therapy are: sanitation of the upper respiratory tract; reduction of mucosal edema; decrease in 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 dose of the aerosol and is determined by a number of factors: the anatomy of the airways; 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, physicochemical properties of aerosol; characteristics of aerosol particles; the dispersion of the aerosol (the ratio of particles in the aerosol by size); aerosol density (content of the sprayed substance in a liter of aerosol); the amount of aerosol produced; sprayer performance (the amount of aerosol generated per unit of time); loss of the drug during inhalation; duration of inhalation; the regularity of the procedures.

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

Evaluation of the results of treatment with aerosols of drugs is carried out on the basis of:

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

Basic rules for taking inhalation

1. Inhalation is carried out no earlier than 1-1.5 hours after eating and physical activity.
2. Smoking is prohibited before and after inhalation.
3. Voice load is not recommended before and after inhalation.
4. Clothing should not constrict the neck and make breathing difficult.
5. Inhalation should be carried out in a calm state, without being distracted by talking and reading.
6. In case of diseases of the nose, paranasal sinuses and nasopharynx, inhale and exhale through the nose, breathe calmly, without tension.
7. In case of diseases of the pharynx, larynx, trachea, bronchi, it is recommended to inhale the aerosol through the mouth - it is necessary to breathe deeply and evenly; after a deep breath with 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, therefore it is necessary to interrupt the inhalation periodically for a short time.
9. Before the procedure, you can not take expectorants, rinse the throat 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.

Inhalation is prescribed after examination of the patient by an otorhinolaryngologist and the development of tactics for complex treatment of the patient together with an allergist-immunologist, and often with a pulmonologist. Examination of the ENT organs should be repeated after a while, since, depending on the results, the nature of the appointments can be changed, and the course of inhalations is lengthened or shortened. At the end of the course, an examination by an ENT doctor is also required.

With medical 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. In case of diseases of the respiratory tract and lungs, inhalation therapy is the most logical, since the drug is directed directly to the place where it should act - into the respiratory tract.

Aerosol therapy in practice is carried out in the form of inhalations, which can be carried out both independently and 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 for long-term inhalation therapy with aerosols of drug solutions. Nebulizers have the longest history of use - they have been in use 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 that converts a liquid substance into an aerosol for medical purposes."

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

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

The main types of compressor nebulizers are listed below.

1. Continuous nebulizer. Aerosol generation occurs constantly in the inhalation and exhalation phase. As a result, a significant part of the drug substance is lost (when using expensive drugs, this quality of the device makes it economically unprofitable).
2. Nebulizer that generates aerosol continuously and is manually operated. In the expiratory phase, the patient stops the aerosol supply from the system by pressing the button. In children, this nebulizer is limited in use due to the difficulty in synchronizing breathing and hand movements. For children of preschool age, it is unacceptable ("work with the key" of parents, as a rule, is not effective enough).
3. Nebulizer controlled by the patient's inhalation. Works in variable mode. 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 aerosol strictly in 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, ensure economical consumption of drugs, reduce the time of exposure of the patient to drugs and increase the effectiveness of treatment. Ultrasonic inhalers are compact, quiet 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;
• an increase in the active surface of the drug substance;
• the possibility of using medicinal substances unchanged, which act more effectively in diseases of the respiratory tract and lungs (bypassing the liver);
• even distribution of drugs over the surface of the respiratory tract;
• the penetration of drugs with air flow into all parts of the upper respiratory tract (nasal cavity, pharynx, larynx, etc.);
• atraumatic drug administration. No need to coordinate breathing with aerosol intake;
• 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 the condition due to the effective intake of the medicinal substance 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 using it from the first months of life. A child's inhaler must meet the following requirements: be ergonomic and easy to use, equipped with a child's mask, have an attractive look (interesting design), which is important for keeping the child interested.

The goal of nebulizer therapy in 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 must be created, and the pharmacodynamic response is 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 the Inter-Eton company. For use in the complex therapy of AR, it is advisable to use the Boreal model, which creates a coarse aerosol with a particle size of 5-10 microns, which settles in the nasal cavity and nasopharynx, that is, in the place where allergic inflammation develops in AR. This nebulizer model is convenient for use both in the outpatient practice of a doctor and at home. It should be noted that the design of the nebulizer and its components does not contain latex.

In children, oral inhalation using a mouthpiece is preferred. For babies in the first years of life, you can use a tight-fitting mask.

With a therapeutic purpose in AR using a nebulizer, it is possible to use various groups of drugs. These are the following tools:

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

Drugs that thin the nasal secretion

• Ambroxol is represented by the drugs Lazolvan, AmbroGEXAL, Ambroxol, Ambrobene and others. Lazolvan: for aerosol therapy, it can be used using various inhalers, but it is preferable to use a nebulizer in order to more accurate dosage and save the drug. The solution for inhalation is produced in bottles of 100 ml. 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 a day, children under 6 years old - 2 ml - 1-2 inhalations day. The drug is used in pure form or with dilution with saline (distilled water cannot be used) in a 1: 1 ratio immediately before inhalation. At the end of inhalation, drug residues are unusable for use.

Ambroxol is available in 40 ml vials.

AmbroGEXAL: release a solution for inhalation in dropper bottles of 50 ml each containing 7.5 mg of the drug in 1 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: a 2% solution is used to liquefy mucus and create an alkaline environment in the focus 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 sodium chloride solution (NaCl): 0.9% NaCl solution does not irritate the mucous membrane. It is used to soften it, cleanse and rinse the nasal cavity when corrosive substances enter. The recommended dose is 3 ml 1-2 times a day. You can use the slightly alkaline mineral water Narzan, Essentuki-4 and Essentuki-17. Before use, it must be degassed by settling in an open container.

A hypertonic solution of NaCl (3% or 4%) is advisable to use with a small amount of viscous secretion. It helps to cleanse the nasal cavity from mucopurulent contents. For one inhalation use up to 4-5 ml of solution. Warning: use with caution with concomitant bronchial asthma, possibly increased bronchospasm.

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

Aqua Maris is an isotonic sterile solution of the 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 inhalation. For hygienic and preventive purposes - to moisturize the nasal mucous membranes.

Mucolytics. Acetylcysteine \u200b\u200bis represented by the drugs Fluimucil, Mukomist 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 for inhalation 3-4 times a day.

Fluimucil is available as a 10% solution for inhalation in ampoules of 3 ml (300 mg of 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 glassware, avoiding contact with metal and rubber products. The ampoule is opened immediately before use. Warning: with concomitant bronchial asthma, an increase in bronchospasm is possible (!).

Mukomist: an ampouled 20% solution is used for inhalation. For nebulizer aerosol therapy, Mukomist is used in pure form or in dilution with saline in a ratio of 1: 1 per day 2-3 times (not exceeding a 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 AR combination with bronchial asthma. It is especially recommended for severe hyperproduction of nasal secretions - with exacerbation of AR with abundant watery discharge. Produced in vials of 20 ml, 1 ml of solution contains 250 μg of ipratropium bromide. The effect when used occurs in 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: for adults - on average 8-40 drops are used for one inhalation, for children - 8-20 drops (for young children under medical supervision). The drug is diluted with saline (do not dilute with distilled water!) To a volume of 3-4 ml immediately before the procedure. Use through a mouthpiece is recommended to avoid eye contact. Residues of the drug in the nebulizer are not suitable for reuse.

Cromones. Cromoglic acid - KromoHEXAL - is available in 2 ml plastic vials (contain 20 mg of cromoglic acid). Recommended dose: 20 mg (2 ml) 4 times a day. Dilute with saline 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. The use in children of the first years of life can be widely recommended, in the treatment of which topical glucocorticoids are not used.

Anti-inflammatory drugs.Glucocorticosteroids are represented by the drug Pulmicort (budesonide). Produced as a ready-made solution for inhalation in plastic containers of 2 ml at 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. The doctor sets the daily dose 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 aerosol therapy, you should rinse your mouth thoroughly with Pulmicort.

Antibacterial agents. These drugs are indicated for AR complicated by chronic infectious rhinitis or rhinosinusitis. Furacilin - in the form of a solution of 1: 5000 - affects gram-positive and gram-negative microbes. Its inhalation is effective in the acute phases of the disease (during an 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 for combination of AR with a 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 sturgeon milk. The drug has immunomodulatory, anti-inflammatory, detoxification, reparative properties. It is indicated in combination with ARVI / influenza, acute catarrhal rhinitis, acute catarrhal rhinopharyngitis, 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 asthma and obstructive bronchitis ...

Combined drugs. Fluimucil: the drug contains acetylcysteine \u200b\u200b(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 vial is dissolved in 5 ml of saline. Recommended doses: adults - 250 mg 1-2 times a day, children - 125 mg 1-2 times a day. Contraindicated in bronchial asthma (!).

conclusions

The widespread prevalence of AR determines the relevance of the search for more effective and economical therapy. The use of some drugs that affect different links in the pathogenesis of the pathological process that make up the treatment complex using a nebulizer makes it possible to shorten the duration of the exacerbation of AR, reduce the severity of its symptoms, especially rhinorrhea, and also reduce the consumption of the drug used, i.e., it gives a pronounced its savings.

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

Literature

1. Balabolkin I.I., Efimova A.A., Brzhzovsky M.M. et al. Influence of environmental factors on the prevalence and course of allergic diseases in children // Immunology. 1991. No. 4. S. 34-37.
2. Geppe N.A. Nebulizer therapy for bronchial asthma in children // Pulmonology. 1999.S. 42-48.
3. National program "Bronchial asthma in children. Treatment strategy and prevention". M., 1997.96 p.
4. Petrov V.I., Smolenov I.V. Bronchial asthma in children. Volgograd, 1998.S. 71-76.
5. Polunov M. Ya. Fundamentals of inhalation therapy. Kiev, 1962.
6. Eidelstein S.I. The basics of aerotherapy. M., 1967.
7. Bisgaard H. Patient-related factors in nebulized drug delivery to children // Eur. Respir.Rev. 1997; 51; 7: 376-377.
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 nebuliser tretment // Thorax. 1997.52; 2: S25-S30.

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

Get acquainted with the doctor's prescription (type of inhalation, composition of the inhalation mixture, its amount, duration of the procedure);

Preparing for the patient's procedure:

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

2. Fill the inhaler with the medicine;

3. Sit down the patient at the inhaler;

4. Make sure it is ready.

Procedure:

1. Switch on the inhaler.

2. Ensure correct behavior and breathing of the patient.

3. Monitor the patient.

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

End of procedure:

1. Turn off the inhaler.

2. Remove the handpiece and sterilize.

3. Offer 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, MAHOLD INHALER WITH ESSENTIAL OILS, UN-231 ULTRASONIC INHALER. EASY TO APPLY.

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

Given: Patient P., 45 years old.

Ds: Bronchial asthma.

Appointed: Individual aerosol therapy, medicinal mixtures: solution of aminophylline 1% -1 ml, solution of ephedrine hydrochloride 1% -1 ml. Duration 5-10 minutes.

Course of 15 procedures.

Questions:

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

2) What is the sequence of actions of the nurse during 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 at home are currently used? What is their feature?

5) What other physiotherapy procedures can be used to combine inhalation therapy for this pathology?

Decision:

1) Inhalers grind drug particles to a predetermined size, spraying it in air or in any other gas (oxygen), and supply it to patients for breathing. Spraying is carried out in the usual mechanical way using nozzles like a spray gun. Active deep breathing of the patient promotes deep penetration and uniform distribution of aerosol in the respiratory tract.

In modern medicine, for the treatment of respiratory diseases, inhalation therapy has become more widely used. This has become possible with the introduction of inhalers that can spray drugs into small particles.
These inhalers are called - nebulizers (from the Latin word “nebula” - fog).

Nebulizers spray liquid dosage forms to an aerosol state (small particles, 2-4 microns in size). This allows you to ensure the flow of medicines down to the small bronchi and alveoli.

In this regard, there are ample opportunities for treatment.
With the help of nebulizer therapy, it is possible to relieve spasm of the bronchial muscles, to achieve mucolytic, anti-inflammatory, antibacterial effects.

more—\u003e Most often nebulizer therapy applied with bronchial asthma, obstructive bronchitis, pneumonia with obstructive syndrome. Also, this therapy has found application in pharyngitis, rhinitis.

The main goal of nebulizer therapy is to maximize the therapeutic effect of drugs in the airways with minimal side effects.

Now, briefly about the nebulizers themselves.

There are 3 types of nebulizers:

• Compressor... The aerosol is atomized using a stream of compressed air or oxygen through the nebulizer chamber. Particle sizes up to 5 μm are formed. This is considered to be the most optimal for the penetration of particles into the most distant parts of the respiratory tract.
• Ultrasonic... Sputtering occurs due to the high-frequency vibration of the device's piezoelectric crystals.
• Mesh nebulizers (membrane inhalers or electronic mesh). They use vibrating mesh technology by sifting liquid through a membrane with very small holes and mixing the resulting particles with air.

Each of these types of devices have their own pros and cons.

For example, compressor nebulizers allow the use of all kinds of medicines, it is possible to adjust the particle size. But they make noise, are heavy.

Ultrasonic nebulizers do not emit noise, make aerosol particles homogeneous, and supply large volumes of drugs. But antibiotics and hormones cannot be used in these inhalers (ultrasound destroys these drugs). Also, the particle size cannot be controlled.

Mesh nebulizers belong to the third generation of nebulizers. They combine all the advantages of compressor and ultrasonic inhalers. Their disadvantage is the high price.

Nebulizer therapy has several advantages.

Benefits of nebulizer therapy:

• Delivery of the drug directly to the lesion focus (down to the lower respiratory tract), in connection with which a quick therapeutic effect can be achieved.
• There is no risk of getting a burn of the mucous membranes of the respiratory tract (in contrast to oil or steam inhalers).
• It is not necessary to synchronize breathing during inhalation, as when using a spray dispenser. Therefore, inhalation through a nebulizer can be used in children from an early age.
• Inhalation can be carried out in patients in serious condition.
• Respiratory tract is not irritated by solvents and carrier gases (as is the case when using metered aerosol inhalers).
• High doses of drugs can be accurately dosed and used.

Nebulizer therapy solves the following tasks:

• Reduces the phenomenon of bronchospasm.
• Improves the drainage function of the airways.
• Reduces swelling of the mucous membrane.
• Sanitizes the bronchial tree.
• Reduces the activity of the inflammatory process.
• Delivers medicines to the alveoli.
• Affects local immune responses.
• Protects the mucous membrane from the action of allergens
• Improves microcirculation.

What medicines can be used in the nebulizer?

For nebulizer therapy, solutions are used in ampoules and in special plastic containers - nebulah... For one inhalation, you need from two to five ml of solution. Initially, two ml of saline is injected, and then the required amount of medication (depending on the patient's age). Do not use distilled, boiled, tap water, hypertonic and hypotonic solutions as a solvent (can cause bronchospasm).

For inhalation through a nebulizer, you can use the following drugs:

1. Mucolytics : lazolvan, ambrohexal, fluimucil, ambrobene.
2. Bronchodilators: Ventolin, Berodual, Berotec, Salamol.
3. Glucocorticoids: pulmicort, flixotite.
4. Cromones (stabilizes mast cell membranes): cromohexal.
5. Antibiotics: fluimucil with antibiotic, gentamicin 4%, tobramycin.
6. Antiseptics: dioxidin 0.25% solution (0.5% dioxidine diluted in half with saline 0.9%), furacillin 0.02%, dekasan.
7. Saline and alkaline solutions: 0.9% sodium chloride, mineral water Borzhomi, Luzhanskaya, Narzan, Polyana kvassova.
8. Also you can apply: magnesium sulfate 25% (dilute 1 ml of the drug with 2 ml of saline solution), rotokam (dilute 2.5 ml in 100 ml of saline, apply 2-4 ml 3 times a day), leukocyte interferon, laferon,
   lidocaine 2%, antifungal agents Ambizom.

Dosing of drugs for children.

• Laferon, laferobion - 25-30 thousand IU / kg per day (divided into three doses).
• Ventolin - a single dose of 0.1 mg / kg of body weight (0.5 ml per 10 kg.). With obstructive syndrome, it is possible every 20 minutes. 3 times, then three times a day.
• Ambrobene (in 1 ml 7.5 mg) - up to two years - 1 ml. 2 times, from two to five years -1 ml 3 times, from five to twelve years, 2 ml. 2-3 times.
• Fluimucil 10% solution - 0.5-1 ampoule 2 times a day.
  - Berodual up to six years old 10 drops for inhalation 3 times a day, over six years 10-20 drops 3 times a day.
• Berotek - up to six years 5 drops of the solution 3 times a day, six to twelve years 5-10 drops 3 times a day, over twelve years 10 drops 3 times a day.
• Atrovent - up to one year, 5-10 drops 3 times a day, for older children 10-20 drops 3 times a day.
• Pulmicort - the initial dose is in children over the age of 6 months. 0.25-0.5 mg / day. If necessary, the dose can be increased to 1 mg / day (in 1 ml - 0.5 mg of the drug).
• Fluticasone (Flixotide) nebula 0.5 and 2 mg, 2 ml. Adults and adolescents over 16 years old: 0.5-2 mg twice a day, 4-16 years: 0.05-1.0 mg twice a day.The initial dose of the drug should correspond to the severity of the disease.The drug can be mixed with Ventolin and Berodual.

What products can not be used for inhalation through a nebulizer.

• Any oils;
• Solutions that contain oils;
• Solutions and suspensions containing suspended particles;
• Infusions and decoctions of herbs.

• Papaverine
• Platyphyllin
• Theophylline
• Euphyllin
• Diphenhydramine (the above drugs do not have a substrate for action on the mucous membrane).
• Systemic glucocorticosteroids - prednisolone, dexazone, hydrocortisone (their systemic action is achieved, not local).

Contraindications for the use of nebulizer therapy:

• Pneumtorax;
• Pulmonary bleeding;
• Heart failure;
• Cardiac arrhythmia;
• Intolerance to medications used for inhalation.

For inhalation, you need to know:

• The recommended course of treatment with inhalation through a nebulizer is from 7 to 15 procedures.
• The duration of inhalation should not be more than 8-10 minutes.
• Before the procedure, it is not recommended to rinse your mouth with antiseptic solutions, take expectorants.
• After inhalation of hormonal drugs, you must rinse your mouth with boiled water (the child can be given food or drink).
• Periodically, it is necessary to interrupt the inhalation for a short time, as frequent breathing can cause dizziness.

Finally I would like to say that nebulizer therapy is the most promising method of treating the respiratory system.
Previously, this therapy was only possible in a hospital, now a nebulizer can be bought at any pharmacy for outpatient treatment. A nebulizer should be purchased for those families where there is a sick child with bronchial asthma or frequently ill children with obstructive bronchitis. In this case, you need to consider which inhaler to choose. Compressor nebulizers are considered the "gold standard". But if you do not need to use hormonal drugs (Pulmicort, Flixotide) or antibiotics (Fluimucil with an antibiotic), then you can purchase an ultrasonic nebulizer.