Nebulizers and nebulizer therapy. Nebulizer therapy and its features Drugs intended for nebulizer therapy

• Distress syndrome of adults and children

  Produce inhalation of surfactant preparations.

• primary pulmonary hypertension

  Inhalation administration of iloprost (a stable analogue of prostacyclin) using a nebulizer from 6 to 12 times a day is effective method treatment of primary pulmonary hypertension. Such treatment leads to improved hemodynamics, increased physical performance, and possibly improved prognosis.

• Acute respiratory diseases.
• Pneumonia.
• bronchiectasis.
• Bronchopulmonary dysplasia in newborns.
• Viral bronchiolitis.
• Tuberculosis of the respiratory organs.
• Chronic sinusitis.
• Idiopathic fibrosing alveolitis.
• Post-transplant bronchiolitis obliterans.

In palliative therapy, the objectives of which are to alleviate the symptoms and suffering of terminal patients, inhalation therapy is used to reduce refractory cough (lidocaine), incurable dyspnea (morphine, fentanyl), bronchial secretion retention (physiological saline), bronchial obstruction (bronchodilators).

Promising areas for the use of nebulizers are such areas of medicine as gene therapy (in the form of an aerosol, a gene vector - adenovirus or liposomes is injected), 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
  • Pulmonary bleeding and spontaneous pneumothorax on the background of bullous emphysema.
  • Cardiac arrhythmia and heart failure.
  • Individual intolerance to the inhalation form of medicines.

• Factors that determine the effectiveness of the use of nebulizers

  Conventionally, all factors that affect the production of an aerosol, its quality and deposition in the patient's respiratory tract, i.e. determining the effectiveness of nebulizer technology can be divided into three large groups:

  • Factors associated with the inhalation device

    The goal of inhalation therapy with a nebulizer is to produce an aerosol with a high proportion (> 50%) of respirable particles (less than 5 µm) within a fairly short time interval (typically 10-15 minutes).

    Aerosol production efficiency, aerosol properties and its delivery to Airways depends on:

    • Type of nebulizer, its design features

      Despite the similar design and construction, nebulizers of different models can have significant differences. When comparing 17 types of jet nebulizers, it was shown that the differences in the aerosol output reached 2 times (0.98-1.86 ml), in the size of the respirable aerosol fraction - 3.5 times (22-72%), and in the speed delivery of particles of the respirable fraction of drugs - 9 times (0.03-0.29 ml/min). In another study, the average deposition of the drug in the lungs differed by 5 times, and the average oropharyngeal deposition - by 17 times.

      The main factor determining the deposition of particles in the respiratory tract is the size of the aerosol particles. Conventionally, the distribution of aerosol particles in the respiratory tract, depending on their size, can be represented as follows:

      • More than 10 microns - deposition in the oropharynx.
      • 5-10 microns - deposition in the oropharynx, larynx and trachea.
      • 2-5 microns - deposition in the lower respiratory tract.
      • 0.5-2 microns - deposition in the alveoli.
      • Less than 0.5 microns - do not precipitate in the lungs.

      In general, the smaller the particle size, the more distally their deposition occurs: at a particle size of 10 µm, the deposition of aerosol in the oropharynx is 60%, and at 1 µm it approaches zero. Particles with a size of 6-7 microns are deposited in the central respiratory tract, while optimal dimensions for deposition in the peripheral airways - 2-3 microns.

      In addition, the effectiveness of nebulizer therapy depends on the type of nebulizer. For example, when using ultrasonic nebulizers, the use of medicines in the form of suspensions and viscous solutions, and heat-sensitive drugs can be destroyed due to heating in ultrasonic nebulizers. Conventional (convection) compressor nebulizers require relatively high working gas flows (greater than 6 l/min) to achieve adequate aerosol output. In patients with cystic fibrosis, it was shown that Venturi nebulizers compared with conventional nebulizers made it possible to achieve twice the deposition of the drug in the respiratory tract: 19% versus 9%.

    • Residual volume and filling volume

      The drug cannot be used completely, as part of it remains in the so-called "dead" space of the nebulizer, even if the chamber is almost completely drained.

      Residual volume depends on the design of the nebulizer (ultrasonic nebulizers have a larger residual volume), and is usually in the range of 0.5 to 1.5 ml. The residual volume is independent of the filling volume, however, based on the residual volume, recommendations are given on the amount of solution added to the nebulizer chamber. Most modern nebulizers have a residual volume of less than 1 ml, for which the filling volume must be at least 2 ml. Residual volume can be reduced by easy tapping the nebulizer chamber by the end of the procedure, while large drops of the solution return from the walls of the chamber to the working area, where they are again nebulized.

      The filling volume also affects the aerosol output, for example, with a residual volume of 1 ml and a filling volume of 2 ml, no more than 50% of the drug can be converted into an aerosol (1 ml of the solution will remain in the chamber), and with the same residual volume and a filling volume of 4 ml up to 75% of the drug can be delivered to the respiratory tract. However, with a residual volume of 0.5 ml, an increase in the filling volume from 2.5 to 4 ml leads to an increase in the drug yield by only 12%, and the inhalation time increases by 70%. The higher the selected initial volume of the solution, the greater the proportion of the drug can be inhaled. However, this also increases the nebulization time, which can significantly reduce the compliance of patients to therapy.

    • Working gas flow rates

      The flow of working gas for most modern nebulizers is in the range of 4-8 l / min. Increasing the flow leads to a linear decrease in the size of the aerosol particles, as well as an increase in the yield of the aerosol and a decrease in the time of inhalation. The nebulizer has a known resistance to flow, therefore, in order to adequately compare compressors with each other, the flow must be measured at the outlet of the nebulizer. This "dynamic" flow is the true parameter that determines particle size and nebulization time.

    • Nebulization time

      The output of the drug differs from the output of the solution due to evaporation - by the end of inhalation, the solution of the drug in the nebulizer is concentrated. Therefore, early cessation of inhalation (for example, at the time of "splashing" (the moment when the process of aerosol formation becomes intermittent) or earlier) can significantly reduce the amount of drug delivery.

      There are several ways to determine the nebulization time:

      • "Total time nebulization" - the time from the start of inhalation to the complete drying of the nebulizer chamber;
      • "Spray time" - the time of the beginning of the spray, hiss of the nebulizer, that is, the point when air bubbles begin to enter the working area, and the aerosol formation process becomes intermittent;
      • "Clinical nebulization time" is the time between "total" and "spray time", that is, the time at which the patient usually stops inhalation.

      Too much long time inhalation (more than 10 minutes) may reduce the patient's compliance to therapy. It is rational to recommend to the patient to carry out inhalation for a fixed time, based on the type of nebulizer, compressor, filling volume and type of drug.

    • Aging nebulizer

      Over time, the properties of a compressor (jet) nebulizer can change significantly, in particular, wear and expansion of the Venturi opening is possible, which leads to a decrease in the “working” pressure, a decrease in the speed of the air jet and an increase in the diameter of aerosol particles. Washing the nebulizer can also cause the nebulizer to “age” faster, and if the chamber is cleaned infrequently, the outlet can become blocked by drug crystals, resulting in a decrease in aerosol output. In the absence of processing (cleaning, washing) of the nebulizer, the quality of aerosol products decreases, on average, after 40 inhalations.

      There is a class of "durable" nebulizers, the service life of which can reach 12 months with regular use (Pari LC Plus, Omron CX / C1, Ventstream, etc.), but their cost is an order of magnitude higher than nebulizers with a shorter service life.

    • Compressor-nebulizer system combinations

      Each compressor and each nebulizer has its own characteristics, so the random combination of any compressor with any nebulizer does not guarantee optimal performance of the nebulizer system and maximum effect. So, for example, when combining the same nebulizer (Cirrus) with 6 different compressors, using 2 of them, the aerosol particle sizes and "dynamic" flow were outside the recommended limits.

      Examples of some optimal nebulizer-compressor combinations:

      • Pari LC Plus + Pari Boy.
      • Intersurgical Cirrus + Novair II.
      • Ventstream + Medic-Aid CR60.
      • Hudson T Up-draft II + DeVilbiss Pulmo-Aide.
    • Solution temperature

      The temperature of the solution during inhalation when using a jet nebulizer can decrease by 10 ° C or more, which can increase the viscosity of the solution and reduce the aerosol yield. To optimize nebulization conditions, some nebulizer models use a heating system to raise the temperature of the solution to body temperature (Paritherm).

  • Patient related factors Aerosol deposition can be influenced by factors such as:
    • breathing pattern

      The main components of the respiratory pattern (cycle) that affect the deposition of aerosol particles are the tidal volume, inspiratory flow and inspiratory fraction - the ratio of inspiratory time to the total duration of the respiratory cycle. Average inspiratory fraction healthy person is 0.4-0.41, in patients with severe exacerbation of chronic obstructive pulmonary disease (COPD) - 0.34-0.36.

      When using a conventional nebulizer, aerosol generation occurs throughout the entire respiratory cycle, and its delivery to the respiratory tract is possible only during inspiration, that is, it is directly proportional to the inspiratory fraction.

      Rapid inhalation and delivery of the aerosol jet into the air stream in the middle and end of inspiration increases central deposition. In contrast, slow inspiration, inhalation of an aerosol at the beginning of inspiration, and breath-holding at the end of inspiration increase peripheral (pulmonary) deposition. An increase in minute ventilation also increases the deposition of aerosol particles in the lungs, but it may also decrease due to an increase in inspiratory flow.

      A particular problem in children is the irregular respiratory pattern associated with dyspnea, coughing, crying, etc., which makes delivery of the aerosol unpredictable.

    • Breathing through the nose or mouth

      Inhalation using a nebulizer is carried out through a mouthpiece or face mask. Both interface types are considered efficient, however nasal breathing can significantly reduce the deposition of aerosol when breathing through a mask. The mask approximately halves the delivery of aerosol to the lungs, in addition, at a distance of 1 cm from the face, the deposition of the aerosol drops by more than 2 times, and at a distance of 2 cm - by 85%.

      Due to the narrow cross-section, the steep change in airflow direction and the presence of hairs, the nose creates ideal conditions for inertial collision of particles and is an excellent filter for most particles larger than 10 microns. Nasal deposition increases with age: in children aged 8 years, about 13% of the aerosol is deposited in the nasal cavity, in children aged 13 years - 16%, and in adults (mean age 36 years) - 22%.

      Given these data, increased use of mouthpieces is recommended, and face masks play a major role in children and intensive care. To avoid getting the drug into the eyes when using a mask, it is recommended, if possible, to use mouthpieces when inhaling corticosteroids, antibiotics, anticholinergic drugs (cases of exacerbation of glaucoma are described).

    • Airway geometry

      Different people have significant differences in the geometry of the airways.

      Central (tracheobronchial) deposition is higher in patients with smaller airway diameters. Narrowing of the airway lumen due to any cause can affect the distribution of particles in the lungs. In most broncho-obstructive diseases, there is an increase in central and a decrease in peripheral deposition. For example, in patients with cystic fibrosis, delivery to the tracheobronchial sections increases by 200-300%, and the pulmonary peripheral deposition of r-DNase is directly proportional to the FEV 1 index. A similar phenomenon is observed in COPD and bronchial asthma. In patients with COPD, the peripheral deposition of the aerosol was the less, the more pronounced the bronchial obstruction.

      Inhalation of terbutaline with a predominant distribution in the central or peripheral respiratory tract leads to the same bronchodilator effect.

    • body position

      In HIV patients who receive regular inhalations of pentamidine to prevent Pneumocystis carini infection, pneumocystis pneumonia can still develop in the upper zones of the lungs, since only a small part of the aerosol reaches these sections during quiet breathing in a sitting position.

  • Drug related factors

    Most often in clinical practice for inhalation using nebulizers, solutions of medicinal substances are used, however, sometimes inhaled drugs can be in the form of suspensions. The principle of generating an aerosol from suspensions has significant differences. The suspension consists of insoluble solid particles suspended in water. When a suspension is nebulized, each aerosol particle is a potential carrier of a solid particle, so it is very important that the particle size of the suspension does not exceed the size of the aerosol particles. The average particle diameter of a suspension of budesonide (Pulmicort) is about 3 microns. The ultrasonic nebulizer is ineffective for delivering drug suspensions.

    Viscosity and surface tension affect aerosol yield and performance. Changing these parameters occurs when adding to dosage forms substances that increase the dissolution of the main substance - co-solvents (for example, propylene glycol). Increasing the concentration of propylene glycol leads to a decrease in surface tension and an increase in aerosol yield, but an increase in viscosity also occurs, which has the opposite effect - a decrease in aerosol yield. To improve the properties of the aerosol allows the optimal content of co-solvents.

    When prescribing inhaled antibiotics to patients with chronic lung disease, the best deposition is achieved by nebulizers that produce very small particles. Antibiotic solutions have a very high viscosity, so powerful compressors and breath-activated nebulizers must be used.

    The osmolarity of an aerosol affects its deposition. When passing through the humidified respiratory tract, an increase in the particle size of hypertonic aerosol and a decrease in hypotonic aerosol can occur.

• Rules for the preparation and conduct of inhalations
  • Preparation for inhalation

    Inhalations are carried out 1-1.5 hours after a meal or physical activity. Smoking is prohibited before and after inhalation. Before inhalation, you can not use expectorants, gargle with antiseptic solutions.

  • Preparation of a solution for inhalation

    Solutions for inhalation should be prepared on the basis of physiological saline (0.9% sodium chloride) in compliance with the rules of antisepsis. It is forbidden to use for these purposes tap, boiled, distilled water, as well as hypo- and hypertonic solutions.

    Syringes are ideal for filling nebulizers with an inhalation solution; pipettes can 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 by the annotation for the use of the drug. Before starting inhalation, the prepared solution is recommended to be heated in a water bath to a temperature of at least + 20 ° C. Decoctions and infusions of herbs can be used only after careful filtration.

  • Carrying out inhalation
    • During inhalation, the patient should be in a sitting position, not talking and holding the nebulizer upright. When carrying out inhalation, it is not recommended to lean forward, since this position of the body makes it difficult for the aerosol to enter the respiratory tract.
    • In diseases of the pharynx, larynx, trachea, bronchi, the aerosol should be inhaled through the mouth. After a deep inhalation through the mouth, hold the breath for 2 seconds, then exhale completely through the nose. It is better to use a mouthpiece or mouthpiece than a mask.
    • In case of diseases of the nose, paranasal sinuses and nasopharynx, it is necessary to use special nasal nozzles (nasal cannulas) for inhalation, inhalation and exhalation must be done through the nose, breathing is calm, without tension.
    • Since frequent and deep breathing can cause dizziness, it is recommended to take breaks in inhalation for 15-30 seconds.
    • Continue inhalation until liquid remains in the nebulizer chamber (usually about 5-10 minutes), at the end of inhalation, slightly beat the nebulizer for a more complete use of the drug.
    • Rinse your mouth thoroughly after inhaling steroids and antibiotics. 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 gas jet (hair dryer). Frequent rinsing of the nebulizer is necessary to prevent drug crystallization and bacterial contamination.

• Drugs used for nebulizer therapy
  • Bronchodilators Short-acting selective β-2-adrenergic agonists:
    M-anticholinergics:
    • Ipratropium bromide (Atrovent) r/r for inhalation 0.25 mg/ml
    Combined bronchodilators:
    • Fenoterol/Ipratropium bromide (Berodual) r/r for inhalation 0.5/0.25 mg/ml
    • Nebulizer bronchodilator therapy for bronchial asthma

      • Adults and children over 18 months: chronic bronchospasm, not amenable to correction by combination therapy, and severe asthma exacerbation - 2.5 mg up to 4 times a day (single dose can be increased to 5 mg).

        For the treatment of severe airway obstruction, adults can be prescribed up to 40 mg / day (single dose not more than 5 mg) under strict medical supervision in a hospital setting.

      • Adults and children over 12 years old, for the relief of an attack of bronchial asthma - 0.5 ml (0.5 mg - 10 drops). In severe cases - 1-1.25 ml (1-1.25 mg - 20-25 drops). In exceptionally severe cases (under medical supervision) - 2 ml (2 mg - 40 drops). Prevention of physical effort asthma and symptomatic treatment of bronchial asthma - 0.5 ml (0.5 mg - 10 drops) up to 4 times a day.

        Children 6-12 years old (body weight 22-36 kg) for the relief of an attack of bronchial asthma - 0.25-0.5 ml (0.25-0.5 mg - 5-10 drops). In severe cases - 1 ml (1 mg - 20 drops). In exceptionally severe cases (under medical supervision) - 1.5 ml (1.5 mg - 30 drops). Prevention of physical effort asthma and symptomatic treatment of bronchial asthma and other conditions with reversible narrowing of the airways - 0.5 ml (0.5 mg - 10 drops) up to 4 times a day.

        Children under 6 years old (body weight less than 22 kg) (only under medical supervision) - about 50 mcg / kg per dose (0.25-1 mg - 5-20 drops) up to 3 times a day.

      • Adults - treatment of exacerbations - 2.0 ml (0.5 mg, 40 drops), possibly in combination with β 2 -agonists, maintenance therapy - 2.0 ml 3-4 times a day.

        Children 6-12 years old - 1 ml (20 drops) 3-4 times / day.

        Children under 6 years old - 0.4-1 ml (8-20 drops) up to 3 times a day under medical supervision.

      • Inhalations through the ipratropium bromide/fenoterol nebulizer ( combination drug)

        Adults - from 1 to 4 ml (20-80 drops) 3-6 times a day at intervals of at least 2 hours.

        Children 6-14 years old - 0.5-1 ml (10-20 drops) up to 4 times / day. In severe attacks, it is possible to prescribe 2-3 ml (40-60 drops) under medical supervision.

        Children under 6 years old - 0.05 ml (1 drop) / kg of body weight up to 3 times a day under medical supervision.

    • Nebulizer bronchodilator therapy for COPD
      • Inhalations through a salbutamol nebulizer

        2.5 mg up to 4 times a day (single dose may be increased to 5 mg). For the treatment of severe airway obstruction in adults, up to 40 mg / day can be prescribed under strict medical supervision in a hospital setting.

        The solution is intended for use undiluted, however, if long-term administration of salbutamol solution (more than 10 minutes) is necessary, the drug can be diluted with sterile saline.

      • Inhalation through a fenoterol nebulizer

        Symptomatic treatment of chronic obstructive pulmonary disease - 0.5 ml (0.5 mg - 10 drops) up to 4 times a day.

        The recommended dose is diluted with saline immediately before use to a volume of 3-4 ml. The dose depends on the method of inhalation and the quality of the spray. If necessary, repeated inhalations are carried out at intervals of at least 4 hours.

      • Inhalations through the ipratropium bromide nebulizer

        0.5 mg (40 drops) 3-4 times a day through a nebulizer.

        Nebulizer mucolytic therapy for COPD
        • Acetylcysteine ​​inhalation through a nebulizer

          To reduce the frequency of exacerbations and the severity of exacerbation symptoms, it is recommended to prescribe acetylcysteine, which has an antioxidant effect. Usually 300 mg x 1-2 times a day for 5-10 days or longer courses.

          The frequency of taking and the size of the dose can be changed by the doctor depending on the condition of the patient and the therapeutic effect. Children and adults the same dosage.

        • Ambroxol inhalation through a nebulizer

          Adults and children over 6 years old - 1-2 inhalations of 2-3 ml of solution daily.

          Children under 6 years old - 1-2 inhalations of 2 ml of solution daily.

          The drug is mixed with saline, it can be diluted in a ratio of 1: 1 to achieve optimal air humidification in the respirator.

          The initial course of treatment is at least 4 weeks. The total duration of therapy is determined by the attending physician. Inhalation is carried out using a nebulizer through a face mask or mouthpiece.

        • Budesonide inhalation through a nebulizer

          The dose of the drug is selected individually. If the recommended dose does not exceed 1 mg / day, the entire dose of the drug can be taken at a time (at a time). In the case of a higher dose, it is recommended to divide it into 2 doses.

          Adult / elderly patients - 1-2 mg per day.

          Children from 6 months and older - 0.25-0.5 mg / day. If necessary, the dose can be increased to 1 mg / day.

          Dose for maintenance treatment:

          Adults - 0.5-4 mg per day. In case of severe exacerbations, the dose may be increased.

          Children from 6 months and older - 0.25-2 mg per day.

    • Proteolytic Enzymes
      • Trypsin crystal amp. 0.005g, 0.01g
      • Ribonuclease amp., vial. 10g
      • Deoxyribonuclease amp., vial. 10 g
    • Immunomodulators
    • Respiratory mucosal humidifiers
      • Mineral waters (Borjomi)
      • Sodium bicarbonate solution 0.5-2%

Allowance for patients. You can learn about what a nebulizer is, what diseases can be treated with it, how to perform inhalation correctly, how to choose a nebulizer and much more about the modern method of inhalation therapy from this article.

Nebulizer therapy is modern and safe.

In the treatment of respiratory diseases, the most effective and modern method is inhalation therapy. Inhalation of drugs through a nebulizer is one of the most reliable and simple methods of treatment. The use of nebulizers in the treatment of respiratory diseases is gaining increasing acceptance among physicians and patients.

In order for the medicine to more easily enter the respiratory tract, it should be converted into an aerosol. A nebulizer is a chamber in which nebulization takes place. medicinal solution to an aerosol and feeding it into the respiratory tract of the patient. Therapeutic aerosol is created due to certain forces. Such forces can be air flow (compressor nebulizers) or ultrasonic vibrations of the membrane (ultrasonic nebulizers).

The modern approach to the treatment of respiratory diseases involves the delivery of drugs directly to the respiratory tract through the widespread use of inhaled forms of drugs. The capabilities of the nebulizer have dramatically expanded the scope of inhalation therapy. Now it has become available to patients of all ages (from infancy to old age). It can be carried out during periods of exacerbations chronic diseases(primarily bronchial asthma), in situations where the patient has a significantly reduced inspiratory rate (children early age, postoperative patients, patients with severe somatic diseases) both at home and in the hospital.

Nebulizer therapy has advantages over other types of inhalation therapy:

• It can be used at any age, since the patient is not required to adjust his breathing to the operation of the device and at the same time perform any actions, for example, press the can, hold the inhaler, etc., which is especially important in young children.
• The absence of the need to perform a strong breath allows the use of nebulizer therapy in cases of a severe attack of bronchial asthma, as well as in elderly patients.
• Nebulizer therapy allows the use of drugs in effective doses in the absence of side effects.
• This therapy provides a continuous and rapid supply of medication with the help of a compressor.
• She is the most safe method inhalation therapy, since it does not use, unlike metered-dose aerosol inhalers, propellants (solvents or carrier gases).
• This is a modern and comfortable method of treating bronchopulmonary diseases in children and adults.

What diseases can be treated with a nebulizer?

The drug sprayed by the inhaler begins to act almost immediately, which allows the use of nebulizers, first of all, for the treatment of diseases requiring urgent intervention - asthma, allergies.

(First of all, nebulizers are used to treat diseases that require urgent intervention - asthma, allergies).

Another group of diseases in which inhalation is simply necessary is chronic inflammatory processes of the respiratory tract, such as chronic rhinitis, chronic bronchitis, bronchial asthma, chronic bronchial obstructive pulmonary disease, cystic fibrosis, etc.

But their scope is not limited to this. They are good for the treatment of acute respiratory diseases, laryngitis, rhinitis, pharyngitis, fungal infections of the upper respiratory tract, and the immune system.

Inhalers help with occupational diseases of singers, teachers, miners, chemists.

When do you need a nebulizer at home:

• In a family where a child is growing up, subject to frequent colds, bronchitis (including those occurring with broncho-obstructive syndrome), for the complex treatment of cough with sputum difficult to separate, treatment of stenosis.
• Families with patients with chronic or often recurrent bronchopulmonary diseases (bronchial asthma, chronic obstructive pulmonary disease, chronic bronchitis, cystic fibrosis).

What medicines can be used in a nebulizer.

For nebulizer therapy, there are special solutions of drugs that are available in vials or plastic containers - nebulas. The volume of the drug together with the solvent for one inhalation is 2-5 ml. The calculation of the required amount of medicine depends on the age of the patient. First, 2 ml of saline is poured into the nebulizer, then the required number of drops of the drug is added. Do not use distilled water as a solvent, as it can provoke bronchospasm, which will lead to coughing and difficulty breathing during the procedure. Pharmacy packaging with medicines is stored in the refrigerator (unless otherwise indicated) in a closed form. After the pharmacy package has been opened, the drug must be used within two weeks. It is advisable to write down the date of commencement of the use of the drug on the vial. Before use, the medicine must be warmed to room temperature.

For nebulizer therapy can be used:

1. mucolytics and mucoregulators (drugs for thinning sputum and improving expectoration): Ambrohexal, Lazolvan, Ambrobene, Fluimucil;
2. bronchodilators (drugs that dilate the bronchi): Berodual, Ventolin, Berotek, Salamol.
3. glucocorticoids ( hormonal preparations, which have a multilateral action, primarily anti-inflammatory and decongestant): Pulmicort (suspension for nebulizers);
4. cromones (antiallergic drugs, mast cell membrane stabilizers): Cromohexal Nebula;
5. antibiotics: Fluimucil antibiotic;
6. alkaline and saline solutions: 0.9% saline, mineral water"Borjomi"

Your doctor should prescribe the drug and tell you about the rules for its use. He must also monitor the effectiveness of treatment.

All solutions containing oils, suspensions and solutions containing suspended particles, including decoctions and infusions of herbs, as well as solutions of eufillin, papaverine, platifillin, diphenhydramine and the like, as they do not have application points on the mucous membrane of the respiratory tract.

What side effects are possible during nebulizer therapy?

With deep breathing, symptoms of hyperventilation (dizziness, nausea, cough) may appear. It is necessary to stop inhalation, breathe through the nose and calm down. After the symptoms of hyperventilation disappear, inhalation through the nebulizer can be continued.

During inhalation, as a reaction to the introduction of a spray solution, a cough may occur. In this case, it is also recommended to stop inhalation for a few minutes.

Inhalation technique using a nebulizer

• Before using the inhaler, you must (always) carefully
• wash your hands with soap; pathogenic microbes may be present on the skin.
• Assemble all parts of the nebulizer according to the instructions
• Pour the required amount of the medicinal substance into the nebulizer cup, preheating it to room temperature.
• Close the nebulizer and attach the face mask, mouthpiece or nasal cannula.
• Connect the nebulizer and compressor with a hose.
• Turn on the compressor and carry out inhalation for 7-10 minutes or until the solution is completely consumed.
• Turn off the compressor, disconnect the nebulizer and disassemble it.
• Rinse all parts of the nebulizer with hot water or a 15% baking soda solution. Brushes and brushes should not be used.
• Sterilize the disassembled nebulizer in a steam sterilization device, such as a thermodisinfector (steam sterilizer) designed to process baby bottles. Sterilization by boiling for at least 10 minutes is also possible. Disinfection should be carried out once a week.
• A thoroughly cleaned and dried nebulizer should be stored in a clean tissue or towel.

Basic rules for inhalation

• Inhalations are carried out no earlier than 1-1.5 hours after a meal or significant physical activity.
• During the course of inhalation treatment, doctors prohibit smoking. In exceptional cases, before and after inhalation, it is recommended to stop smoking for an hour.
• Inhalations should be taken in a calm state, without being distracted by reading and talking.
• Clothing should not constrain the neck and make it difficult to breathe.
• In case of diseases of the nasal passages, inhalation and exhalation must be done through the nose (nasal inhalation), breathe calmly, without tension.
• In case of diseases of the larynx, trachea, bronchi, lungs, it is recommended to inhale the aerosol through the mouth (oral inhalation), it is necessary to breathe deeply and evenly. After a deep inhalation through the mouth, hold the breath for 2 seconds, and then exhale completely through the nose; in this case, the aerosol oral cavity enters further into the pharynx, larynx and further into the deeper parts of the respiratory tract.
• Frequent deep breathing can cause dizziness, so it is necessary to periodically interrupt inhalation for a short time.
• Before the procedure, you do not need to take expectorants, rinse your mouth with antiseptic solutions (potassium permanganate, hydrogen peroxide, boric acid).
• After any inhalation, and especially after inhalation of a hormonal drug, it is necessary to rinse your mouth with boiled water at room temperature ( little child you can give food and drink), if using a mask, rinse your eyes and face with water.
• The duration of one inhalation should not exceed 7-10 minutes. The course of treatment with aerosol inhalations - from 6-8 to 15 procedures

What are the types of nebulizers?

Currently, there are three main types of inhalers used in medical practice: steam, ultrasonic and compressor.

The action of steam inhalers is based on the effect of evaporation of the medicinal substance. It is clear that only volatile solutions can be used in them ( essential oils). The biggest disadvantage of steam inhalers is the low concentration of the inhaled substance, usually less than the threshold therapeutic effect, as well as the inability to accurately dose the drug at home.

Ultrasonic and compressor united by the term "nebulizers" (from the Latin word "nebula" - fog, cloud), they do not generate vapors, but an aerosol cloud consisting of microparticles of an inhaled solution. The nebulizer allows you to enter into all respiratory organs (nose, bronchi, lungs) drugs in their pure form, without any impurities. The dispersion of aerosols produced by most nebulizers ranges from 0.5 to 10 microns. Particles with a diameter of 8-10 microns settle in the oral cavity and trachea, with a diameter of 5 to 8 microns - in the trachea and upper respiratory tract, from 3 to 5 microns - in the lower respiratory tract, from 1 to 3 microns - in bronchioles, from 0, 5 to 2 microns - in the alveoli. Particles smaller than 5 microns are called the "respirable fraction" and have the maximum therapeutic effect.

Ultrasonic nebulizers spray the solution with high-frequency (ultrasonic) vibrations of the membrane. They are compact, silent, do not require replacement of nebulization chambers. The percentage of aerosol that enters the respiratory mucosa exceeds 90%, and the average size of aerosol particles is 4-5 microns. Due to this, the required drug, in the form of an aerosol, reaches the small bronchi and bronchioles in high concentration.

The choice of ultrasonic nebulizers is more preferable in cases where the area of ​​influence of the drug is small bronchi, and the drug has the form saline solution. However, a number of drugs, such as antibiotics, hormonal drugs, mucolytic (thinning sputum), can be destroyed by ultrasound. These drugs are not recommended for use in ultrasonic nebulizers.

Compressor nebulizers form an aerosol cloud by forcing through a narrow opening in a chamber containing a treatment solution, a powerful stream of air pumped by a compressor. The principle of using compressed air in compressor nebulizers is the "gold standard" of inhalation therapy. The main advantage of compressor nebulizers is their versatility and relative cheapness, they are more affordable and can spray almost any solution intended for inhalation.

Compressor nebulizers have several types of chambers:

• convection chambers with constant aerosol output;
• breath-activated chambers;
• breath activated chambers with flow interrupter valve.

When inhaling drugs through a nebulizer, it is necessary to take into account some features:

• the optimal filling volume of the nebulizer chamber is at least 5 ml;
• to reduce the loss of the drug at the end of inhalation, 1 ml of saline can be added to the chamber, after which, shaking the nebulizer chamber, continue inhalation;
• when using inexpensive and accessible drugs, all types of nebulizers can be used, but when using more expensive drugs, nebulizers that are activated by the patient's inspiration and equipped with a valve flow interrupter in the expiratory phase provide the most effective inhalation therapy. These devices are especially effective in the treatment of broncho-pulmonary diseases.

How to choose a nebulizer?

During treatment with a nebulizer, the drug is delivered to the respiratory tract. It is this treatment that is intended for those whose disease has affected the respiratory tract (rhinitis, laryngitis, tracheitis, bronchitis, bronchial asthma, chronic obstructive pulmonary disease, etc.). In addition, sometimes the respiratory mucosa is used to administer drugs to the human body. The surface of the bronchial tree is very large, and many drugs, such as insulin, are actively absorbed through it.

The choice of inhaler depends on the disease you are going to treat and on your financial capabilities.

In Russia, manufacturers of nebulizers from Germany, Japan, and Italy represent their products on the medical equipment market. Unfortunately, there are no domestic manufacturers of compressor nebulizers yet. Detailed information about the technical characteristics of certain types of nebulizers can be obtained from Russian companies selling them. When choosing a nebulizer, the requirements for atomizer and compressor are taken into account. For a compressor, size, weight, noise during operation, ease of use are important. In all these parameters, they differ slightly. But it should be noted that PARI GmbH (Germany) nebulizers are distinguished by traditionally high German quality, exceptional efficiency and long service life. They provide maximum deposition of medicines in the respiratory tract due to the optimal dispersion of the aerosol.

Perhaps the main attention should be paid to the type of atomizer . A nebulizer equipped with a direct-flow nebulizer makes sense for younger children, as they do not have enough inspiratory force to activate the valves (and thus save medicine). For inhalation for children under 3 years old, it is advisable to use a children's mask. Adults can also use this type of atomizer, because. it is originally equipped with a mouthpiece.

Inspiratory-actuated breath-controlled nebulizers have inspiratory and expiratory valves that alternately activate during the act of breathing. When they are used on exhalation, less aerosol is formed, there is a significant savings in the drug.

There are also nebulizers that have a nebulizer equipped with a tee tube (aerosol flow interrupter), which allows you to control the formation of aerosol only on inspiration by blocking the side opening of the tee.

Used with atomizer different kinds nozzles: mouthpieces, nasal cannulas (tubes), masks of adult and children's sizes.

• Mouthpieces (adults and children) are optimal for delivering drugs deep into the lungs, used for inhalation by adult patients, as well as children from 5 years old.
• Masks are convenient for the treatment of the upper respiratory tract and allow you to irrigate all parts of the nasal cavity, pharynx, as well as the larynx and trachea. When using a mask, most of the aerosols settle in the upper respiratory tract. Masks are needed when using nebulizer therapy in children under 3 years of age, since it is impossible to carry out inhalation in such patients through a mouthpiece - children breathe mainly through the nose (this is due to the anatomy of the child's body). An appropriately sized mask must be used. The use of a tight-fitting mask reduces aerosol loss in young children. If the child is older than 5 years, it is better to use a mouthpiece than a mask.
• Nasal cannulas (tubes) are needed to deliver a medicinal aerosol into the nasal cavity. They can be used in complex treatment sharp and chronic rhinitis and rhinosinusitis

Buying a nebulizer for yourself and your loved ones is the right and reasonable decision. You have acquired a reliable assistant and friend

Article author:

AT modern medicine, for the treatment of respiratory diseases, inhalation therapy began to be used more widely. This has become possible due to the introduction of inhalers, which can spray medicines into small particles.
These inhalers are called - nebulizers(from the Latin word "nebula" - fog).

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

As a result, there are many opportunities for treatment.
With the help of nebulizer therapy, you can relieve spasm of the muscles of the bronchi, achieve mucolytic, anti-inflammatory, antibacterial effects.

more—>Most commonly nebulized 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 achieve the maximum therapeutic effect of drugs in the respiratory tract with minimal side effects.

Now briefly about the nebulizers themselves.

Nebulizers come in 3 types:

• Compressor. The aerosol is sprayed using a stream of compressed air or oxygen through a nebulizer chamber. A particle size of up to 5 µm is formed. This is considered the most optimal for the penetration of particles into the furthest parts of the respiratory tract.
• Ultrasonic. Spraying occurs due to the action of high-frequency vibration of the piezoelectric crystals of the device.
• Mesh nebulizers(membrane inhalers or electronic mesh). They use vibrating mesh technology. The bottom line is to sift the liquid through a membrane with very small holes and mix the resulting particles with air.

Each of these types of devices has its pros and cons.

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

Ultrasonic nebulizers do not make noise, make aerosol particles homogeneous, supply large volumes of medicines. 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.

Conducting nebulizer therapy has a number of advantages.

Benefits of nebulizer therapy:

• Delivery of the drug directly to the lesion (up to the lower respiratory tract), in connection with which a quick therapeutic effect can be achieved.
• There is no risk of burning the mucous membranes of the respiratory tract (unlike 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.
• You can carry out inhalation in patients who are in serious condition.
• The respiratory tract is not irritated by solvents and carrier gases (as is the case when using metered-dose aerosol inhalers).
• You can clearly dose and use high doses of drugs.

Nebulizer therapy solves the following problems:

• Reduces the effects of bronchospasm.
• Improves the drainage function of the respiratory tract.
• Reduces swelling of the mucous membrane.
• Conducts sanitation of the bronchial tree.
• Reduces activity inflammatory process.
• Delivers drugs to the alveoli.
• Influences local immune reactions.
• Protects the mucous membrane from the action of allergens
• Improves microcirculation.

What medicines can be used in a nebulizer?

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

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

1. Mucolytics: lazolvan, ambrohexal, fluimucil, ambrobene.
2. Bronchodilators: ventolin, berodual, berotek, salamol.
3. Glucocorticoids: pulmicort, flixotite.
4. Cromons(stabilize mast cell membranes): cromohexal.
5. Antibiotics: fluimucil with antibiotic, gentamicin 4%, tobramycin.
6. Antiseptics: dioxidine 0.25% solution (0.5% dioxidine diluted in half with saline solution 0.9%), furacillin 0.02%, decasan.
7. Salt and alkaline solutions: 0.9% sodium chloride, mineral water "Borjomi", "Luzhanskaya", "Narzan", "Polyana kvasova".
8. Also can be applied: magnesium sulfate 25% (1 ml of the drug diluted with 2 ml of saline), rotocam (2.5 ml diluted in 100 ml of saline, apply 2-4 ml 3 times a day), leukocyte interferon, laferon,
   lidocaine 2%, antifungals 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 3 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 10 drops per 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, 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) nebules 0.5 and 2 mg, 2 ml. Adults and adolescents over 16 years of age: 0.5-2 mg twice daily 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 funds can not be used for inhalation through a nebulizer.

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

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

Contraindications for the use of nebulizer therapy:

• Pneumothorax;
• Pulmonary bleeding;
• heart failure;
• cardiac arrhythmia;
• Intolerance to medicines used for inhalation.

For inhalation you need to know:

• The recommended course of treatment with inhalations 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 with hormonal drugs, it is necessary to rinse the mouth with boiled water (the child can be given food or drink).
• Periodically it is necessary to interrupt 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 respiratory organs.
Previously, this therapy was possible only in a hospital, now a nebulizer can be bought at any pharmacy for outpatient treatment. A nebulizer must 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 also purchase an ultrasonic nebulizer.

NEBULIZER THERAPY

ACUTE AND CHRONIC

RESPIRATORY DISEASES

Moscow 2006 Valentina Petrovna Dubinina - Candidate of Medical Sciences, Head of the Phthisiopulmonological Cabinet of the Central Clinical Hospital of the Russian Academy of Medical Sciences, Corresponding Member of the Russian Ecological Academy, Pulmonologist, Phthisiologist of the highest category.

Reviewer - Doctor of Medicine, Head of the Department of Anesthesia, Resuscitation and Intensive Care of the Central Research Institute of Tuberculosis of the Russian Academy of Medical Sciences - Yuri Nikolayevich Zhilin.

FOREWORD

With the improvement of inhalation equipment, the possibilities and indications for nebulizer therapy are expanding as a method of delivering drugs directly to the target organ - the lungs, upper and lower respiratory tract.

Nebulizer aerosol therapy is the most reliable and fast way delivery of medicinal substances to the lungs, alveoli and pulmonary circulation in comparison with the enteral or parenteral route, when drugs, passing through the stomach, intestines, liver, vascular circulation, reaching the lung tissue, lose their activity and concentration.

Aerosol therapy with the use of nebulizer inhalers is increasingly used in outpatient, outpatient practice, at home. Confirmation is Guidelines developed by a phthisiopulmonologist of the highest category, candidate of medical sciences Valentina Petrovna Dubynina, who has many years of experience in the use of nebulizer therapy for acute respiratory infections, exacerbations of bronchial asthma and chronic obstructive pulmonary disease.

INTRODUCTION

Acute infections of the upper respiratory tract are the most common diseases in outpatient practice, which are encountered not only by otorhinolaryngologists, but also by general practitioners, pediatricians, pulmonologists and other specialists. Patients call this disease a cold.

A significant proportion of acute upper respiratory tract infections are caused by influenza viruses, type 4 parainfluenza, rhinoviruses, enteroviruses, respiratory syncytial virus, coronavirus, adenovirus, and herpes simplex virus.

Viruses are one of the causes of exacerbation of bronchial asthma and chronic obstructive pulmonary disease. Over the past 20 years, the incidence of respiratory infections has increased many times over. According to V.F. Uchaikin, influenza and ORD in our country rank first in overall structure infectious diseases of the respiratory tract in children and adults and account for 85-88% (Fig. 1).

infectious diseases of the respiratory tract.

Uchaikin V.F. Abstracts of the report " Modern technologies in pediatrics and pediatric surgery "-M., 19-20, XI, 2002

But not only viruses cause inflammation of the upper respiratory tract (rhinitis, sinusitis, tonsillitis, otitis media), pathogens can be bacteria, fungi, intracellular pathogens and their associations.

As a result of a violation of the body's defenses, the inflammatory process from the upper respiratory tract can descend into the lower respiratory tract and cause an exacerbation of chronic diseases of the bronchopulmonary system.

Therefore, the main tasks of the doctor are the effective treatment of acute URT (upper respiratory tract) infections, the prevention of their complications and the prevention of exacerbation of chronic processes in outpatient and outpatient practice.

Modern complex methods for the treatment of inflammatory diseases in otorhinolaryngology include various combinations of medications and methods of influencing the primary focus.

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Indications: prevention and relief of asthma attacks, treatment of chronic obstructive pulmonary disease.

Dosage: the drug can be used depending on the severity and severity of broncho-obstructive syndrome and is usually used undiluted at a dose of 0.5 mg/kg of body weight, but not more than 5 mg per day.

It should be warned against large doses of ventolin and avoid contact with the solution in the eyes.

Berotek - a bronchodilator, 0.1% solution in 20 ml vials, contains 1 mg of fenoterol hydrobromide in 1 ml, 20 drops in 1 ml.

Indications: exacerbation of bronchial asthma, prevention of physical effort asthma, basic therapy of moderate and severe asthma, treatment of severe exacerbations of chronic obstructive pulmonary disease.

Dosage: in the treatment of exacerbations of bronchial asthma, adults are prescribed 1 - 2 ml 4-5 times a day ("as needed" until the relief of bronchospasm); children under 6 years old - 5-10 drops up to 3 times a day, and children over 6 years old - 10-20 drops 3 times a day. For the prevention of physical effort asthma, adults and children aged 6-14 years are prescribed 0.5 ml (10 drops) for each dose up to 4 times a day; for basic therapy of moderate and severe bronchial asthma, 0.5 - 1 ml with 3 - 4 ml of saline 4 times a day through a nebulizer.

In chronic obstructive pulmonary disease in the acute phase, 0.5 - 1.5 ml for each inhalation 4-5 times a day.

With an overdose of the drug, side effects may occur:

nervous excitement, palpitations, tachycardia, tremor, cough. It is believed that it is better to use berotek on demand than to take constantly. It is possible to combine Berotek with anticholinergics and mucolytics in one inhalation.

Anticholinergic drugs Atrovent ("Boehringer Ingelheim" Austria - anticholinergic, 0.025% solution in 20 ml vials, contains 0.25 mg of ipratropium bromide in 1 ml, 20 drops of solution in 1 ml).

Indications: prevention and treatment of reversible airway obstruction in bronchial asthma and chronic obstructive pulmonary disease. Effective in children and elderly patients when other bronchodilators are undesirable.

Dosage: for outpatient basic therapy for adults, 1-2 ml up to 4 times a day (both alone and in combination with beta-agonists).

It is diluted with saline to 3-4 ml in a nebulizer.

For children under 1 year, 10 drops 3-4 times a day.

Atrovent is the drug of first choice for nebulizer therapy of exacerbations and long-term basic (basic) therapy for COPD.

In COPD, in most cases, atrovent is superior in its bronchodilatory effect to beta-agonists, but inferior to them in bronchial asthma. Non-addictive with long-term use, effective in children and elderly patients when other bronchodilators are undesirable. Safe even at high doses. It has no systemic side effects due to low absorption through the mucous membrane. Therefore, atrovent is preferred over beta-agonists, especially in elderly patients with concomitant cardiovascular disorders. However, the use of Atrovent is undesirable in glaucoma, arterial hypertension, significant tachycardia and tachyarrhythmia, intestinal atony.

Berodual ("Boehringer Ingelheim" Austria - a combined preparation containing the m-anticholinergic ipratropium bromide (350 μg) and the agonist fenoterol hydrobromide (500 μg), in 20 ml vials (1 ml - 20 drops)).

Indications: prevention and treatment of chronic obstructive airway diseases with reversible bronchospasm: bronchial asthma, chronic bronchitis, complicated or uncomplicated by emphysema.

Dosage: in the treatment of exacerbations in adults, as well as the elderly and adolescents, 1-2 ml of the solution is prescribed, in severe and acute cases of bronchospasm, the dose of berodual can be increased to 2.5-4 ml. With long-term and intermittent therapy, 1-2 ml per dose is prescribed up to 4 times a day. For children aged 6-12 years in the treatment of asthma attacks, the recommended dose is 0.5-1 ml, but in severe attacks it can be increased to 2-3 ml, and if multiple inhalations are necessary with prolonged or continuous therapy, it can be reduced to 0.5 -1 ml per reception up to 4 times a day. For children under 6 years of age and weighing up to 22 kg, berodual is inhaled through a nebulizer at the rate of 1 drop per 1 kg of the child's body weight. The recommended doses of berodual are diluted with saline to a total volume of 3-4 ml and inhaled for 5-7 minutes. The solution is diluted immediately before use, the remaining solution is poured out and the nebulizer is washed.

Avoid getting the drug into the eyes, especially in patients predisposed to glaucoma, so berodual aerosol therapy should be carried out through a nebulizer with a mouthpiece.

AFTERWORD

The author and a group of patients thank the head of the company Inter-Eton LLC and the entire team of employees for the contribution that the company makes to solving serious urgent health problems in the prevention and treatment of patients with various bronchopulmonary pathologies. Inter-Eton is not just a distributor of nebulizers. His main merit is that he implements a large medical program for the education and training of doctors, nurses, patients in the methods of nebulizer therapy through the medical manuals published by the company and medical recommendations written by leading specialists of various specializations - allergists, otorhinolaryngologists, phytotherapists, anesthesiologists - resuscitators.

According to WHO, every third inhabitant of the planet suffers from acute respiratory infections 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. Respiratory diseases (RDD) are the most common pathology childhood, which can be explained by several main reasons: the intensity of the immunity of an actively growing organism, anatomical and physiological features respiratory system and its high susceptibility to microbial penetration. The mucous membrane of the respiratory tract constantly experiences the negative effects 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 the treatment of ZOD in children is not only right choice medication and dosing regimen, but also the way the drug is delivered to the lungs.
To date, inhalation methods of drug delivery are recognized as the most optimal for the treatment of children with AOD in the world, which is very logical, since when they are used, the drug enters directly into the respiratory tract. Aerosols are used to deliver bronchodilators, mucolytics, antiviral drugs, inhaled glucocorticosteroids, antibiotics and other drugs into the bronchi.
Inhalation therapy has been known since ancient times in China, Egypt, India: its first description is given in the texts of Ayurveda more than 4000 years ago. In the writings of Hippocrates and Galen, one can find references to inhalations with fragrant smoke of various plants. Aerosols (from the Greek aero - air and lat. 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 more often used, which are obtained by creating dispersion mixtures with a liquid or solid phase.
International programs define the following key success factors for inhalation therapy:

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

Benefits of nebulizer therapy:

Basic principles of treatment of infectious complications of ENT organs using nebulizer therapy

sinusitis.
These include inflammatory processes in the paranasal sinuses (maxillary, frontal, ethmoidal, main), which develop when the function of the osteomeatal complex is impaired. Treatment is usually conservative. Broad-spectrum antibiotics, vasoconstrictive nasal drops, drugs that improve mucociliary clearance through inhalation therapy (0.9% NaCl, 2% Na bicarbonate, rinofluimucil, lazolvan, phytocollections) are prescribed. Recently, topical corticosteroids (flixonase, nasonex) have been 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, isophra, etc.), an antibiotic is widely used local action bioparox. 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, dioxidine, 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 herbal remedies (Rotokan 1:50, Elekasol), irrigation with warm alkaline solutions 4-6 times a day for several days . Widely used local antiseptics of the oral cavity and pharynx (antiangin, septolete, decatilene, ingalipt, etc.).

Laryngitis.
With the development of an acute inflammatory process in the larynx, a sparing voice regimen is required for 5–7 days, warm drinks, nebulizer inhalations (with mucolytics, 0.9% NaCl, 2% Na bicarbonate, hydrocortisone suspension, oils of eucalyptus, fir, herbal teas (calendula, chamomile, coltsfoot, thyme, etc.)). Local antibiotic therapy with bioparox, physiotherapy on the larynx area (ultrasound, magnetotherapy, phonophoresis of drugs), and distraction therapy are also used. In severe cases, broad-spectrum antibiotics are prescribed.

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

With the therapeutic purpose with the help of a nebulizer, it is possible to use various groups of drugs. These are the following tools:
thinning nasal secretion;
mucolytics;
M-anticholinergics, contributing to the reduction of increased secretion production;
cromones;
anti-inflammatory drugs;
antibacterial agents.

Nasal thinners

There are 4 main areas of application of NT in pediatrics:

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

The experience of using nebulizers in children with broncho-obstructive diseases indicates the high efficiency of this method of drug delivery. Thus, when evaluating inhalation therapy in children of different age groups, it was noted that the use of a nebulizer rather quickly contributed to improving well-being, reducing, and in some patients even stopping, the effects of bronchial obstruction. The use of a nebulizer made it possible in most cases to refuse infusion therapy. The use of a nebulizer leads to more pronounced bronchodilation mainly at the level of small bronchi compared to the use of metered-dose inhalers, which is reliably confirmed by the dynamics of function indicators external respiration. At the same time, NT is a safe and convenient means of drug delivery, especially in young children.
Thus, nebulizer therapy currently occupies a major place in the treatment of respiratory diseases in children and adults. This is due to the optimal possibility of delivery necessary drugs directly into the respiratory tract, which has a higher therapeutic effect, contributes to the early relief of symptoms and a decrease in the severity of the course of diseases. Improvement of nebulizer therapy and its implementation in the daily work of inpatient and outpatient facilities, 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.