MODERN ASPECTS OF NEBULIZER THERAPY
https://doi.org/10.57256/2949-0715-2023-1-50-59
Abstract
Nebulizer therapy is widely used in modern respiratory medicine. Nebulizers are devices that convert a liquid into a suitable for inhalation by a patient aerosol, which meets the requirements of the European standard for nebulizer therapy prEN 13544-1. The fundamental differences between nebulizers and other inhalation devices (metered aerosol inhalers, powder inhalers) are the possibility to perform maneuvers on spontaneous breathing, the use of drugs, which do not involve the use of other inhalers, and the possibility to select drug doses depending on patients need.
Although this delivery method is effective for many respiratory diseases, and it is preferred for special groups (children, the elderly, as well as severe exacerbations, etc.), there are some peculiarities and limitations of its use, which should be taken into account by clinicians. According to the principle of operation, nebulizers are divided into compressor, ultrasonic and electronic-mesh, which differ in technical characteristics and indications for use. Compressor nebulizers are most widely used in medical institutions (intensive care units, hospitals, offices) and at home, relatively inexpensive, simple and easy to maintain, have additional components (chambers with inhalation-exhalation valves, masks for children and children) adults, nasal aspirator, etc.). Modern jet nebulizers are equipped with spray mode switches, so that the aerosol feed rate and the aerodynamic diameter of particles of an average mass from 2-3 to 10 microns can be adjusted. Depending on the selection of the switch mode and the corresponding medication, the nebulizer can be used in the treatment of rhinitis, laryngitis, bronchitis, asthma and other diseases of both upper and lower respiratory tract.
About the Author
Svetlana N. Buynova
ГБОУ ДПО ИГМАПО
Russian Federation
Russian Federation
Cand.Med.Sci., associated professor Department of Clinical Allergology and Pulmonology, Irkutsk State Medical Academy of Postgraduate Education – Branch of Russian Medical Academy of Continuing Professional Education
References
1. Geddes D. The history of respiratory disease management. Medicine (Abingdon). 2016 Jun; 44(6): 393–397. doi: 10.1016/j.mpmed.2016.03.006
2. Sanders M. Inhalation therapy: an historical review. Primary Care Respiratory Journal (2007) 16(2): 71-81. doi.org/10.3132/pcrj.2007.00017
3. Stein SW, Thiel CG. The History of Therapeutic Aerosols: A Chronological Review. J Aerosol Med Pulm Drug Deliv. 2017 Feb 1; 30(1): 20–41. doi: 10.1089/jamp.2016.1297
4. Clark AR. Medical Aerosol Inhalers: Past, Present, and Future. Aerosol Science and Technology, 1995, 22:4, 374-391. doi.org/10.1080/02786829408959755
5. Nikander K, Sanders M. The early evolution of nebulizers. Medicamundi. 2010;54:47–53. doi:10.1089/jamp.2016.1297
6. Boe J, Dennis JH, O'Driscoll BR et al. European Respiratory Society Guidelines on the use of nebulizers. European Respiratory Journal 2001 18: 228-242. DOI: 10.1183/09031936.01.00220001
7. Faarc DR. Nebulizers: principles and performance. Respir. Care, 45 (June (6)) (2000), p. 609
8. https://c.aarc.org/marketplace/reference_articles/06.00.0609.pdf
9. Gardenhire DS, Burnett D, Strickland Sh, Myers TR. A Guide to Aerosol Delivery Devices for Respiratory Therapists, 4th Edition American Association for Respiratory Care. 2017. [access 10.09.20] URL: https://www.aarc.org/wp-content/uploads/2015/04/aerosol_guide_rt.pdf
10. Braido F, Chrystyn H, Baiardini I et al. Respiratory Effectiveness Group. “Trying, but failing” – the role of inhaler technique and mode of delivery in respiratory medication adherence. J Allergy Clin Immunol Pract. 2016;4(5):823–832. DOI: 10.1016/j.jaip.2016.03.002
11. Chandel A, Goyalb AK, Ghoshc G, Ratha G. Recent advances in aerosolised drug delivery. Biomedicine & Pharmacotherapy. 2019. V. 112. DOI: 10.1016/j.biopha.2019.108601
12. McGrath JA, O’Sullivan A, Bennett G, et al. Investigation of the Quantity of Exhaled Aerosols Released into the Environment during Nebulisation Pharmaceutics. 2019 Feb; 11(2): 75. DOI: 10.3390/pharmaceutics11020075
13. Hatley RHM, Byrne SM. Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information? Med Devices (Auckl). 2017; 10: 17–28. DOI: 10.2147/MDER.S125104
14. Posa D, Pizzulli AO, Wagner P et al. Efficacy and usability of a novel nebulizer targeting both upper and lower airways. Ital J Pediatr. 2017; 43: 89. DOI: 10.1186/s13052-017-0400-x
15. Skaria Sh , Smaldone GC. Omron NE U22: Comparison between vibrating mesh and jet . J Aerosol Med Pulm Drug Deliv 2010 Jun;23(3):173-80. DOI: 10.1089/jamp.2010.0817
16. Osipov LV, Zhilin YuN, Avdeev SN, Mizernitskiy YuL. The use of ultrasonic and compressor inhalers (nebulizers) for the treatment of diseases of the respiratory tract and lungs / ed. L.V. Osipov Moscow: 2014.132 s, ill.
17. Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir. Care, 50 (October (10)) (2005), pp. 1313-1322. URl: http://rc.rcjournal.com/content/50/10/1313/tab-pdf
18. Dolovich MB, Ahrens RC, Hess DR et al. Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines. CHEST 2005; 127:335–371 DOI: 10.1378/chest.127.1.335
19. Everard ML. Inhalation therapy for infants. Adv. Drug Deliv. Rev., 55 (July (7)) (2003), pp. 869-878. DOI: 10.1016/s0169-409x(03)00082-6
20. Sturm R. Bioaerosols in the lungs of subjects with different ages-part 1: deposition modeling. Ann Transl Med. 2016 Jun; 4(11): 211. DOI: 10.21037/atm.2016.05.62
21. Laube BL, Janssens HM, de Jongh FH et al. What the pulmonary specialist should know about the new inhalation therapies. Eur. Respir. J. 2011; 37 (6): 1308–1331. DOI: 10.1183/09031936.00166410
22. Modern inhalation devices for the treatment of respiratory pathology: report of the working group of the European Respiratory Society and the International Society for the Use of Aerosols in Medicine. Pulmonology. 2011; (6): 17-41.
23. Chuchalin AG, Knyazheskaya NP, Potapova MO. The place of nebulizer therapy in the inhalation therapy of chronic obstructive pulmonary diseases. - Russian medical journal. - 2006.- T. 14, No. 7. - S. 521-524.
24. Geppe NA, Mokina NA. Modern inhalation therapy: a practical guide for doctors. - 2nd ed., Rev. and add. Moscow: GEOTAR-Media, 2016.122 p.
25. Barta SK, Crawford A, Roberts CM. Survey of patients' views of domiciliary nebulizer treatment for chronic lung disease. Respir Med 2002;96(6):375–381 DOI: 10.1053/rmed.2001.1292
26. Smaldone GC, Cruz-Rivera M, Nikander K. In vitro determination of inhaled mass and particle distribution for budesonide nebulizing suspension. J Aerosol Med 1998;11:113–125. doi.org/10.1089/jam.1998.11.113
27. O'Doherty MJ, Miller RF. Aerosols for therapy and diagnosis. Eur J Nucl Med. 1993 Dec;20(12):1201-13. DOI: 10.1007/BF00171019
28. Kamin W, Schwabe A, Krämer I. Inhalation solutions: which one are allowed to be mixed? Physico-chemical compatibility of drug solutions in nebulizers-update 2013. J Cyst Fibros. 2014 May;13(3):243-50. DOI: 10.1016/j.jcf.2013.09.006
29. Melani AS. Effects on aerosol performance of mixing of either budesonide or beclomethasone dipropionate with albuterol and ipratropium bromide. Respir Care. 2011 Mar;56(3):319-26. DOI: 10.4187/respcare.00955
30. Axelsson I, Naumburg E, Prietsch S Om, Zhang L. Inhaled corticosteroids in children with persistent asthma: effects of different drugs and delivery devices on growth. Cochrane Database Syst Rev. 2019 Jun 10;6(6):CD010126. DOI: 10.1002/14651858.CD010126.pub2
31. Sukumaran TU, Pawankar R, Ouseph J. Asthma diagnosis and treatment –1009. A clinical study of NE-C900 (Omron) nebulizer. World Allergy Organization Journal 2013, 6(Suppl1):P9. DOI: 10.1186/1939-4551-6-S1-P9
32. Rogliani P, Calzetta L, Coppola A, Cavalli F, Ora J, Puxeddu E, Matera MG, Cazzola M. Optimizing drug delivery in COPD: The role of inhaler devices. Respir Med. 2017 Mar;124:6-14. doi: 10.1016/j.rmed.2017.01.006.
33. Roggeri A, Micheletto C, Roggeri DP . Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues. Int J Chron Obstruct Pulmon Dis. 2016; 11: 597–602. DOI: 10.2147/COPD.S103335
34. Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Therapeutics and Clinical Risk Management 2019:15 461–472 DOI: 10.2147/TCRM.S160365
Supplementary files
Review
For citations:
Buynova S.N. MODERN ASPECTS OF NEBULIZER THERAPY. Baikal Medical Journal. 2023;2(1):50-59. (In Russ.) https://doi.org/10.57256/2949-0715-2023-1-50-59
Views:
2129
