Nebulizer therapy in the practice of the therapist

List of abbreviations

AB - antibiotic (antibiotic-)

Ba - bronchial asthma.

Kgf - glucocorticosteroids

Dai - dosage aerosol inhaler.

IVL - artificial lung ventilation.

IGCC - Inhalation glucocorticosteroids

Oak - general analysis blood

About - acute bronchitis

OFV 1 - the amount of forced exit for 1 s.

PSV - peak speed of exhalation.

FBS - Fibrobronchoscopy

COPD - chronic obstructive pulmonary disease.

Introduction What is nebulizer?

The term nebulizer, nebulizer therapy literally broke into Russian-speaking medical literature and lexicon doctors relatively recently - in the first years of this century. So what is this - a new direction in medicine with modern technologies, change the terminology or summarizing the experience of the past with the development of specific recommendations?

With the term "inhalation therapy" with each doctor since the student bench. The task of the inhalation method of delivery to everyone is also well known and understandable - create the highest therapeutic concentration of the drug in respiratory tract With minimal concentration in general blood flow, and accordingly, without exposing it to active metabolism and inactivation.

Most doctors remember physics or inhaled in hospitals and sanatoriums equipped with noisy steam inhaleators with compressors. However, a set of therapeutic drugs that can be used in such inhalers, is small due to high temperatures The solution, in addition, the magnitude of the particles of such an aerosol did not allow to talk about their delivery to small and even medium bronets. Subsequently appeared silent ultrasound inhalerators With a high degree of dispersion, however, they are not capable of spraying suspensions and a piezoelectric element leads to a significant heating of the solution, which, together with the effects of ultrasound, inactivates a number of drugs. In addition, for more than 30 years, dosage "pocket" is actively used and improved inhalers.Modern compressor inhalerators It was widely used relatively recently - in the last decade of the last century, and it is with their appearance that the actively use of the term nebulizer, nebulizer therapy is connected. At the same years, pathogenesis bronchial asthma, A new generation of steroid anti-inflammatory drugs (inhalation glucocorticosteroids) appears, the production of bronchophyolic preparations for a stationary inhaler is being established. It is the term nebulizer therapy (instead inhalation) Allows you to emphasize the delivery of the medicinal substance not through a metered or steam inhaler.

In the future, in this methodological manual, only compressor inhalers will be considered as a nebulizer.

If we talk generally, the nebulizer is a device consisting of:

· Compressor, which under pressure supplies air;

· The aerosol chamber (nebulizer chambers) connected to the compressor through the tube in which the aerosol formation occurs;

· Replaceable mouthpiece, masks or nasal cannula.

In this manual, the structure and physical principles of operation of nebulizers will not be considered in detail. They are described in detail in other literary sources. The purpose of the manual is to answer the most frequently asked practical doctors and their patients questions, concretize the use of nebulizer therapy with various diseases Breath organs, dispel, alas, some misconceptions.

What are the main types of nebulizers?

The following types of nebulizers exist:

· River (the formation of aerosol occurs constantly both in the breath and in exhalation); There are two types:
1) An ordinary nebulizer operating in constant mode. Its main disadvantage is that the generation of aerosol occurs in the phase of the inhalation and the exhalation of the patient, as a result of which a significant part of the aerosol (55-70%) is lost and enters the atmosphere and to medical personnel. Only a small (≈7%) part falls into the lungs of the patient. Relatively high working gas flows (more than 6 l / min) are required;
2) Nebulizer generating an aerosol constantly and manageable manually. It is characterized by the fact that the patient's exhalation phase has the ability to independently stop entering the aerosol, reducing its loss into the atmosphere. It can be used in patients distinguished by high discipline.

· Respirable breathing activated by inhale (Veenturi nebulizers). Work in variable mode. Also produce aerosols constantly during the entire respiratory cycle, but the release of the aerosol is enhanced during the inhalation due to the opening of the special valve (valve) located at the top of the chamber. Outdoor air is additionally enabled to the area of \u200b\u200baerosol products, which leads to an increase in total flow and, thus, to an increase in the formation of an aerosol. During the exhalation, the valve closes and the exhalation of the patient passes only in one direction, bypassing the area of \u200b\u200bthe aerosol product, through the valve next to the mouthpiece, which leads to a decrease in the flow through the chamber. This significantly reduces the loss of the drug (up to 30%), increases the dose of the inhaled aerosol. Environmental pollution, nebulization time decreases. Nebulizers of this type do not require a powerful compressor (a stream of 4-6 l / min). Their disadvantages include the dependence on the patient's inspiratory flow and the slow speed of the aerosol product when using viscous solutions.

· Synchronized with breathing, dosimetric. Electronics are controlled and adjusted to the respiratory rhythm of the patient. They generate an aerosol strictly to the inhalation phase thanks to the special valve, the operation of which controls the electronic sensor. Theoretically, the ratio of the exit of the aerosol during the inhalation and exhalation should be 100: 1. Their main drawbacks are a large duration of one inhalation and the high cost of the device.

How to choose a nebulizer?

1. If a question arises about the acquisition of a nebulizer for a medical institution, then it is necessary to purchase at least two types - direct-flow (allows you to use in children and patients with a reduced inspiratory volume due to pronounced obstruction) and inhalation activated by breath (or synchronized) - when used in exhalation Less aerosol is formed and significant drug savings occurs accordingly.

2. The choice of nebulizer for use at home is determined by the clinical situation that must be previously discussed with the doctor. For patients, with various chronic respiratory facilities using expensive drugs, it is better to choose nebulizers with an alternating aerosol delivery mode.

3. It is necessary to take into account the completeness of the nebulizer: mouthpiece, nasal cannulas and masks of different sizes.

· Mouthpieces (adults and children) are optimal for the supply of drugs deep into the lungs, used in inhalations by adult patients, as well as children from 5 years.

· Masks are convenient for the treatment of upper respiratory tract and allow you to irrigate all the departments of the nasal cavity, pharynx, as well as the lag and the trachea. When using a mask, most aerosols settles in the upper respiratory tract. Masks are needed when using nebulizer therapy in children under 3 years old, as it is impossible to carry out inhalations in such patients through the mouthpiece - the children breathe mainly through the nose (this is due to anatomy children's body). It is necessary to use the appropriate mask. Using a tightly adjacent mask reduces aerosol loss in young children. If a child over 5 years old, it is better to use the mouthpiece than a mask.

· Nasal cannulas (tubes) are needed to deliver a drug aerosol into the nasal cavity. They can be used in complex treatment acute and chronic rhinitis and rhinosinusitis

4. You should pay attention to the average particle size of the aerosol (less than 5 μm), as well as the flow rate of the working gas (at least 4 l / min).

6. When choosing a nebulizer brand, it is important to ask if additional ("spare") cameras include whether they can be purchased separately.

7. If it is supposed to use a nebulizer away from power supplies matter portability with autonomous power supply. In some cases, the noise level is important during the compressor.

Below are approximate treatment schemes of various pulmonary pathology, which can and should be adjusted by the attending physician, depending on the specific clinical situation. It must be remembered that all the following drugs have their own contraindications for the appointment and side effectswhich are set out in the relevant reference books or manuals and in these recommendations are not given.

· Like all medicinal productsPreparations for administration through the nebulizer must be appointed by the attending physician in strictly recommended doses.

· Trial nebulization should take place in the hospital or in an outpatient basis under the control of the doctor.

· Dose medicinal preparationprescribed during nebulization, higher than when inhalations using dosage inhalers.

· The patient must be warned about the danger of using high doses, and if the brightness response to the usual doses of nebulized solutions drops, the patient must immediately appeal for help.

The following drugs shown by ordinary font are registered in the Republic of Belarus (as of January 2008). Rest possible drugs Led italics. Commercial names of drugs are indicated in brackets.

Bronchial asthma (BA)

In the pathogenesis of bronchorates, with bars, three components have a decisive role (in varying degrees of severity) - the spasm of the smooth muscles of the bronchi, swelling of the mucous membrane of the bronchial tree, hyper- and discretion (increase in the amount and violation of the rheological properties of the mucus). Nebulizer therapy can be directed to all three components.

· As a rule, the easier flow of Ba does not require the use of a nebulizer.

· Ba of medium severity can be treated with the use of nebulizer, especially during periods of exacerbation and to relieve attacks.

· Heavy flow should be treated with nebulizer therapy due to a sharp decrease in the respiratory flow and, accordingly, the insufficient efficiency of dosage inhalers.

· Patients should have clear indications from a doctor about the method of using a nebulizer and picofloometer monitoring.

Treatment BA using nebulizer is carried out in three directions:

· Saving an attack Ba.

· Basine therapy B in outpatient conditions.

· Treatment of severe asthma in hospital conditions, including asthmatic status.

Cutting an attack of bronchial asthma

To relieve the attack Ba B 2 -Gonists are prescribed through a nebulizer in the following doses, depending on the severity of the attack:

· Fenoterol (Berothek) 0.5-1.5 mg or Ventoline) 2.5-5 mg.

Under the attacks of Ba, accompanied by pronounced hypercrenions, appropriate use:

· Combinations of bronchoditics (phenoterol 0.5-1.5 mg and ipratropium of bromide 250-500 μg). Or finished form - Berodal (1-2 ml / 20-40 drops)

With low efficiency or poor tolerability B 2 -Gonists, the mono-use of the cholinoblocator is possible (based on proven efficacy during spirometric tests)

· Ipratropium bromide 0.5-1.0 mg.

With the low efficiency of the conducted bronchology therapy, additional inhalation of ICCCs is possible

· Budesonide ( Pulmikort) - 1.0-1.5 per one or two receptions (30 minutes after the first inhalation.

In case of incomplete effect, it is possible to repeat the inhalation with bronchodilies to three times within an hour. In the absence of the effect of adding system steroids (prednisone).

Ba therapy in outpatient conditions.

Nebulizer therapy BA light current does not have proven advantages in treatment before Dai. Nebulizer therapy BA median-heavy and, especially, severe flow can consist of three components acting on all elements of bronchulation: bronchhalytic therapy, steroid anti-inflammatory drugs (ICCC), mucchair therapy. Recommended doses are indicated for the medium-heavy flow of asthma, in brackets are shown for heavy.

Broncholitic therapy consists of regular use of the above bronchodiolitic, it is possible to combine nebulizer therapy using similar drugs Through Dai (for example, in the morning and in the evening through the nebulizer, in the afternoon through DEA).

· Fenoterol (Berothek) 0.5-1.0 (1.5 - 2.0) mg or Salbutamol (Salgim, Salbutamol, Ventoline) 2.5 (5.0) mg - 2-3 (4-6) times a day. Or

· Berodal (1-2 ml / 20-40 drops) - 2-3 (4-6) times a day.

Anti-inflammatory therapy Through the nebulizer is carried out in inhalation glucocorticosteroids (ICCC). Inhalation ICCC is carried out 30 minutes after the use of broncholics.

· Budesonide ( Pulmikort) - 0.5 (1.0-1.5) - twice a day.

Morning regulating therapyBa is carried out in violation of muco-cyiliary clearance (abundant thick wet) ambroxol.

Mukosolvan

The inhalation use of plant preparations and acetylcysteine \u200b\u200bin an outpatient basis with Ba is contraindicated.

Treatment of severe asthma in hospital conditions, including asthmatic status.

In stationary conditions, incl. A ambulance brigade with a severe attack Ba, nebulization should begin with 5 mg of salbutamola or in combination B 2 -agonist plus 0.5 mg of cholinoblocator (bromide ipratropium). If the answer (according to the assessment of physical data, the dynamics of PSV, the general condition of the patient) is regarded as good, then re-nebulization is performed every 4-6 hours for 1-2 days.

In case of unsatisfactory response, it is necessary intravenous administration GCS and Euphillin, re-inhalation of the above doses can be repeated after 4-6 hours. In the absence of the effect of the treatment of severe attack for 6 hours, the state should be regarded as an asthmatic status. When transferring the patient to the IVL, the inclusion is possible (a number of modern devices are already equipped with a nebulizer in the contour) of the nebulizer in the circuit of the device.

With a pronounced edema of the mucousa of the bronchial tree, the inhalation use of adrenaline is possible (permissible under intensive therapy).

· Adrenaline 1% - 0.2-0.3 ml in 5-6 ml. isotonic solution.

In asthmatic status, the inhalation use of direct fleets

· N-acetylcistenin (floimumucil) to 1.2 g per day.

At the same time, it is necessary to remember the need for additional sanations (if the patient is on the IVL) after applying direct fluxes.

Patients with severe asthmatic attacks during non-ulissions should receive oxygen, if possible, since they b 2 -agonists can enhance arterial hypoxemia.

Chronic obstructive pulmonary disease (COPD)

In the pathogenesis of bronchorates, two main components have a crucial role in the COPD - spasm smooth musculature of bronchi and hyper- and (or) discretion (increasing the number and violation of the rheological properties of the mucus. Elevation of the mucous membrane of the bronchial tree -non-permanent component and has a different degree of severity depending on the shape and stage of the disease . It has a certain meaning bacterial inflammation In the development of exacerbations and the serious flow of COPD. However, infection is not the only reason for the exacerbations of COPD, and in 1/3 cases the reason for exacerbations cannot be identified.

COPL treatment with a nebulizer is carried out depending on the stage and severity and consists of five directions.

· Broncholy therapy is basic therapy, mandatory in the treatment of all COPD patients.

· Antibacterial therapy (if necessary).

· ICCC therapy (if necessary).

For patients with heavy chronic bronchitis and oxygen hypercaps, as a rule, is dangerous and, therefore, air is used to nebulize the drug.

Bronchievishing therapy COPD.

The bronchoranting therapy during COPD depends on the severity and stage of the disease (exacerbation, unstable remission, remission). Mostly medigative, and especially, severe flow requires the use of nebulizer therapy. At FEV 1.<35% должной величины использование ДАИ неэффективно. Холинолитики являются средствами первого выбора при лечении ХОБЛ как более эффективные, чем b 2 -агнисты. Однако, синергизм комбинации этих препаратов позволяет рекомендовать их одновременное применение.

· IPratropium bromide (atrovant) 0.25-1.0 mg (1-4 ml. Solution) 2-4 times a day, depending on the severity (severity of obstruction) - monotherapy is recommended only at a slight course of COPD for need or moderate out exacerbations.

· Combination of bronchodilitics (salbutamola 2.5-5.0 mg and yipratropium of bromide 250-500 μg) - 2-4 times a day. Or the finished form - Berodal (a solution of berodual for inhalation contains in 1 ml (20 drops) of 250 μg of the bromide and 500 μg of the hydrobromide phenoterol) - 1-2 ml. / 20-40 drops - 2-4 times a day, with severe exacerbations up to 6 times.

Mulitatic and turbulent therapy.

The use of proteolytic enzymes as the flourity of proteolytic enzymes is unacceptable due to the high risk of developing serious side effects - hemochnya, allergies, bronchokonstrictions.

Ambroxol improves mukiciliary transport, which, in combination with a mucrokinetic action, causes a pronounced expectorant effect. Long reception of the drug significantly reduces the frequency and severity of COPD exacerbations.

· Ambroxol (Ambroben, Ambrohexal, Lazolyvan, Mukosolvan) 30.0 (60.0) mg - twice a day. It is possible a combination within the limits of daily dosages with enteral use.

Acetylcysteine \u200b\u200b(Ass) is free from the damaging effect of proteolytic enzymes. Sulfhydryl groups of its molecules tear the disulfide bonds of sputum mucopolysaccharides. Stimulation of amusing cells also leads to springs. Acetylcysteine \u200b\u200bincreases glutathione synthesis, taking part in detoxification processes. Of particular importance is in the patients of elderly and senile age. In some cases, the flouric effect of acetylcysteine \u200b\u200bmay be undesirable because the state of mukiciliary transport adversely affects both an increase and excessive decrease in the viscosity of the secret. Meanwhile, acetylcysteine \u200b\u200bis sometimes able to have an excessive dilution effect, which can cause syndrome of the so-called "flood" lungs.

· Acetylcysteine \u200b\u200b(20% R-P) - 3-5 ml 2-3 times a day.

· N-acetylcistenin (floimumucil) - 300 mg (3 ml of solution) 2 times a day.

With a combination of the need for musolithic therapy and an infectious process in TBD, it is advisable to use the combined preparation of acetylcysteine \u200b\u200band tiamphenicol (the antibiotic of a wide range of action) -

· Fluimucil antibiotic IT - 2.5 ml of the finished solution twice a day.

Carbocystein Normalizes the quantitative ratio of the acidic and neutral sialomycins of the bronchial secret. Under the influence of the drug, the regeneration of the mucous membrane occurs, a decrease in the number of glazing cells, especially in terminal bronchops, i.e. The drug has flourishing and musually effects. This restores the secretion of IGA and the number of sulfhydryl groups. However, the drug inhalation does not apply.

Antibacterial therapy.

In patients with COPD, infectious origin often arise. Antibiotics are prescribed in the presence of clinical signs of intoxication, increasing the number of sputum and the appearance of purulent elements in it. The most effective method of determining the participation of bacterial infection in the exacerbation of COPD plays a clinical analysis of sputum (cellular composition) - an increase in the number of granulocytes is more than 60%. With the decrease in the FEV1 below, 40% the infectious process is considered reliable. Typically, treatment is prescribed empirically and lasts 7-14 days. The selection of an antibiotic in the sensitivity of the in vitro flora is carried out with the ineffectiveness of empirical antibiotic therapy. For inhalation use, aminoglycosidic antibiotics are used. In case of infections of TBD caused by a cinema wand - Kolistin, dioxidin.

· Gentamicin of 40 mg (2 ml) inhaled twice a day.

· Kolimicin - 0.5-1.0 million meters 1-2 times a day.

· Dioxidine (dioxidine, chindiox) - 100-300 mg twice a day.

In severe cases of infectious damage and the low efficiency of the inhalation use of antibiotics, the combined application of AB (with other methods of administration) is shown. Antibacterial therapy, as is well known, significantly increases the viscosity of sputum due to the release of DNA with lysis of microbial bodies and leukocytes. In this regard, it is necessary to carry out activities that improve the rheological properties of sputum and facilitating its destruction. In all cases, AB is preferably used by ambraksol (see above). When combined with antibiotics, ambroxol enhances their penetration into the bronchial secret and mucous membrane of the bronchi, increasing the effectiveness of antibacterial therapy and reducing its duration.

ICCC therapy (if necessary).

The testimony for corticosteroid (COP) COPL therapy is the ineffectiveness of maximum doses of basic therapy - bronchoids. The effectiveness of corticosteroids as a means of reducing the severity of bronchial obstruction in patients with COPD, non-etinakov. Only 10-30% of patients with their use improves bronchial permeability. In order to resolve the question of the feasibility of systematic use of corticosteroids, should be held trial oral therapy: 20-30 mg / day at the rate of 0.4-0.6 mg / kg (prednisone) within 1-2 weeks. The increase in the response to the bronchoditics in the bronchodial test of 10% of the proper FEV 1 values \u200b\u200bor an increase in FEV 1, at least 200 ml during this time, testify to the positive effect of corticosteroids on bronchial patency and may be the basis for prolonged applications. If the CS test therapy improves bronchial patency, which makes it possible to effectively deliver the inhalation forms of drugs to the lower respiratory tracts, patients are prescribed inhalation forms of the COP. Inhalation ICCC is carried out 30 minutes after the use of broncholics.

· Budesonide ( Pulmikort) - 0.5-1.0 - twice a day.

The use of prednisolone (5 mg inhaled twice a day or dexamethasone 2 mg once a day inhalation) is possible, but data on the prognosis of clinical efficacy is not represented.

With the simultaneous purpose of several drugs, the sequence should be observed. The first is inhaled by the bronighting agent, after 10-15 minutes - expectorant, then, after the wetting of sputum, is an anti-inflammatory or disinfectant.

Inhalation broncho-sanitary therapy at COPD.

Inhalation broncho-sanitary therapy is aimed at improving evacuation from TBD Secret. It is carried out 1-3 times a day predominantly in the morning hours. Low-alkaline mineral waters or sodium chloride physiological solution are used. Moisturize the mucous membrane at all its length, softening catarrhal phenomena, increase the liquid part of the bronchial secret.

· Borjomi, Narzan (mineral water it is necessary to defend to degassing) at 5-6 ml per inhalation. After inhalation, it is necessary to use respiratory gymnastics with elements of the forced exhalation, it is advisable to combine with vibrator massage (self-massage).

With caution, use hypertensive solutions due to a possible significant increase in the number of sputum and aggravation of the bronchorate. It is used at extremely viscous meager sputum.

· NaCl2-3% 4-5 ml in the morning through a nebulizer.

Pneumonia

Nebulizer therapy for pneumonia is shown in the case of attaching acute bronchitis or exacerbation of chronic (see above). In other cases, not applicable, in addition to the inhalation use of ambraksol, and in severe cases requiring the use of immunomodulators.

· Ambroxol (Ambroben, Ambrohexal, Lazolyvan, Mukosolvan) 30.0 (60.0) mg - twice a day.

· Leucinferon - 1 ml of leukeinferon in 5 ml of saline. Combined with intramuscular administration. The first week with an interval in 2 days - in the morning inhalation, in the evening the introduction of the drug intramuscularly. Subsequently, within 1-2 weeks, only the intramuscular method of administration of the drug is used 2 times a week.

In the threat (or early) of the abscessant during the difficult flow of pneumonia, the use of antimemental drugs is shown.

· Contrickle 5000-10000 cells 1-2 times a day before the permission of pneumonia.

Bronchiectatic disease (Bab).

The treatment of Bab using a nebulizer is carried out depending on the prevalence and severity and consists of three directions.

· Inhalation broncho-sanational therapy.

· Mulgarity and turbulent therapy.

· Antibacterial therapy (periodically according to indications).

And aims to improve drainage in the affected departments. All three directions of inhalation therapy are described in the COPD section (see above). With the easiest course of BEB therapy is carried out only during periods of exacerbations. With moderate and severe inhalation Broncho-Sanational Therapy must be carried out daily if necessary with the addition of periodically mukolithicsand use Position drainage.

· Acetylcysteine \u200b\u200b(20% r-p) - 3-5 ml 1-3 times a day.

· N-acetylcistenin (fluimucil) - 300 mg (3 ml of solution) 1-2 times a day.

Due to the frequent use of antibiotics with Bab, the use of the recommended above AB should be based on sensitivity data to them.

With diffuse purulent bronchitis and severe BEB, the use of antimenimen drugs is possible

· Contrickle for 10,000 cells 1 time per day 3-7 times a week for 2-6 weeks

The back of the Bab is often complicated by COPD, the inhalation therapy of which is described above.

Other states.

Method of induced sputum.

This technique is used to obtain a sputum for various types of research (primarily for the detection and identification of the pathogen - a specific and non-specific).

· A 4% hydrocarbonate solution or sodium chloride is used by 5-10 ml through a nebulizer, followed by coupling 10-30 minutes after three forced exhalations.

Apply with caution in patients with chronic damage to TBD due to a possible significant increase in the number of sputum and appearance (agility) of the bronchorate.

Patients subject to operational intervention located on IVL.

Preventive nebulizer immunomodulatory therapy reduces the frequency of postoperative pneumonium 2.5 times and mortality 1.4 times, and also reduces the lesion of lung tissue. Nebulizer immunomodulatory therapy

· T-activist is carried out according to the following scheme: 4 days before surgery, 3 days after surgery, as well as on the day of operation once a day in the evening at a dose of 200 micrograms.

· In the presence of foci of chronic infection, even those in a sanitized state - it is necessary to supplement nebulizer gentamicin therapy. On the eve of the operation, on the day of operation and one day after (in the case of IVL after operation and more than one day) - 40 mg. Gentamicin in two or four inhalations.

The use of an antibiotic inhalation is not an alternative to antibiotic therapy with other delivery methods, but only complements it and allows you to significantly reduce the frequency of infectious complications by the respiratory tract.

Similar courses of immunomodulatory and antibacterial nebulizer therapy are shown to patients who are long on the IVL.

Preparation for fibrobronchoscopy (FBS).

Traditional for anesthesia techniques and the suppression of cough reflex during preparation for bronchoscopy is

· Inhalation of 4 ml of 2% lidocaine through a mask (with superficial breathing and breathing retention on inhalation for 2 seconds) immediately before the procedure.

The interval between the inhalation and the beginning of bronchoscopy is no more than 5 minutes. For these purposes, it is desirable to equip an endoscopic compartment (cabinet) nebulizer. The volume of lidocaine used directly during the FBS process should be reduced.

Conduct adequate bronchio-alcoholic lavage is impossible without inhalation of lidocaine. 6 ml of 2% lidocaine is used through a spray with in-depth breathing immediately before the procedure.

When carrying out bronchoscopy, patients with bronchological pathology require the purpose of the bronchodiolitic drugs (preferably to use atrovate) 30 minutes before the FBS for the prevention of bronchospasm during or after bronchoscopy.

Conclusion

These recommendations, on the choice of pathology and recommended doses, are focused on adult patients, but when correction of dosages can be used in principle and in pediatric practice. The possibilities of inhalation therapy of other rareral or specific diseases of the respiratory tract that did not enter these recommendations (tuberculosis of respiratory bodies, fibrosis, respiratory distress syndrome and others) are set out in the relevant treatment protocols.

From the standpoint of evidence-based medicine, nebulizer therapy diseases of respiratory disease is a perspective direction in the treatment of patients in modern conditions. However, to obtain the expected effect from treatment, it is necessary: \u200b\u200bthe use of adequate inhalation devices, special dosage forms for inhalation, the correct conduct of procedures in constant control of their effectiveness by the doctor, the rational operation of equipment, the cooperation of the doctor and the patient.

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Success in the treatment of respiratory diseases is determined not only to the right choice of drugs, but largely depends on the method of delivering them to the respiratory tract.

Nebulizer is a device that converts a liquid drug into an aerosol consisting of drug microparticles.

Nebulizer therapy is spraying the drug to the aerosol and feeding it into the patient's respiratory tract.

Nebulizer therapy is a modern alternative to the usual methods for the treatment of diseases of the respiratory organs.

What is nebulizer therapy? What diseases do nebulizer therapy use?
With the help of a nebulizer, the drug (liquid) is converted to an aerosol form or a fog that is inhaled through the mouthpiece or mask. This treatment is called inhalation. Nebulizer therapy is the most efficient type of inhalation therapy and the method of delivering a drug directly to the respiratory tract. The most widespread use of nebulizer therapy was obtained in the treatment of bronchial asthma and chronic obstructive pulmonary disease (COPD), but this scope of the application of nebulizer therapy is not limited. Nebulizer therapy can be used to treat sharp respiratory diseases: rhinitis, laryngitis, pharyngitis. Inhalers are helping with professional diseases of singers, teachers, miners, chemists.

In action from the cause of the disease The inflammation of the respiratory tract is selected for nebulizer therapy. The choices of the apparatus type (compressor - predominantly, or ultrasonic inhaler) depends on the features of the prescribed medication) for nebulizer therapy. The main purpose of nebulizer therapy is to achieve the maximum local therapeutic effect in the respiratory tract in the absence of side effects or their minor manifestations.

The main tasks of nebulizer therapy are:
Reducing bronchospasm.
Improving the drainage function of the respiratory tract.
Sanitation of the upper respiratory tract and bronchial tree.
Reducing the edema of the mucous membrane.
Reducing the activity of the inflammatory process.
Delivery of drug in Alveola.
Impact on local immune reactions.
Improving microcirculation.
Protection of the mucous membrane from the action of allergens.

What significant advantages have nebulizer therapy?
Dispersion (transformation of drugs in an aerosol consisting of small particles) of the drug, which occurs during the formation of an aerosol, increases the total amount of drug suspension, the surface of its contact with the affected tissues, which significantly increases the effects of exposure. Some medications are poorly absorbed from the gastrointestinal tract or have toxic exposure to the liver. In such cases, local destination, and in this case the inhalation path of the drug supply is predominant. In severe respiratory diseases, the use of nebulizer therapy in comprehensive therapy significantly increases the effectiveness of treatment and speeds up the period of recovery. Nebulizer therapy is the most secure method of inhalation therapy, as it is not used in it, in contrast to dosing aerosol inhalers, propellants (solvents or carriers). The lack of the need to perform a strong breath makes it possible to use nebulizer therapy in cases of severe attack of bronchial asthma, as well as in patients in old age. The drug sprayed by the compressor 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.

From what age can nebulizer therapy be held?
The ability of the nebulizer sharply expanded the scope of inhalation therapy. Now it has become available for patients of all ages (from thoracic to deep old age). It can be carried out in periods of exacerbations of chronic diseases (first of all - bronchial asthma), in situations where the patient has significantly reduced the speed of inhalation (early-age children, postoperative patients, patients with severe somatic diseases) both at home and in the hospital.

Types of nebulizers
There are two main types of nebulizers: compressor nebulizers and ultrasound nebulizers. Recently, portable nebulizers with power supply from the built-in battery or cigarette lighter appeared. Portable devices for nebulizer therapy are necessary for persons who need treatment away from home.

In compressor nebulizers The formation of an aerosol occurs when air is supplied to the spray chamber by means of a compressor.
Air or oxygen (working gas) enters the nebulizer chamber through a narrow hole. At the outlet of this opening, the pressure drops, and the air velocity increases significantly, which leads to suction to this area of \u200b\u200breduced fluid pressure through narrow channels from the camera tank. The fluid when a air flow is encouraged by small particles with dimensions of 15-500 microns ("primary" aerosol). In the future, these particles face a "flap" (plate, ball, etc.), resulting in a "secondary" aerosol - ultra-like particles with dimensions of 0.3-0.7 microns. The secondary aerosol is further inhaled, and a large proportion of particles of the primary aerosol (99.5%) is deposited on the inner walls of the nebulizer chamber and is again involved in the process of forming the aerosol.

Advantages of compressor inhalers (nebulizers):
- Efficiency of aerosol production from medicinal solutions intended for conducting nebulizer therapy (floimucil IT antibiotic, bulvikort, etc.).
- No residual drug volume (importantly, given the value of some drugs).
- no increase in the temperature of the solution during the nebulization and preservation of the structure of the drug.

In what cases is a compressor nebulizer at home?
In the family where a child is growing susceptible to frequent colds, bronchitis (including both the bronchicstructive syndrome), for the complex treatment of cough with difficult to separate the sputum, the treatment of stenosis.
Families having patients with chronic or often recurrent bronchopile diseases (bronchial asthma, chronic obstructive pulmonary disease, chronic bronchitis, fibergation).

Ultrasound nebulizers
In ultrasound nebulizers, the conversion of fluid into the aerosol is achieved due to the high-frequency vibration of piezoelectric crystals. The vibration from the crystal is transmitted to the surface of the solution, where the formation of "standing" waves occurs. With a sufficient frequency of the ultrasonic signal at the crossroads of these waves, the "microphtandan" is formulated, i.e. Education aerosol. The particle size is inversely proportional to the frequency of the signal. As in the compressor nebulizer, the aerosol particles face a "flap", larger return back into the solution, and smaller - inhaled. Aerosol products in an ultrasonic nebulizer is almost silent and faster compared to compressor. Ultrasonic inhalers do not apply for some drugs Designed for nebulizer therapy. The choice of ultrasound nebulizers is more preferable in cases where the drug exposure zone is small bronchi, and the drug has the shape of the salt solution. However, a number of drugs, such as antibiotics, hormonal drugs, and muscolitic (diluting wet) can be destroyed. Under the influence of ultrasound. These drugs are not recommended to be used in ultrasound nebulizers.

Disadvantages of ultrasound nebulizers:
- ineffectiveness of aerosol production from suspensions and viscous solutions.
- greater residual amount of medication.
- an increase in the temperature of the solution during the nebulization with the possibility of destroying the structure of the drug.

When buying a nebulizer, it is important to take into account which solution of the drug you will use for inhalation, since the incorrectly selected type of nebulizer can lead to the destruction of the drug, unobimage the purpose of treatment and causing harm.

What medicines can be used in a nebulizer?
For nebulizer therapy there are special solutions of drugs, which are available in bottles or plastic containers - nebul. The volume of the drug together with the solvent for one inhalation is 2-5 ml. The calculation of the required amount of medication depends on the age of the patient. First, 2 ml of physiological solution is poured into the nebulizer, then the required amount of drug droplets is added. Distilled water should not be used as a solvent, as it can provoke bronchospasm, which will result in a procedure for coughing and difficulty breathing. Pharmacy packaging with medicines is stored in the refrigerator (if there are no other instructions) in a closed form. After the pharmacy packaging was opened, the drug must be used for two weeks. Preferably on the bottle to record the date of commencement of the drug. Before use, the medicine must be heated to room temperature.

For nebulizer therapy in compressor nebulizers can be used:
1. Mulcolics and muggulators (drugs for wetting and improving expectoration): Ambrohexal, Lazolvan, Ambroben, Fluimucil.
2. Bronchulytators (preparations, expanding bronchi: Berodual, Ventoline, Berretk, Salamol.
3. Glucocorticoids (hormonal preparations with a multilateral action, primarily anti-inflammatory and anti-ethnicate): Pulmikort (suspension for nebulizers).
4. Cromons (anti-allergic drugs, stabilizers of puffed membranes): Kromegexal nebula.
5. Antibiotics: Fluimucil antibiotic.
6. Antiseptics: dioxidin 0.25% solution (0.5% dioxidine solution in dilution 1: 1 with sodium chloride 0.9%).
7. Alkaline and saline solutions: 0.9% saline, Mineral water "Borjomi".

Assign a drug and tell about the rules of its use should your attending physician. It must also monitor the effectiveness of treatment.

It is categorically impossible to use for inhalations with a nebulizer drugs not intended for nebulizer therapy: all oils and solutions (suspensions) containing oils, suspensions and solutions - containing suspended particles, Including brazers and tinkers.
It is not recommended to use theophylline solutions, papaverine, platifilin solutions for nebulizer therapy, plates, such as not having an application points on the mucous membrane of the respiratory tract.

Contraindications for maintenance of nebulizer therapy.
- pulmonary bleeding and spontaneous pneumothorax against the background of bullose emphysema lungs.
- Cardiac arrhythmia and heart failure.
- Individual intolerance to the inhalation form of medicines.

What can you feel when conducting nebulizer therapy?
With deep breathing, symptoms of hyperventilation (dizziness, nausea, cough) may appear. It is necessary to stop inhalation, risk the nose and calm down. After the symptoms of hyperventilation are disappeared, inhalation through the nebulizer can be continued during inhalation, as a reaction to the introduction of the sprayed solution, cough may appear. In this case, it is also recommended to stop inhalation for several minutes.

Before applying nebulizer therapy, carefully read the instructions for the medicinal product that you use for inhalation!

Rules for the preparation and conduct of nebulizer therapy

Preparation for inhalation

Learn detail the instructions attached to your inhaler (nebulaizer). Correct all components of the nebulizer. Check that the nebulizer assembly is correct once again as indicated in the instructions for the inhaler.

Inhalations are carried out 1-1.5 hours after meals or physical exertion. Before and after inhalation, smoking is prohibited.

Preparation of a solution for inhalation

Inhalation solutions should be prepared on the basis of a physiological solution (0.9% sodium chloride), or a special solution for the drug in compliance with the rules of antiseptics. It is forbidden to use water, boiled, distilled water, as well as hypo- and hypertensive solutions for these purposes.

To fill the nebulizers in the inhalation solution, syringes are ideal, it is possible to use pipettes. It is recommended to use the volume of filling the nebulizer 3-5 ml.

The cooked solution is stored in the refrigerator not more than 1 day, uncleaned to the use of the drug. Before starting inhalation, the prepared solution is recommended to warm on a water bath to a temperature of at least + 20 ° C.

Inhalation

During inhalation, a person must be in the sitting position, do not talk and keep the nebulizer vertically. When carrying out inhalation, it is not recommended to be tilted forward, since this position of the body makes it difficult to enter the aerosol into the respiratory tract.

For diseases of the pharynx, larynx, trachee, bronchi should be inhaled aerosol through the mouth. After a deep breath, his breath should be delayed for 2 seconds, then make a complete exhalation through the nose. It is better to use a ruined or mouthpiece than a mask.

In case of diseases of the nose, the incomplete sinuses and nasopharynses, it is necessary to use special nasal nozzles for inhalations (nasal cannula), breathing and exhale should be done through the nose, calm breathing, without tension.

Since frequent and deep breathing can cause dizziness, it is recommended to take interruptions in inhalation by 15-30 seconds.
Continue inhalation until liquid remains in the nebulizer chamber (usually about 5-10 minutes).

After the inhalation of steroid preparations (hormones), it is necessary to carefully rinse the mouth. It is recommended to rinse the mouth and throat of boiled water room temperature.

After inhalation, flushing the nebulizer should be pure, whenever possible, sterile water, dried using gauze sterile wipes. Frequent washing of the nebulizer is necessary to prevent crystallization of drugs and bacterial pollution.

Course treatment with aerosol inhalations - from 6-8 to 15 procedures.

Antibiotic for nebulizer compressor type
Floimucil Antibiotic IT.

Mulitics for nebulizer therapy
Lazolvan

The article prepared Zyryanov S. G. - Editor of the portal 03digest.ru
When quoting the article link to 03digest.ru is obligatory

Nebulizer therapy in the complex
Treatment of respiratory infections
The main entrance gates for the penetration of pathogenic microorganisms,
As noted above, the upper respiratory
Ways. After the penetration of the pathogen, two consistent
Included protection systems: Mulkociliary and immune.
Mukiciliary protection
The mucous membrane of the respiratory tract is covered by a secret containing
antibacterial protection substances, and thanks to
Motoric Celebration Epithelia This secret is constantly transported
The particles of gary, dust, microbes, mushrooms are removed from it.
If this mechanism does not work for various reasons, including
including viral infection, fake epithelium dies;
The pathogens are fixed on the surface of the mucous membrane and begin
multiply. Particularly dangerous areas where there are scar stenosis. There
The secret is stimulated, which gives an additional incentive for development
Local infection. The secret with the modified viscosity is worse transported,
At the same time increases the risk of superinffication,
Therefore, patients with chronic respiratory diseases always
Have a high predisposition to infection.
Immune defense
Factors responsible for violation of mukicilliary protection, at the same time
Impair and immune protection. This applies to both external
factors, including tobacco and pathogens: mushrooms, bacteria,
viruses.
With the inclusion of the body's immune system under the action
The infectious agent may occur its oppression due to
products secretion of bacteria and endotoxins released
In the process of bacteriolization, the state of immune suppression occurs. IN
this situation, along with strengthening the risk of recurrence or
exacerbations appear a threat to the transition of disease from acute form in
chronic.
In the mechanism of immunosuppression lies the reduced ability of lymphocytes
peripheral blood of man to reparation DNA and accumulation
DNA damaged, which leads to genetic instability. This long
The process is increasing under the influence of antibacterial therapy,
It can be weakened when applying immunomodulators. With absence
Immunological support arises a real risk of recurrence
and the threat of the transition of the disease from the acute form in chronic.
It is also known that inflammatory processes lead to violation
systems oxidants-antioxidants, to the formation of oxidative
stress, excessive products of active forms of oxygen - aggressive
radicals (monovalent oxygen, hydrogen peroxide, etc.), which leads
Damage to proteins, nucleic acids, cell biomembran
And ultimately the development and maintenance of pathological conditions
in the body.
Oxidative stress in patients with pneumonia, tuberculosis and chronic
inflammatory diseases of the lungs in the aggravation phase also
Protect respiratory infections. Inflammatory reaction
Developed in response to viral or bacterial infection, represents
a complex interlacing of events including products
various mediators aimed at the capture and destruction of the pathogen, but
The same reaction can get an unfavorable course and also cause
Defeat of body tissues.
Thus, a vicious circle is created that can be broken,
Impacting various parts of the pathological process.
Inhalation therapy allows the use of drugs that provide
act:
. on the inflammatory process;
. on the correction of immunity;
. On the regulation of the system of oxidant antioxidant.
The purpose of complex therapy:
. stop inflammation;
. reduce swelling;
. improve drainage function;
. resolve bronchial obstruction;
. restore local immunity;
. ensure the removal (eradication) of significant pathogens;
. Restore mukicillion transport

Scheme of the mechanism for the development of infectious diseases of the respiratory system
Penetration of the pathogen in the respiratory tract
Fixation on the surface of the mucous membrane
Reproduction on the mucous membrane
Violations in the system of oxidant antioxidant -
Accumulation of active forms of oxygen,
Arachidonic acid metabolism shift
Inflammatory reaction
Immunosuppression
Infectious disease: acute, aggravation of chronic

Despite the fact that infectious diseases of the respiratory tract
well-known doctors of different specialties, problems of prevention remain,
Diagnosis and treatment of ORVI and their complications.
To form a diagnosis of ARVI, along with an assessment of epidemiological
Entertainment, history, physical examination of the patient important
The importance is to inspect the upper respiratory tract by the physician otorhinolaryngologist.
It can define not only the localization of inflammatory
process, but also to evaluate the gravity of the defeat on the intensity and prevalence
Inflammation and character of inflammation on mucous membranes
LOR organs.
According to E.P. Berbenzova (2000), visual differences of inflammation,
caused by virus and bacteria, consist in the fact that for viral
Catarial inflammation accompanied by education
serous secret on the mucous membranes of the upper and lower
respiratory tract. According to K.G. Astakhova (1989), in the first 2-3
The sedimentation day of viral infection on the mucous membrane of the nose, pharynx
There is an injection of vessels, on the 3-5th day hyperemia spreads
on other departments of the upper respiratory tract, and becomes diffuse
Entries joined, appear (more often under paragrippe)
or group hemorrhages from fine-point to large on the mucous
The shell of the nose, soft and solid sky, in the larynx on voice folds.
Bacterial flora can join, character changes
Secret: It becomes serous-purulent or purulent. In the process involved
Pressing sinuses of nose, almonds, trachea. According to V.M.
Zhdanova, S.Ya. Gaidamovich (1982) the first 5-10 days of the severity of ARVI, as
and any viral infection depends mainly from functioning
Interferon systems: Heavy forms of ARVI with complications develop
In patients with secondary compromised immunodefic
Quits for this system.
When choosing etiotropic therapy, ORVI basic should be
Antiviral therapy used in the form of different ways of administration
in the human body. Preference must be given to inhalation
Forms: aerosol inhalations, irrigation, intracheal
fillings.
The purpose of antibacterial drugs should be reasonable
Clinically, bacteriologically and confirmed by laboratory indicators
Blood: Leukocytosis, SE EXEPORT, COLORCHED SHIP, RAIN
Concentrations of fibrinogen, serumcoid, C-reactive protein.
For effective therapy of viral infection, there are synthetic
Antiviral drugs: "Remantadin" (Russia), "Arbidol"
(Russia), "Vioraza" or "Ribavirin" (Canada, USA). For treatment
Nerpes Simplex viruses, cytomegolerus applied "Zoviraks" or
"Acyclovir". All of them are used by PER OS or in the form of ointments.
In the inhalation forms through the nebulizer use the following
Preparations.
Human leukocyte interferon. Interferon belongs
To the factors of non-specific immunity. He participates in providing
homeostasis of nucleic acids, blocking reproduction of RNA viruses and
DNA. One of the most important features of interferon - cell protection adjacent
with virus-infected preventive penetration of viruses
In a healthy cage. Resistant person to respiratory viral
infections, according to many studies provide interferons and
Interrelated mechanisms of a specific immune system.
Dosage: The contents of the ampoule are dissolved 2 ml of distilled

- 10-15 inhalations.
Paul Dan. (Russia) - Inductor Interferon. Lyophilized
powder. Each ampoule (100 units) is divorced by distilled water.
In medical practice, used in the form of a colorless transparent solution,
Which is prepared from white hygroscopic powder. Apply
with adenovirus and herpes conjunctivilation, keratitis and in the form
irrigations and inhalations for ORVI.
Dosage: The contents of the ampoule are bred 2 ml of distilled
water. Inhalation on the nebulizer is carried out 2-4 times a day. On the course of treatment
- 10 inhalations.
Aminocaproic acid It has diverse therapeutic
Properties, has anti-allergic activity, reduces reproduction
influenza viruses, paragrippa, removes inflammatory edema (sails,
1981). In aerosolherapy, a 5% solution of ammocaproic acid is used,
2 ml on inhalation 2 times a day for 3-4 days.
Sodium thiosulfat - The drug of multifaceted action. Anti-
The oxidant blocks the products of aggressive radicals, is anti-allergic,
detoxification, antibacterial antisclerotic
act. Inhalation therapy uses 5% aqueous solution
3 ml thiosulfate sodium on inhalation 2 times a day. On the course of treatment
10-15 inhalations.
Immunotherapy exists in several species.
1. Immunotherapy based on the introduction of ready-made specific
antibodies (plasma, gamma globulin, immunoglobulin). Them followed
use into the sharp stage of the disease, i.e. In the first 10 days when
severe and moderate the course of the disease. Most used
Gamma-globulins are a totality of immunoglobulins
Man serum enriched with specific class antibodies
IgG (Petrov R.V., 1976, 1982). Normal human immunoglobulin
For parenteral applications are used in the form of 10%
Solution of donor immunoglobulins. In one ampoule contains
One dose 0.15 g, i.e. 1.5 ml for intramuscular injection.
2. Immunomodulators. These are drugs affecting the immune
System.
Leucinferon - domestic immunomodulator, is
Preparation of human interferon and other cytokines synthesized
Leukocytes from the blood of clinically healthy people. Leucinferon
Provides antiviral and immunomodulatory action, speeds up
Proliferation processes, activates cytological and phagocytic
Reactions in the body. In one ampoule contains 10,000 me antiviral
Activity of human interferon. For inhalation diluted
1 ml of leukeinferon in 5 ml of distilled water, the contents are poured
In nebulizer. In chronic bronchitis, pneumonia, pulmonary tuberculosis
Telecommunication inhalation combined with intramuscular administration. If a
In the morning, the administration of leukeinferon is carried out intramuscularly, then in the evening - in inhalations.
Within 1-2 weeks Leucinferon is used in such a way 2 times in
Week, then within 2-3 weeks. Using only intramuscular way
administration of the drug.
Derinat - domestic immunomodulator, produced by the Russian
FP Technomedservis CJSC. Derinate - high-purified sodium
salt of native deoxyribonucleic acid, partially depoly
Merized ultrasound dissolved in 0.1% aqueous sodium solution
chloride. Biologically active substance isolated from sturgeon milk
Fish. The drug has immunomodulating, anti-inflammatory,
detoxifying, reparative and antioxidant properties. Released
Derinate 0.25% (for outdoor use), 10 ml in the vial;
Derinat 0.25% (drops in the nose), 10 ml in a bottle with a dropper; Derinate 1.5%
(for injections), 5 ml in ampoules.
Indications - to increase the effectiveness of the treatment of patients with acute
The pathology of the upper and lower respiratory tract (ORVI / influenza, sharp
catarrhal rhinitis, acute catarrhal rinofaring, acute laryngo
tracheitis, acute bronchitis, community-hospital pneumonia); For prophylaxis
and the treatment of recurrences and exacerbations of chronic diseases (chronic
Rinoinusitis, chronic mucous-purulent and obstructive bronchitis,
bronchial asthma).
For the treatment of patients with acute pathology of the upper respiratory tract
Derinat is recommended to enter and / or inhalation through compressor
Nebulaizers.
The DNA-Na aerosol must have particles of 5 to 8 microns in size, so
How smaller particles settle in the lower respiratory tract.
The advantage of inhalation therapy is due to a number of reasons:
. wide coverage of the surface of the mucous membranes of the respiratory tract;
. increasing suction intensity;
. An increase in the deposit of the drug in the sublifting layer and the focus
Defeat.
Technique of nebulizer therapy Derinat
In contact with the patient of ARVI or at the first signs of the disease
0.25% Derinat solution is recommended for outdoor use. IN
The nebulizer is cast 1-2 ml of the drug from the bottle (pipette to divert the drug
do not do it). On the inhaler install II mode of operation, patient
Blowing through a mask or cannula for a nose for 5-7 minutes. This procedure
Repeat 2 times a day for 2-3 days.
With riinononunctive syndrome, aerosol therapy is complemented
Drip administration of Derinat: 1 drop in both eyes 2-3 times in
day.
With pneumonia, aerosol inhalations are carried out at i mode and
complemented by intramuscular injections of 1.5% Derinat solution
In a dose of 5 ml every other day. 5-10 injections are recommended for treatment.
At the same time, etiotropic therapy should also be carried out, i.e. Relevant
Antibacterial therapy causative agent.
With exacerbations or relapses of bronchial asthma or chronic
obstructive pulmonary disease Inhalation therapy 0.25% solution
Derinata is necessarily combined with bronchovers and musolithic drugs,
antibiotics and mandatory intramuscular administration
Derinat. On the course - 5-10 injections. Such therapy is necessary for prophylaxis
immunodeficiency and transition of the acute phase of the disease in the protracted
Under the influence of antibacterial therapy, viral infection, intracellular
pathogens and mushrooms.
. Alkaline solutions
Sodium bicarbonate (Natrii Hydrocarbonas). It is applied for
Lighting mucus and creating an alkaline medium in the focus of inflammation. Such
Inhalation on the nebulizer increases the efficiency of removal of mucous membrane
The purulent nasal separated from the cavity is more than 2 times.
Dosage: 2% solution in an amount of 2-3 ml per inhalation.
Sodium chloride (Natrii Chloridium). 0.9% isotonic solution
has an irritant action on the mucous membranes, applies
To mitigate, purify and washing the nasal cavity when hit
Essentials. 2% hypertensive solution promotes cleansing
25
Nasal cavities from mucous-purulent content. Solutions can be prepared
Patients themselves: isotonic solution - 1 teaspoon
Salt salt on 1 liter of boiled water.
Dosage: 2-3 ml of isotonic solution for inhalation. Procedure
You can repeat 3-4 times a day.
Aqua Maurice.Isotonic sterile water solution of the Adriatic
Sea with natural trace elements. 100 ml of solution contains 30 ml
Sea water with natural ions and microelements. Used
for washing the nasal and nasophack cavity, it is recommended to apply with
hygienic and prophylactic goals for moisturizing mucous
Nose shells. The dosage is similar to the recommended chloride for sodium.
. Mulitatic drugs
ACS. (Acetylcistein) "Hexal" (Germany). It is applied for
Inhalation as a musolitic and expectorant agent 10% solution in
quantity of 2-5 ml 3-4 times a day.
Ambrohexal(ambroxol hydrochloride) has a mercolite
And expectorant action, facilitates and eliminates cough. Viscosity
The sputum decreases 5 times compared to the initial level.
Ambrexal has a secretolitical effect due to depolymerization
Mukopolisaccharide fibrils of separated bronchi and stimulation
secretory cells of mucosa of bronchi producing neutral
Polysaccharides. Secret-Engine Action: Enhances the activities of the flicker
Epithelium bronchi, promoting sputum evacuation.
Regeneration of focusing epithelium college cells is regenerated,
Stimulation of the production of a surfactant that improves the respiratory function
lungs. When combined with antibiotics increases them
Concentration in the bronchial secretion, mucous membrane and alveoli.
2-3 ml with 2 ml of saline 3-4 times a day through the sky
Liser.
Fluimucil 10% solution in "Zambon Group" (Italy) ampoules. Active
The beginning is the derivative of the amino acid L-cysteine \u200b\u200b- N-acetylcysteine.
Refers to the Mukolithics of Direct Action. Affects directly
on a thick and viscous secret in the lumen of the respiratory tract, so effectively
and quickly dilute and removes the sputum along with pathogens
microorganisms. The drug retains activity and in the presence of purulent
sputum. Fluimucil has a pronounced anti-inflammatory
effect due to antioxidant action. Mode of application:
in inhalations 1 ampoule 1-2 times a day for 5-10 days or more
long courses. Due to the high safety of the drug frequency
adoption and relative dose value can be changed by a doctor in
permissible limits, depending on the state of the patient and therapeutic
Impact. No need to change an adult dose in case
Applications of the drug for the treatment of children. Used with exacerbation
chronic obstructive bronchitis with difficult wettero, and
Also in sinusitis, rhinosinusitis, laryngotrachites, bronchiolites.
Rinofluuimucil "Zambon Group" (Italy) is the only spray
Double action for the treatment of rhinitis and sinusitis.
Composition: 100 ml of the drug contain: N-acetylcysteine \u200b\u200b- 1 g, TuminoP-
Tana sulfate - 0.05 g, other ingredients.
Multic and reparative action of acetylcysteine \u200b\u200bis complemented
The vasoconstrictor effect of the Tumingeptan sulfate contributing
Employment of edema, cleansing and restoring
Occolone sinuses and nasal cavities. Thanks to the listed effects
The rapid healing of the mucous membrane of the nasal moves and
Reducing inflammation symptoms.
Indications for use: acute, subacute rhinitis with thick purulent,
mucinous-purulent exudate, chronic rhinitis, sinusitis with symptoms
rhinitis.
Method of application: adults 2 doses of aerosol in every half
nos 3-4 times a day, for children 1 dose 3-4 times a day in every half
Nose. Course of treatment 5-7 days.
Contraindications: Clothing glaucoma, hyperthyroidism, hypersensitivity
To the drug, treatment with antidepressants.
Lazolvan - Mukolitic, derivative of ambroxol, is produced in
100 ml bottles (in 1 ml of 7.5 mg of active substance).
Shown in chronic obstructive diseases of the lungs, tuberculosis
lungs and bronchi, pneumonia, sharp bronchopulmonary diseases
With a violation of the secretion of wet wet.
Dosage: for liquefying viscous thick sputum and its best
Calciation is used in adults and children (over 6 years old) 2 ml
(15 mg) up to 4 times a day, in children under 6 years old - 1-2 ml 1-2 times a day. Solution
Lazolyvan is usually mixed with 2 ml of heated saline.
With severe exacerbations of chronic bronchitis, you can apply
3-4 ml of Lazolyvan in breeding with saline or pure
The form in combination with the bronchodiolitic.
Lazolyvan (ambroxol) has mucocinetic and secretolithic
Property. It contributes to the removal of a viscous secret from the respiratory
paths and reduces mucus blockage. Advantage of Lazolyvan
It is its wide range of action. The drug reduces viscosity
sputum (due to the depolymerization of mucopolysaccharide fibrils),
reduces the adhesion of sputum to the wall of the bronchi (due to the stimulation of
Factation), stimulates the evacuation of the secret from the respiratory tract (due to
Regeneration of fiscal epithelium). Thanks to good tolerability
The drug can be used for a long time.
Lazolyvan can be combined with other drugs,
used as standard treatment with bronchitis syndromes
(heart glycosides, corticosteroids, bronchophytes and antibiotics).
With the subsequent use of antibiotics in aerosols, the Lazolyvan contributes
An increase in their penetration into the pulmonary tissue. Lazolvan
Metabolized in the liver and excreted through the kidneys with urine.
. Proteolytic enzymes
Tripsin crystal. (Trypsini Crystallisatum). Chimothrixin
Crystallisatum, Himopsin, Hymopsin (Chymopsinum),
Ribonuclease (Ribonucleasi amorphum), deoxyribonucleasum (desoxyribonucleasum),
Lisozyme (Lisocimi). All drugs have anti-inflammatory
and anti-ethnic effects lysed necrotic
Fabrics, dilute pus and mucus, selectively give antiviral
Effect. With acute processes, they are recommended to use in a dose of 0.005 g
In 5 ml of isotonic sodium solution chloride with antibiotics.
. Decongestants(vasoconstrictors)
"Xilomezoline", "Oxymetazolin", "Nafazolin", "Tetri-
zolin "-. All drugs - αt - adrenomimetics, influence
Sympathetic regulation of tone of blood vessels due to action
on adrenergic receptors. Applied in the form of droplets and aerosols.
The advantage of aerosols in their impact on the entire mucous membrane
NASA cavities, which ensures effective disclosure of all stations
Occolone sinuses, restores drainage function and improves
Nasal breathing. Their concentration should not exceed 0.01% for
Children of the first 2 years of life, 0.025% for children under 6 years and 0.05% for younger
Schoolchildren. For nebulizer therapy, the appropriate concentration
The drug in the amount of 4-5 drops is divorced in 2 ml of physiological
Solid. Inhalations are held no more than 2 times a day.
Decongensants should not be used more than 5-7 days to avoid occurrence.
Changes in the mucous membrane of the nose and the effect of addiction.
Antiseptic agents and biostimulants
Dioxidin. Aerosol inhalation with dioxidine are effective in chronic
Catarial and hypertrophic rhine. One ampoule dioxidin
(5 ml - 25 mg) divorces in 5 ml of saline and is calculated
on 2 inhalations. With the appearance of itching in the nose, the drug should not be applied.
28
Jodinol. 1% aqueous solution is widely used as an aerosol
In atrophic processes in the nasal cavity, ozen. For one inhalation
Used 2-5 ml.
Furacilin(1: 5000) affects gram-positive and considerable
Tsaten microbes; Effective inhalation in acute phases of the disease.
Inhalation is recommended 2 times a day in an amount of 2-5 ml.
Gumizol, Peloidin as biostimulants are used in atrophic
processes in the cavity of the nose and a sip. On one inhalation used 2
ml 0.01% solution of humizol or not less than 5 ml of peeloididine 1 time per day.
. Intranasal glucocorticoids
"Beclomeletazon", "Flunicolid", "Triamcinolone", "Fluticazone".
Render anti-inflammatory, anti-allergic effect
intranasal inhalation. Systemic effect expressed
Minimum.
« Budesonide"(" Pulmikort ") is a suspension for nebulizer therapy.
In one plastic container contains 2 ml of budesonide suspension,
The amount of active substance is 0.125 mg / ml, 0.25 mg / ml,
0.5 mg / ml. Widely used with bronchial asthma, vasomotor
Rinit, seasonal and year-round allergic rhine. For prophylaxis
growth of nasal polyps after their removal.
Dosage: in preschool children, the daily dose is
0.25-0.5 mg, and in adults - 0.5-1 mg twice a day.
. Stabilizers Membranes of Fat Cells
Kromegexal.Inhalation Solution (Cromoglycial Acid)
- Kromegexal Nebules "Hexal" Germany.
Bronchospasm warns, blocking calcium ions in fat
The cage preventing its degranulation and release of histamine.
Kromegexal contains critical acidic acid and is used for
nebulizer aerosolterapia as an antiallergic
The drug warning bronchospasm caused by contact with
Allergen or other provoking factor (cold air,
Smells, stress, physical stress). Systematic application
Cromogexala leads to a decrease in allergic inflammation in
respiratory system.
In one-time vial volume, 2 ml contains 20 mg of ditrium
chromaglic acid salts; Packing 50 pieces. Adults and children with
2 years is recommended to be inhalation 4 times a day on one bottle.
Chromgexal inhalation solution can be sprayed at the same time
with other drugs. In many cases, during asthma, a combination with
Inhalation forms of beta sympathomimetics is the most
Effective. Sideless unwanted effects This drug causes
Rarely, and they easily pass after his cancellation. He can be appointed
Doctors regardless of their specialization. In the treatment of allergic
Rinith Maximum dose for children is 2 ml 4 times a day. Cro-
Mona are shown for the treatment of lungs and initial forms of allergic
rhinitis and effective in their prevention.
. Preparations for local antibacterial therapy
« Isofra "(" Rifamycetin ")- Bactericidal antibiotic aminogly
goat row for local use, has bactericidal activity
in terms of gram-positive and gram-negative flora,
Paths of infection of the upper departments of the respiratory tract. Applied
in children, including newborns, and in adults in those cases
When vasoconstrators and corticosteroids are not shown. Available in
The form of a spray, for the nebulizer inhalation of one dose is used one
Injecting into a flask with 2 ml of saline. Applied
in the treatment of infectious rhinitis, rinopharygitis, sinusitis, as well as
For the prevention of postoperative complications for endonazal
interventions.
« Polydx "(with phenylefrin). The effectiveness of the drug is due
combination of anti-inflammatory and anti-allergic action
dexamethasone with antibacterial action of two complementary
antibiotics and vasoconductive effect of phenylephrine hydrochloride,
allowing to reduce the swelling of the mucous membrane. Applied in children
from 2.5 years and in adults for local treatment of rhinitis, rinopharygitis
and sinusits, for preparing for the operations of the nasal cavity and in postoperative
period. Produced in the form of spray, the dosage is the same as
using isofra.

For those who do not have respiratory problems, free breathing is perceived as granted, but for many patients it is not at all. The respiratory tract is in direct contact with the ambient air and are therefore exposed to various stimuli, allergens and pathogens of microorganisms. Inhalations are one of the oldest and traditional methods of treating the respiratory tract, whether it is in the conditions of marine climate, salt caves, steam saunas or inhalation using nebulizers. Wet air-saturated air salt ions or inhalation of therapeutic aerosols open significant opportunities for the prevention of exacerbations, moisturizing and therapy of respiratory diseases from the nasal cavity to pulmonary alveol.

The PARI inhaler is a proven long-term practice of use, an effective device for the treatment of respiratory tract. In this article, you will find information on the structure of the respiratory tract, the main functions of inhalation devices and many practical advice on how to conduct treatment with inhalations. We invite you to visit the site http://pari.com.ru/, where you can find out even more and watch a video about the conduct of inhalations, ask your questions on-line consultants.

Anatomy of respiratory tract

The respiratory tract is conditionally divided into:
Upper respiratory tract
nose, apparent nose sinuses
pharynx
larynx
Lower respiratory tract
trachea
bronchi, bronchioles and pulmonary alveoli

Inhalation is simple, quickly, nice!

There are a number of benefits of inhalation before taking medication inside: during inhalation, the medicine is delivered to the respiratory tract, that is, wherever its action is necessary. At the same time, the therapeutic effect is achieved very quickly. When inhaled treatment, side effects and unwanted reactions to the medication occur much less often than when using tablets or other forms of medicines for intake, because in the case of delivery directly to the place of high dose is not required.

Inhalation contributes to self-purification and humidification of respiratory tract, which helps reduce dryness and irritation symptoms characteristic of many respiratory tract diseases. To carry out inhalation, so that the medicine has achieved its goal, it is converted to the smallest aerosol. The transformation of the liquid drug into the aerosol can occur in different methods. After inhalation, the aerosol is precipitated and the medication penetrates the mucous membrane of the respiratory tract. Where the aerosol is delivered and where he will act depends on the size of its particles. Large particles are absorbed already in the upper departments: in the cavity of the nose, rotoglot, larynx, trachea. Smaller aerosol particles reach the lower parts of the respiratory tract: bronchi, bronchioles, alveoli. For the purposes of the therapy of the lower respiratory tract, it is important to use an aerosol with a large particle content of less than 5 microns, especially in the case of inhalation of children and babies.

The advantages of nebulizer therapy:

During the nebulizer inhalation, the therapeutic effects turns out directly on the mucous membrane of the respiratory tract.
Delivery of the required dose of medication is carried out in a short time.
The speed of the effect of the effect.
The procedure of nebulizer inhalation does not require compliance with special breathing techniques.
The possibility of varying the dispersion of the aerosol depending on the level of the lesion (deep penetration into the respiratory tract due to the shallow dispersion of the aerosol).
Minimum side effects: no systematic impact on the body.
Low drug losses in the environment (nebulizer activated by inhale - 30%, di - 80%).
The most effective and comfortable means of delivering aerosol drugs in young children and severely ill patients.
It has a training effect on respiratory muscles.

Inhalation therapy: differences and applications

Depending on the nature of the disease, age and other patient needs, various systems of inhalation therapy are used. All of them differ in many respects, for example, in the method and field of application, the mechanism of action.

Dry powder inhalers or sprays

Powder inhalers are often used for long-term drug intake, however, they are only suitable for those patients who can make a fast and powerful breath, resulting in a medicine exempted from the device. Sprays or dosage aerosol inhalers are the same as powder inhalers Frequent form of inhalation of drugs for people with chronic respiratory diseases. Most of the well-known, including combined drugs are produced in the form of Dai. Inhalation with Dai requires clear coordination between the activation of the inhaler and inhale. However, studies have shown that about a third of users of Daii may not well perform such coordination, which can be reflected on the results of treatment, since most of the drug is deposited on the rear wall of the pharynx and swallows. To optimize inhalation with dii used spacer (see on the site) , Valve camera, where the drug is first sprayed from Dai, and then inhalation of aerosol is carried out. When using the spacer, a slowing down of the spraying rate of the medication from Dai, the aerosol is located in the Spacer chamber for some time, and the patient can make a calm and deep breath several times. This is especially important when using inhalation glucocorticosteroids, to minimize side effects due to the precipitation of medication in the rotoglot.

Wet inhalation

With wet inhalation through a nebulizer, an additional advantage compared to powder inhalers or sprays is the humidification of the respiratory tract. It is important, since many diseases are accompanied by the symptoms of dryness of the mucous membrane of the respiratory tract. Inhalation using a nebulizer does not require a certain respiratory maneuver or coordination, so they are easily fulfilled for children, older people and seriously ill patients. When wet inhalation, you can also mix different drugs if it is allowed by the instructions for the drug. For nebulizer inhalation, saline solutions can be used in different concentrations. Calm breath during nebulizer inhalation is perceived as a more comfortable treatment method. Therefore, nebulizer inhalation therapy in many cases is the only method of preventing and treating respiratory diseases.

Technologies for obtaining wet aerosols

1. Ultrasound nebulizers

Create an aerosol with a piezoelectric element. This type of nebulization is not suitable for all drugs, since under the influence of ultrasonic oscillations, some of them can be destroyed. Therefore, ultrasound inhalations are used less often.

2. Inkjet nebulizer

The most common form of transformation of liquid dosage forms into the aerosol when the compressed air from the compressor passes through a narrow nozzle of the nebulizer and as a result of the physical phenomenon of the venturi, the liquid is divided into small particles of 1 to 15 microns. The aerosol flow enters the mouthpiece and can be inhaled. There are nebulizers controlled by breathing, when, thanks to the valves of inhalation and exhalation, the products of the aerosol during the patient's inhalation increases, and during the exhalation decreases. This reduces the inhalation time and reduces the loss of the aerosol into the environment.

3. Membrane nebulizers

Represent the most modern form of aerosol generation. The mechanism of obtaining an aerosol is based on the vibration of the perforated movable membrane under the influence of an electron signal, as a result, the "sifting" of the liquid medicine is "sifting" through the smallest holes in the membrane and the transformation into an aerosol. This modern technology allows you to quickly, almost silently, if necessary, in autonomous connection mode from batteries, carry out inhalation, which significantly improves the quality of life during acute or chronic respiratory diseases. However, when using membrane nebulizers, it remains not to the end of a solid problem of the residual amount of medication, which cannot be sprayed.

How it works?

The nebulizer system consists of a compressor and a nebulizer, which is filled with a solution for inhalations. The compressor and nebulizer are interconnected by a duct tube, along which compressed air falls into the nebulizer. In the nebulizer housing, the medication turns into an aerosol. Then the aerosol is inhaled through the mask or mouthpiece, which is connected to the nebulizer.

Nebulizer is the main part of the inhalation system, the size and density of aerosol particles depends on its inner structure. Modern nebulizers are equipped with inch and exhalation valve system, which allows you to more economically spend the medication.

There are two main types of nebulizers: an inhale-activated nebulizer for continuous inhalation and respiratory respiration nebulizer with a breaker.
The keys of the interrupter is pressed during inhalation, this means that inhalation is carried out only at this time. The keys of the interrupter is not pressed during the exhalation, i.e. Spraying is interrupted.

Electronmage nebulizer

The aerosol is generated by high-frequency vibration of the perforated membrane and passing through it the solution of the medication transformed as a result into an aerosol, which enters the storage device of the nebulizer, after which the patient inhales the aerosol through the mouthpiece and exhales through the exhalation valve on the mouthpiece.

VELOX - Frequently Asked Questions

1. Is it possible to use the VELOX device for daily inhalations in patients with cystic fibrosis?

Considering that most patients with fibrosis must carry out several inhalations per day and daily disinfect the nebulizer, it is necessary to take into account that the nebulizer and the aerosol generator (membrane) are designed for 365 inhalations and 52 disinfections (see the instruction manual). Thus, during daily multiple inhalations, it will have to change the membrane more often.

The use of a control unit for at least 3 years, manufacturer's warranty - 2 years. For this group of patients, it is advisable that VELOX is applied only for temporary use, for example, trips as a mobile device.

2. How to breathe when carrying out inhalation using VELOX?

Compared to compressor inhalers, the VELOX MASH inhaler requires more active breathing. After the start of spraying, it is necessary to immediately begin to inhale the aerosol through the mouthpiece or through the mask. At the same time, you need to try to breathe without breaks. If you need to take a break, you should turn off the inhaler. When inhalation of the aerosol through the mouthpiece should not be breathed to the nose, since in this case the medicine will not flow into the respiratory tract.

3. Do I need to use detergent to clean the components of the nebulizer after each inhalation?

Yes, it is necessary, as indicated in the instructions for use: "Put all the details about 5 minutes in warm tap water, adding a small amount of detergent (suitable neutral detergent for dishes). Wash all parts under running water thoroughly. Accelerate the removal of water droplets by shaking all the details for this. "

Attention! To prevent damage to the aerosol generator, do not cover the tank for the medicine in the microwave or dishwasher. Mechanical cleaning with a brush can also adversely affect the performance of the device.

It is very important after cleaning and disinfection to dry all the components. Especially the container for the medication with the built-in aerosol generator.

4. How often do you need to clean the membrane using VELOXCARE?

The washing of the membrane built into the drug capacity using VELOXCARE provides mechanical cleaning of the aerosol generator membrane. It is necessary that the membrane is not clogged, and served longer. The more often you will clean the membrane using VELOXCARE, the longer the service life of the membrane. (This should be done at least once a week, and with multiple inhalations during the day - every day).

What do I need to inhalation?

Always true as follows: You must have a survey before the start of any treatment. You need to use only prescribed medications prescribed or physician. Your doctor must decide which treatment to you more suitable. He is familiar with your diagnosis and can choose a medication suitable for your state and determine the optimal dose. Your pharmacist can also help you in any issues related to medicines.

Fully not suitable for inhalations:cough medicines, solutions for rinsing, balsams or drops used as ointments or hot water as a "bath for bath", vegetable oils, and the like. Similar drugs are often sticky and thick; They can long worsen the operation of the inhalation system (i.e., block the nozzle). In addition, such drugs may contain essential oils, which, in the case of bronchial hypersensitivity, can lead to an asthma rig. With such drugs should be extremely careful. If you have doubts, please consult your doctor.

Please follow the instructions for use and hygiene both before the first use of the nebulizer and after a long break.

Make sure that the nebulizer was cleaned after the last use. Disconnect the inner part of the nebulizer and fill with a medicine in accordance with the recommendations of the doctor (maximum volume 8 ml). Attach the mouthpiece and the inner part. If you are using a mask of betting for children or for adults (optional), the valve inhale does not join. Connect the compressor and nebulizer.

Now you have completed training and you can start inhalation.

How to carry out inhalation (on the example of the nebulizer bet ll)

1. Sit right and relax. Turn on the compressor.

2.
"A" Press the mouthpiece with teeth, graze lips and press the keystap key on the breath. Inhale as calmer.

"B" release the keys of the interrupter and slowly exhale. Exhaled air should pass through the exhalation valve in the mouthpiece (the exhalation valve opens).

Repeat the steps "a" and "b" until the sound of the sound published by the nebulizer will change. This means that the medication is over. Check if there is an aerosol from the mouthpiece (press the interrupter key). Stop inhalation when pairs will be irregular.

For continuous inhalation, the interrupter key can be blocked by turning clockwise.

Hygiene comments

There are certain standards in hygienic procedures: cleaning, disinfection and sterilization of nebulizer systems.

Today, inhalation is a standard part of the therapy of chronic respiratory diseases. Nebulizer systems today play an important role in inhalation therapy. However, the repeated use of these systems entails the risk of infection, since the causative agents of diseases penetrate the system, even though it is subjected to effective purification processes. Paris prevents such a situation, providing you as a user inhalation system with detailed care and hygiene instructions.

Parish Nebulizersdeveloped specifically for repeated use and are used both in clinics (in many patients) and at home (for one patient). Special hygienic procedures are necessary, depending on the main area of \u200b\u200buse of the nebulizer.

Maintenance and care for nebulizer betting

Please check the components of the nebulizer regularly and replace in case of defect (damaged, bleaching, deformed). With regular use, the nebulizer of Paris Lz Plus must be replaced once a year, nebulizer beta lles every two years.

Your nebulizer connecting tube must be replaced by approximately once a year, or if it lost its color.

4. Air filter
Check the air filter of the bet compressor once a month for the presence of contaminants or foreign objects, and replace if necessary. Use only insertion filter betting.

Practical set per year for regular replacement:

All spare parts for nebulizer Paris Systems Tour Bobe and Battering Junior Bags are included in these sets: a set for the year Paris Turgocoe and Batting Junior (available, like all other additions and accessories, your dealer).

If you have any other issues related to nebulizer therapy, then you can set them to Titovaya E.L., by clicking on the link ..

Respectfully,
LLC "Paris Synergy in Medicine"
Titova Elena Leonidovna, Ph.D.

Convection (general type)

This nebulizer with constant aerosol exit is the most common. During the inhalation, air is involved through the tube and breeding aerosol. The aerosol enters the respiratory tract only during the inhalation, and during the exhalation there is a loss of its greater part (55-70%). Ordinary nebulizers to achieve adequate aerosol exit require relatively high working gas flows (more than b l / min).



Fig.2. Scheme and aerosol output at convection nebulizer




Activated (controlled) inhalation (vesturi nebulizers)
Also produce an aerosol constantly throughout the entire respiratory cycle, but the release of the aerosol is enhanced during the inhalation. Such an effect is achieved by receiving an additional air flow during the inhalation through a special valve into the aerosol product area, the total flow increases, which leads to an increase in the formation of an aerosol. During the exhalation, the valve closes and the exhalation of the patient passes along a separate path, bypassing the area of \u200b\u200baerosol products.
Thus, the ratio of aerosol exit during inhalation and inhalation increases, the amount of inhaled drug increases, the loss of the drug decreases (up to 30%), and the nebulization time is reduced. Venetour nebulizers do not require a powerful compressor (a stream is 4-6 l / min).
Their disadvantages are the dependence on the patient's inspiratory flow and the slow speed of the aerosol product when using viscous solutions.
In patients with cystic fibrosis, it was shown that venturi nebulizers compared with ordinary allowed to twice the greater deposit of the drug in the respiratory tract: 19% against 9%.


Fig.3. Scheme and aerosol output at the nebulizer activated by inhalation (Venturi type)



Synchronized with breathing (dosimetric nebulizers)

Aerosol is produced only during the inhalation phase. The generation of aerosol during inhalation is ensured using electronic flow sensors or pressure, and theoretically, the ratio of the aerosol exit during the inhalation and exhalation reaches 100: 0. The main advantage of a dosimetry nebulizer is to reduce the loss of the drug during exhalation.
In practice, however, the loss of the drug may occur into the atmosphere during exhalation, since not the whole drug is postponed in the lungs. Dosimetric nebulizers have indisputable advantages when inhalation of expensive drugs, because Reduce their loss to a minimum. Some dosimetric nebulizers were created specifically for delivery of expensive drugs, for example, the Visan-9 nebulizer is designed to inhalation of surfactant preparations. The disadvantages of such systems are longer inhalation time and high cost.

Fig. 4. Schemes and aerosol output at a dosimetric nebulizer
Adaptive delivery devices also belong to the type of dosimetric nebulizers, although some experts consider them a new class of inhalation devices.
Their principal difference is the adaptation of the products and the release of the aerosol with the respiratory patter. An example of a nebulizer of this type is Halolite. The device automatically analyzes the inspiratory time and the patient's inspiratory flow (over 3 respiratory cycles), and then provides products and the release of the aerosol during the first half of the subsequent breath. Inhalation continues until the output of the exactly established dose of the drug substance is achieved, after which the device gives a beep and stops inhalation. Advantages of the device: fast inhalation of the dose of the drug (4-5 min), high compliance of patients to the therapy, high respiractive fraction (80%) and a very high deposition of aerosol in the respiratory tract - up to 60%.

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