Home atomization, what are the precautions? This article is enough

Guide

Inhaled nebulization is commonly used in pediatric patients. Whether it is acute laryngitis or asthma attack, nebulized inhalation has the advantages of non-traumatic, fast onset of action, and small adverse reactions. It can even play a first aid role at critical moments.

Many parents have the experience of taking their children to the outpatient atomization center for treatment. Some parents choose a household nebulizer according to the doctor's advice and do nebulization treatment for their children at home.

During the COVID-19 pandemic, in order to reduce the potential for aerosol-borne viruses from nebulization, the GINA guidelines also mention that nosocomial nebulization should be avoided if possible [1].

At the same time, home atomization also has safety problems caused by improper operation. Once on duty, the nurse received a call from a parent, and due to improper operation, the liquid inside the atomized mask was poured into the child's eyes, causing an emergency. Fortunately, under the guidance of the nurse, the child's eyes were washed in time without serious consequences.

Therefore, the specification of home nebulization inhalation therapy and the choice of household nebulizer have become a topic of common concern of pediatricians and parents of children.

Which households may require a household nebulizer

Most healthy children do not need this "medical device". For these children, the frequency of nebulization inhalation may be higher, and household nebulizers are necessary.

●Recurrent wheezing (wheezing): Wheezing in children, which may be viral-induced, may also be the initiating symptom of asthma. Empiric nebulized inhalation therapy observes wheezing response to treatment and is very helpful for diagnosis and subsequent treatment.

●Chronic cough (e.g., cough variant asthma): The Clinical Practice Guidelines for the Diagnosis and Treatment of Cough in Chinese Children (2021 Edition) recommend that children with chronic nonspecific cough be re-evaluated after 2 to 4 weeks of treatment with inhaled glucocorticoids (ICS) [2].

● Acute laryngitis and recurrent croup: Recurrent laryngitis refers to acute laryngitis that occurs more than twice a year and is itself a risk factor for asthma [3, 4]. Acute laryngitis is a common disease in children, many children with upper respiratory tract infections, due to vocal cord edema caused by hoarseness, coughing "empty" sound, can be diagnosed as acute laryngitis according to symptoms. On the mainland, inhalation nebulization is the most commonly used regimen for the treatment of acute laryngitis in children.

Some children with asthma do not have access to reservoirs and dosing aerosols (MDI): For these children, GINA guidelines recommend inhaling drugs through nebulizers as an alternative [1].

Source: Stand Cool Helo

In remote areas, when it is inconvenient to seek medical treatment: In some areas, the medical conditions are not good, the traffic is not developed, resulting in the inconvenience of medical treatment, if there is a need for nebulization inhalation treatment, the role of household nebulizers is necessary.

Misconceptions about the use of nebulized inhalation therapy

After the common cold, it is easy to use nebulized inhalation therapy: cough and asthma caused by viral infections, such as influenza and respiratory syncytial virus (RSV) infection, the effect of nebulization inhalation therapy is not good, and domestic and foreign guidelines do not recommend the conventional use of nebulized inhalation ICS treatment [5, 6]. UpToDate, the authoritative clinical database, also does not recommend aerosol inhalation therapy for cough after the common cold [7]. However, it should be noted that some cough and asthma have complex etiology, and nebulized inhalation therapy may be used for empiric treatment, adjusting subsequent treatment regimens according to the effect of treatment.

Feel free to use saline aerosolization: Some parents prefer to use saline for aerosol inhalation therapy, but there is not enough evidence that saline aerosolation is beneficial for the common cold. Do not use this treatment regimen lightly unless advised by your doctor.

Classification and selection of nebulizers

At present, there are more nebulizer brands on the market, the price is not equal, according to the working principle of the nebulizer, it can be divided into the following three categories:

● The compression atomizer crushes the liquid into droplets of varying sizes through high-speed air flow (compressed air), and then filters the droplets of standard size through the baffle in front of the mask. It is similar to the principle of oxygen atomization in hospitals. It is the mainstream product in the market, powerful and reliable. The disadvantage is that the noise is too large and it is not conducive to carrying.

● Mesh atomizer: using a newer technology, the use of piezoelectric principle, the noise is relatively small, relatively light and portable, but the atomization efficiency is low, is a trendy product.

● Ultrasonic nebulizer: the technology is earlier, the atomization particles are larger, and the liquid medicine stays in the oropharynx, which is rarely used at present.

How to be more effective in home nebulization treatment

Strict medical instructions for medication: Medication should be strictly followed by medical advice. If necessary, the first use can be learned in a medical institution, and the skills can be mastered before starting to use outside the hospital.

Keep calm breathing: Be patient and skillful when atomizing your child, play with your child, watch videos, etc., and improve your child's cooperation by distracting your attention. The atomization effect when breathing calmly is better than deep breathing and crying.

Correct placement of the mask: Pay attention to holding the mask in the correct position, usually vertical, to avoid pouring the liquid. At the same time, the mask should be placed correctly, so that it fits the face and reduces the contact of the atomizing drug to the eyes.

Avoid infection of utensils: Masks and pipes should be cleaned after use and stored after air drying. Avoid cross-use of fogging masks and take care to replace masks and pipes regularly.

Prevent adverse reactions: after each atomization, be sure to pay attention to scrubbing the face and gargling, reduce local drug residues, so as not to cause contact dermatitis, fungal infections, etc.

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Image source: Stand Cool Helo

bibliography:

[1] Global Initiative for Asthma . 2020. GINA Report, Global Strategy for Asthma Management and Prevention.

[2] Clinical Pharmacology Group of Science Branch of Chinese Medical Association, National Clinical Research Center for Children's Health and Disease, Respiratory Group of Pediatrics Branch of Chinese Medical Association, etc. Clinical Practice Guidelines for the Diagnosis and Treatment of Cough in Children in China (2021 Edition)[J]. Chin J Pediatrics, 2021, 59(9): 720-729.

[3] Lin SC, Lin HW, Chiang BL. Association of croup with asthma in children: A cohort study. Medicine (Baltimore). 2017;96(35):e7667.

[4] Nicolai T, Mutius EV. Risk of asthma in children with a history of croup. Acta Paediatr. 1996 Nov;85(11):1295-9.

[5] Editorial Board of Chinese Journal of Pediatrics, Respiratory Group, Science Branch of Chinese Medical Association. Expert Consensus on the Diagnosis, Treatment and Prevention of Bronchiolitis (2014 Edition) [J] . Chin J Pediatrics,2015,53(3): 168-171.

[6] Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics November 2014; 134 (5): e1474–e1502.

[7] Common Cold in Children: Treatment and Prevention, UpToDate Clinical Advisor, https://www.uptodate.com/.