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What are the commonly used drugs for home nebulization? Check it out!
Respiratory diseases are extremely common among urban and rural residents in mainland China, and the case fatality rate and economic burden are high, which is a major challenge for public health management in mainland China [1]. Nebulized inhalation therapy is one of the main treatments for respiratory diseases, which can deliver drugs directly to the airways and lungs, and has many advantages, such as small drug dose, high local drug concentration, short drug onset time, few systemic adverse reactions, high bioavailability, and no need for patients' deliberate cooperation [1-2]. In recent years, with the popularization of domestic use of medical devices, home nebulization therapy has gradually emerged, and has become a treatment option for patients with respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD).
So what are the commonly used home nebulizer therapy drugs? What are the therapeutic effects of each of them? What are the precautions? This article is summarized below according to the consensus of the relevant guidelines for the benefit of readers.
吸入性糖皮质激素（ICS）
ICS is currently the strongest airway topical anti-inflammatory drug, which exerts anti-inflammatory effects through its effects on cells and molecules necessary for the inflammatory response[1]. Nebulized inhaled ICS is effective in reducing airway inflammation and airway hyperresponsiveness, controlling asthma symptoms, improving lung function, reducing asthma exacerbations, improving patients' quality of life, and even reducing asthma mortality [3]. In addition, compared with systemic glucocorticoids, ICS has a good safety profile, a low incidence of adverse reactions, and a small impact on blood glucose and bone mineral density [4], and can be used not only for long-term control of asthma and acute exacerbations, but also for the treatment of various respiratory diseases such as cough-variant asthma (CVA) and chronic obstructive pulmonary disease [1-4].
Notes[2]:
(1) In the acute exacerbation of asthma, high-dose ICS combined with bronchodilators is required to quickly control asthma symptoms, and the dose of ICS should be reduced after asthma symptoms are controlled, and long-term high-dose inhaled hormones can lead to adverse reactions. This point should be of particular concern to patients using home nebulization.
(2) For patients with chronic airway inflammatory diseases who need to take long-term standardized inhalation of ICS to control airway inflammation and protect lung function, they should follow the doctor's advice and avoid changing the dosage of drugs at will. Although the available literature supports the safety of long-term low-dose inhaled corticosteroids, overuse should be avoided.
Bronchodilators
Bronchodilators are commonly used in patients with asthma, chronic obstructive pulmonary disease, chronic bronchitis, and other diseases, and can be divided into two categories: beta-2 agonists and anticholinergic drugs [4-5].
- Beta-2 agonists
It can be divided into short-acting β2 agonists (SABAs) and long-acting β2 agonists (LABAs), and SABAs are currently commonly used nebulized inhalation preparations [1]. SABA activates adenylyl cyclase (AC) and increases intracellular cyclic adenosine monophosphate (cAMP) synthesis by stimulating β2 receptors on the surface of airway smooth muscle and mast cell membranes, thereby stabilizing mast cell membranes and relaxing airway smooth muscle [5].
Notably, ICS has a synergistic effect when used in combination with SABA, which upregulates β2 receptor expression and reduces tolerance due to beta2 receptor downregulation, while SABA promotes GS receptor translocation, thereby increasing the anti-inflammatory effects of ICS [5]. The Global Asthma Initiative (GINA) states that when SABA therapy is indicated, ICS should be used in combination [6].
- Anticholinergic drugs
It can be divided into short-acting anticholinergic drugs (SAMAs) and long-acting anticholinergic drugs (LAMAS), and the most commonly used nebulized inhalation preparations are SAMAs [1]. SAMA inhibits airway mucus secretion and smooth muscle contraction by competing with endogenous choline for muscarinic receptors (M receptors) on target cells[2]. The addition of SAMA is recommended for acute exacerbations of moderate to severe asthma or for patients who are poorly controlled with SABA [5].
Precautions[5]:
(1) Excessive or inappropriate use of SABA can lead to adverse reactions, such as headache, tremor, tachycardia, etc.
(2) The use of SAMA in patients with glaucoma and prostatic hypertrophy may lead to the aggravation of the original disease, so pay attention to identifying and replacing the drug.
Anti-infective drugs
At present, only some manufacturers of amphotericin B for injection have been approved for the nebulized inhalation treatment of severe fungal infections in mainland China [5].
Precautions[5]:
Although the injection form of anti-infective drugs is commonly used in the nebulized treatment of various respiratory diseases, there is a lack of sufficient evidence-based medical evidence for their efficacy and safety. There is evidence that nebulised therapy with non-nebulised inhaled dosage forms may cause a variety of adverse effects.
Expectorant medications
Commonly used expectorant drugs include acetylcysteine and ambroxol hydrochloride. The sulfhydryl group in the chemical structure of acetylcysteine can break the disulfide bonds between the mucin molecular complexes, reduce the viscosity of sputum, and make sputum easy to cough up, which is suitable for patients with excessive thick mucus secretions. Ambroxol hydrochloride can not only reduce the viscosity of mucus, but also stimulate the synthesis and release of alveolar surfactant, enhance the oscillation ability of airway cilia, and further promote sputum discharge, which is suitable for patients with abnormal sputum secretion and poor expectoration function [2].
Notes[2]:
(1) After the use of expectorant drugs, the discharge of sputum should be promoted to avoid aggravating airway obstruction.
(2) Acetylcysteine and ambroxol hydrochloride may cause bronchospasm, which should be used with caution, and if bronchospasm occurs during use, the treatment should be terminated immediately. Summary ·
Home nebulizer therapy has become the treatment option for many patients with respiratory diseases, but there is a lack of professional supervision in the home environment, and the blind or wrong use of therapeutic drugs may cause counterproductive effects and affect disease recovery and health. Therefore, medical staff should strengthen health education about nebulization therapy drugs to ensure the safety and effectiveness of home nebulization therapy and better protect the health of patients.
Bibliography:
[1] Expert Group on the Application of Nebulized Inhalation Therapy in Respiratory Diseases by the Chinese Society of Respiratory Diseases. Expert consensus on the application of nebulized inhalation therapy in respiratory diseases. Chinese Medical Journal,2016,96(34):2696-2708.
[2] Liu Hanmin, Fu Zhou, Zhang Xiaobo, et al. Expert consensus on the rational application of nebulization therapy for pediatric respiratory diseases. Chinese Journal of Pediatrics,2022,60(04):283-290.
[3] Shen Kunling, Deng Li, Li Yunzhu, et al. Expert consensus on the application of glucocorticoid nebulized inhalation therapy in pediatrics (revised edition in 2018) [J].Journal of Clinical Pediatrics,2018,36(02):95-107.)
[4] Li Fan, Zhang Huizhi. Nursing Research,2018,32(18):2838-2842.)
[5] Du Guang, Zhao Jie, Bu Shuhong, et al. Expert consensus on rational use of nebulized inhalation therapy (2019 edition) [J].Herald of Medicine,2019,38(02):135-146.)
[6]2024 Global Strategy for Asthma Management and Prevention（2024 GINA）.https://ginasthma.org/2024-report/
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