Inhalation in chronic and obstructive bronchitis in adults and children: drugs, solutions, antibiotics

On a question - whether it is possible to do inhalations at a bronchitis? - Pulmonologists answer in the affirmative, since the introduction of drugs through the respiratory tract, bypassing the gastrointestinal tract, is one of the most important methods of cough treatment for respiratory diseases.

Inhalation with bronchitis makes it possible not only to quickly and purposefully influence the ciliary epithelium of the mucosa of inflamed bronchi, improve the clearance of the tracheobronchial secretion and relieve spasm, but also minimize possible side effects of the drugs.

[1], [2], [3], [4], [5]

Indications for the procedure

The main indications for inhalation therapy with any nebulizer or device (inhaler) include all forms of diseases of the tracheobronchial and respiratory areas of the respiratory tract: acute and chronic bronchitis and tracheobronchitis, purulent bronchitis, bronchopneumonia, obstructive bronchitis and COPD (chronic obstructive pulmonary disease) , asthmatic bronchitis and bronchial asthma.

It should be borne in mind that hot steam inhalation with bronchitis at a body temperature above the subfebrile (more than + 37.5 ° C) is contraindicated, and with severe arterial hypertension, it is not recommended.

[6], [7], [8], [9]

Preparation

The main preparation for inhalation concerns the preparation of the solution - in exact accordance with the indicated proportions and dosage. The solution injected by a mechanical or electrical sprayer should be approximately the body temperature.

[10], [11], [12], [13]

Technique of the inhalations with bronchitis

The technique depends on the device used. It should be sprayed at the same time as the inhalation (slightly tilted head), the input should be calm, without forcing. After a delay of 3-4 seconds, the breath is exhaled through the nose. Most conveniently, inhalers with a mouthpiece: the main thing is not to open your lips when you inhale.

The rule is simple: one dose (inhalation) - one spray solution.

Preparations for inhalation with bronchitis

With all the variety of spraying devices used today (pneumatic, membrane or ultrasonic inhaler) are considered the most effective due to the finely dispersed aerosol into which the liquid drug is converted and penetrates passively into the ciliated epithelium of the bronchial mucosa.

To conduct effective inhalation with bronchitis, you need drugs that provide the maximum therapeutic result in fighting the main symptoms of the disease - coughing and narrowing of bronchial lumens.

In practice, the following drugs are used for inhalation with bronchitis:

• bronchodilators (bronchodilators) - Salbutamol (Salbutan, Salvobent, Ventolin, Aeroline and other trade names), Berodual, Formoterol (Foradil), Terbutaline, Fenoterol (Berotek, Aerum, Arutherol);
• diluting mucous secretions of bronchi (mucolytics) on the basis of ambroxol hydrochloride (Ambrobe, Lazolvan, etc.) and acetylcysteine (solution of Acetylcysteine for inhalations, Tussicom, Fluimucil);
• compounds of cromoglycic acid (Cromolin powder for solution, Tileed or Taleum aerosols);
• fluorinated glucocorticosteroids for inhalation with a nebulizer: Pulcicort (Budesonide), Fluticasone (Flixotide), Dexamethasone, Beclomethasone dipropionate (Beclometh, Becotid). Experts emphasize that in the presence of these preparations of inhalation with Prednisolone now no one conducts: prednisolone is a non-fluorinated GCS (that is, its mineralocorticoid activity is higher and systemic side effects are manifested more often) and is intended for parenteral and oral administration.

About that, when antibiotics are necessary for inhalations at a bronchitis, speech will go further.

Solutions for inhalation with bronchitis

In addition, some antiseptic solutions for inhalation in bronchitis, conducted with a nebulizer, are used. True, some of them are used in otorhinolaryngology - patients with angina, laryngitis or pharyngitis.

Despite the fact that the application in pulmonology is not indicated in the official instruction,  Miramistin inhalations are popular due to the bactericidal properties of this quaternary ammonium compound benzalkonium: practically not absorbed by the mucous membrane, the drug (in the form of 0.01% solution) has a harmful effect on the microbial, viral and fungal infection. It is recommended that adults take one inhalation per day (single dose - 4 ml), and children 5-12 years - 3 ml (1 ml miramistina + 2 ml saline). Although this antiseptic is effective only at the initial concentration.

Bacteriostatic drug Decamethoxin or  Dekasan for inhalation is used in the case of complicated bronchitis, when there is an admixture of pus in the cough. Then nebulizer inhalations are carried out twice a day - 5-10 ml of the solution: it is prepared from a mixture of the drug with saline in a ratio of 1: 1 for adults and 1: 3 for children (over two years old).

Antiseptic and anti-inflammatory agent, which is a 1% alcohol solution of eucalyptus leaf extract -  Chlorophyllipt for inhalation is  also more used in ENT practice. It is also diluted with saline (1:10) and applied 3-5 ml twice daily.

By the way, to moisturize the mucous it is possible to do  inhalations with saline solution : once or twice a day for 5-10 ml of a slightly warm 0.9% aqueous solution of sodium chloride.

Inhalations with Dioxydinum  - also are evaluated ambiguously. First, this bactericidal drug, according to the instructions, is used in the treatment of severe purulent inflammation, necrotic wounds (including burns) and sepsis. Secondly, Dioxydin inhalations are done only with purulent diseases of the nasopharynx and only adults. In addition, this drug is toxic, and its tolerance to patients is monitored in a health facility (with monitoring of the basic indicators of the functioning of the body).

Regarding  inhalation with Eufillin  it should be noted that this drug is designed to relieve spasms of the bronchi, vessels of the lungs and brain - by ingestion, intramuscular and intravenous injections, as well as rectally (make microclysters). On the mucous membranes, Euphyllin acts irritatingly, so the doctor will not prescribe it for inhalations.

Inhalation in acute and chronic bronchitis

Inhalations in acute bronchitis are carried out in order to relieve cough by diluting thick sputum, which is difficult to cough up. For this, mucolytics are used.

Do inhalations with a nebulizer with acetylcysteine (in the form of a 20% solution for inhalation in ampoules, another trade name - Tuussicom) - 2-5 ml to three times during the day (duration of the procedure is 15 minutes). Inhalation in bronchitis in children with this drug is allowed only after two years. More useful information in the material -  Treatment of bronchitis in children

Ready solution (15 mg / 2 ml)  Lazolvan with bronchitis - inhalations are administered to adults and children from the age of five - 2.5 ml; children from two to five years - 2 ml each; children under 2 years - 1 ml of the drug, no more than twice a day. In saline solution Lazolvan can not be dissolved: the pH of the saline solution is higher than 5 (7-7.5), and the drug will precipitate. It is allowed to dilute in equal proportions with distilled water. The same applies to  inhalation with Ambrobe, since both agents contain ambroxol hydrochloride and are synonymous. The concentration of Ambrobene solution is 7.5 mg / ml, but this is not reflected in the dosage at all.

Pulmonologists recommend to prevent coughing attacks after the procedure with the help of preliminary use of bronchodilator agents. And about an hour after inhalation to make a drainage massage, read in detail -  How to do a massage with bronchitis

Inhalations in chronic bronchitis are carried out with both mucolytic agents and bronchodilators: Salbutamol, Berodual, Formoterol, Terbutalin, Fenoterol. And when exacerbating, Dekasan is used.

In acute and chronic inflammation of the bronchi, narrowing of their lumen often occurs, which is manifested by difficulty breathing with shortness of breath and wheezing. And in such cases, inhalations are performed in obstructive bronchitis.

Salbutamol inhalation is prescribed (in the form of an inhalation solution of 1.25 mg / ml in ampoules) - 2.5 ml (without diluting anything) up to four times a day. Possible side effects in the form of tachycardia, nausea and vomiting, tremors and heightened anxiety.

Inhalation with Berodual is allowed five times a day (but no more than two hours after the next procedure, lasting about five minutes). The dosage for the nebulizer is 4 drops of the drug on 3 ml of saline. When using a manual inhaler, the drug is not diluted. Side effects of Berodual are similar to Salbutamol.

Read also -  Treatment of obstructive bronchitis

Inhalation with purulent bronchitis

If the disease has entered the stage of inflammation with necrosis (as evidenced not only by yellow-green sputum when coughing and wheezing with breathing, but also subfebrile fever), it should be borne in mind that do hot (steam) inhalations for purulent bronchitis in no case it is impossible. And you can inhalation Dekasan, Chlorophyllipt or Miramistin.

And here it would be necessary to use antibiotics for inhalations with bronchitis, best of all - fluoroquinolones, macrolides and cephalosporins of the last generations. But they all refer to systemic drugs and have other uses, oral or parenteral.

As the studies show, even in a modern clinical hospital, only half of patients with acute bronchitis can reliably identify the pathogen. And a key role in the etiology of this disease (in more than 90% of cases) is played by viruses. Therefore, treatment, even without the verification of a bacterial pathogen, requires the use of antibiotics in the presence of purulent sputum and an increase in its quantity.

Previously, doctors prescribed inhalation with Bioparox (with a polypeptide antibiotic fusaphungin), but the European Medical Agency, after examining the side effects of the drug, banned its release in the spring of 2016.

Now antimicrobial preparations for inhalations in bronchitis are limited to 4% solution of Gentamycin sulfate (an antibiotic of the aminoglycoside group), which is diluted for inhalations with physiological saline - 1: 6 for adults and adolescents over 12 years old, and for children 2-12 years - 1:12 . One procedure per day consumes no more than 3 ml. In the list of side effects of Gentamicin (true, with parenteral administration), not only a decrease in kidney function, but also a worsening of hearing before it is completely lost.

See also -  Antibiotics for bronchitis

Inhalation with asthmatic bronchitis

Asthmatic or  allergic bronchitis  suggests - in addition to the previously indicated bronchodilators and mucolytics - the appointment of glucocorticoids, which relieve inflammation.

For  inhalation with Dexamethasone  , a solution for parenteral administration (2 ml ampoule) is used, which is mixed with saline (12 ml). The dose of one procedure does not exceed 4 ml, and their number and duration of treatment is determined by the doctor.

The Pulmicort suspension  for inhalations  (in 2 ml of a suspension of 0.5 mg of active substance budesonide) is also used. Dosage: 1-2 mg per day for an adult, for children older than six months - 0.25-0.5 mg.

Effective inhalations in bronchitis (adults and children over five years old) - procedures with a nebulizer with compounds of cromoglycic acid in the form of nedocromil sodium (Cromolin powder for solution, ready aerosols Tileed, Taleum): three to four times a day for 5-10 mg 4 times a day. It is recommended before the procedure to make inhalation with one of the bronchodilators, since after nedocromil-sodium there may be spasm of the bronchi.

Inhalation in bronchitis at home

The proposed inhalation prescriptions for bronchitis, which can be done to relieve cough, are numerous and varied.

The most famous inhalations for bronchitis in the home are steam: to breathe with the mouth above the water tank t <+ 60-65 ° C (for the child t <+ 42-45 ° C), covering the head with a towel, exhale through the nose. The effect of steam contributes to the flow of blood and the improvement of the trophism of the tissues of the lower respiratory tract; the excreted mucus becomes less viscous, and it is easier to cough it out.

If for every half-liter of water put a teaspoon of table salt or sea salt, will be inhaled with salt. When sodium chloride is replaced with sodium bicarbonate, inhalations with soda are obtained. And if you boil the potatoes in the peel, drain the water and, with your head covered up, take a hot brew, then it will be inhalation with potatoes.

The last two procedures are alkaline, which is useful for thick, difficultly excreted sputum. Therefore, inhalations with mineral water are made: with natural hydro-carbonate mineral water - Borjomi inhalations with bronchitis; Transcarpathian waters of Svalyava, Polyana Kvasova and Luzhanskaya, as well as inhalations with Essentuki (Essentuki No. 4 and No. 17).

Despite the entire arsenal of phytoncides with their bactericidal properties, garlic inhalation (a teaspoon of juice squeezed from grated garlic, 200 ml of water) is unlikely to get rid of a cough: they are better for inflammation localized in the pharynx and larynx.

If you use an inhaler (and not a funnel or a cone that closes the container with a solution), then an inhalation of propolis will bring an unconditional benefit to the inflamed mucosa (adults can use propolis tincture on alcohol by adding a teaspoon to 100 ml of boiled water).

How many times do inhalation for bronchitis? No more than twice a day at 10-12 minutes of one procedure for an adult, five minutes for children 6-10 years and three minutes for an infant.

It is recommended to use medicinal plants and herbs for inhalation with bronchitis (in the form of broths).

Warm-humid inhalation with chamomile: the broth is prepared from the flowers of the plant (a couple of tablespoons in a glass of water), used in a warm form (after filtering the broth) - using a hand-held inhaler.

Inhalation of eucalyptus: a decoction of dried leaves is prepared similarly.

Inhalation decoction of pine buds or young needles (two or three tablespoons cook for 10-15 minutes in 700 ml of water).

The most effective herbal collection for inhalation consists of flowers of chamomile and calendula; herbs of thyme, peppermint and sage, as well as leaves of spray and eucalyptus.

Which oil for inhalation is better for bronchitis? Phytotherapists advise: cough for infectious inflammation is useful for inhalation with fir oil (4-5 drops of 150-180 ml of water), clove oil, essential oils of thyme, rosemary, fir, eucalyptus, tea tree, lemon grass (herb), marjoram, sage.

But inhalation of sea buckthorn oil is technically difficult to implement: in the inhaler-nebulizer solutions with oil are not poured, and all other devices simply will not bring to the bronchi a heavy oil suspension, and it will settle in the throat and trachea.

Due to the presence of menthol and camphor, as well as the essential oils of mint, eucalyptus, cloves and Chinese cinnamon, inhalations are made with an asterisk (in the sense, with a grain of balm "Golden Star"). However, it should be remembered that such inhalations in bronchitis in children are contraindicated, and with asthmatic bronchitis this recipe is not suitable, moreover, will lead to increased cough and edema.

Obviously, as a surrogate of essential oil of mint, inhalation of Validol has dispersed among the people, since in Validol contains a solution of menthol in methyl ester of isovaleric acid, and it relieves spasms and soothes. But children under 12 years old and those who have low blood pressure or problems with blood supply to the brain, Validol in any form is contraindicated.

Contraindications to the procedure

In addition, contraindications for inhalation apply to patients with: cardiac and / or pulmonary insufficiency in severe form; marked tachycardia or cardiac arrhythmia; pneumonia caused by infections such as Haemophilus influenzae, Pneumocystis, Chlamydia trachomatis, or Cytomegalovirus; pulmonary hemorrhage (primarily, with pulmonary tuberculosis); purulent inflammation of the pleura or the presence of air in its cavity; Bullous form of pulmonary emphysema.

In the presence of bacterial, viral and fungal infections of the respiratory system, inhalations with corticosteroids are contra-indicated.

You can not do any inhalation in bronchitis in infants with congenital problems of pharyngeal reflex and soft palate if they have recurrent aspiration bronchitis.

With bronchitis of an allergic nature, inhalations are not carried out with decoctions of medicinal plants and essential oils. Inhalation solutions containing menthol oil or camphor are unacceptable in the treatment of young children (up to two years).

Inhalations with bronchitis in pregnant women do not allow the use of most drugs (especially antibacterial, steroid and bronchodilator); in the first three months pregnant women are not recommended inhalation with acetylcysteine and Ambroxol hydrochloride (Lazolvanom). Remains such means as salt, soda, mineral water and, of course, steam inhalations in bronchitis - over boiled potatoes in a uniform or decoction of eucalyptus leaves. Read more -  How to treat a cough during pregnancy

[14], [15], [16], [17]

Complications after the procedure

Experience shows that the main negative consequences after the procedure of steam inhalation, which are carried out at home, are burns of the mucosa of the respiratory tract.

Complications after the inhalation procedure Berodual or Salbutamol include the appearance of headache, tachycardia, tremor of the extremities. In patients with diabetes, blood sugar levels may rise, in elderly patients - nausea, vomiting, intestinal problems may begin.

With asthmatic bronchitis, inhalations can cause increased spasms, airway obstruction and asthma attacks.

With prolonged use of inhalations with glucocorticosteroids in children with chronic asthmatic bronchitis, growth retardation and a reduction in bone tissue density may be due to a disruption in the production of hormones of the hypothalamus, pituitary gland, and adrenal glands.

[18], [19], [20], [21], [22], [23]

Care after the procedure

Special care after inhalations is not required, just need to calmly rest in a warm room, about an hour not to drink and do not take any food, and it is better not even to talk.

[24], [25], [26]