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Why Albuterol Is No Longer Used for Bronchiolitis

Bronchiolitis is a lower respiratory tract infection that commonly occurs in children under 2. It is usually caused by the respiratory syncytial virus (RSV), which triggers inflammation of the smaller air passages (bronchioles). The inflammation causes the partial or complete constriction of the bronchioles, resulting in wheezing and shortness of breath.

Bronchiolitis is the leading cause of hospitalization in infants and young children. Since there is no cure for bronchiolitis, treatment is primarily aimed at alleviating symptoms of fever and breathing difficulties. If hospitalization is required, the treatment may also include supplemental oxygen and intravenous fluids to prevent dehydration.

In the past, the drug albuterol was commonly used in hospitals to help the child breathe. Albuterol is classified as a bronchodilator that works by relaxing muscles in the air passages. It is available in inhaled, oral, and injectable formulations and is commonly prescribed to people with chronic obstructive pulmonary disease (COPD) and asthma.

While it would seem reasonable to use albuterol in cases of severe bronchiolitis, updated guidance from the American Academy of Pediatrics (AAP) now recommends against its use.

Why the AAP Advises Against Albuterol

In their updated 2014 recommendations, the AAP acknowledged that albuterol can provide transient relief in children with bronchiolitis in the same way that it does asthma. However, the actual effectiveness of the drug in this scenario was largely subjective.

Research published in 2013 has shown that the use of albuterol in hospitalized children did nothing to improve outcomes or reduce hospital stays. Moreover, the AAP recommends against other treatments commonly used in the past, including nebulized hypertonic saline, systemic corticosteroids, antibiotics, and chest physiotherapy.

When to Go to the Hospital

Bronchiolitis in children will usually develop after two to three days of the common cold. It typically starts with nasal congestion and discharge, a mild cough, and a fever over 100.4 F.

If the infection progresses and the lower air passages are involved, the condition can become serious and lead to symptoms of:

  • Rapid breathing
  • Wheezing
  • Persistent coughing
  • Difficulty feeding
  • Gaps in breathing (apnea)

A parent will know that it’s time to take the child to the emergency room if the wheezing lasts for more than seven days or progresses to grunting.

Another indication that a trip to the ER is warranted is if a child is using the muscles between the ribs or at the neck to take in breaths, is belly breathing (meaning the belly is going up and down severely with each breath), or cannot complete sentences without taking breaths in-between.

If the child weakens considerably and has a bluish tinge to the skin or lips (cyanosis), the parent should consider it a medical emergency and call 911.

Current Hospital Recommendations

Approximately 2-3% of all children will require hospitalization for bronchiolitis. Treatment involves the monitoring of vital signs and supportive care based on the child’s condition and symptoms.

Supplemental oxygen may be needed for children who are unable to catch their breath. This is usually done by placing a tube, called a nasal cannula, under a child’s nose or by using a face mask. For infants, an oxygen headbox may be used.

If the child is unable to eat or drink, either because the respiratory rate is too fast or breathing is severely impaired, fluids and nutrition may need to be delivered intravenously (into a vein).To prevent the spread of the virus, the child would be isolated from siblings and other children until the condition is fully resolved.

Most children hospitalized for bronchiolitis are well enough to return home after three to four days.

Breathing Easier Through Treatment and Management

Causes of Bronchitis

A variety of factors have been recognized as triggers for bronchitis, including exposure to irritants (chemical and pollution), but the most common causes of acute bronchitis include the same viruses that cause the common cold and the flu. 1-3 Bacterial infection may also cause acute bronchitis.1-3 The most frequent cause of chronic bronchitis is tobacco use, representing an estimated 80% to 90% of chronic bronchitis cases.1-3 According to the American Lung Association, chronic bronchitis is one of the 2 main types of chronic obstructive pulmonary disease (COPD).1,3,5 Most individuals with COPD have both emphysema and chronic bronchitis.1,3,5,6

Airway obstruction in chronic bronchitis occurs because swelling and excessive mucus production cause the bronchioles to become narrower than usual.7 Chronic bronchitis may be a manifestation of a history of several acute bronchitis attacks, or it may have a gradual onset due to a history of heavy tobacco use or inhalation of irritants such as secondhand smoke or other pollutants.1,2,6,7 The most common sign of bronchitis is cough, followed by possible sputum production; the condition appears to occur most frequently during the winter months.7,8 Other common signs and symptoms of bronchitis are outlined in Online Table 2.7,8

TABLE 2: SIGNS AND SYMPTOMS OF BRONCHITIS

Acute Bronchitis

Chronic Bronchitis

  • Hacking cough that is productive or minimally productive and persists for 10 to 20 days
  • If mucus is colored, an infection may be present
  • Possible low-grade fever
  • Tenderness or soreness in the chest with coughing
  • Sore throat from constant coughing
  • Chronic cough and sputum that last for at least 3 months
  • Increased mucus production
  • Sputum may be clear or yellowish or greenish depending on the presence of a bacterial infection
  • Dyspnea, wheezing
  • Frequent clearing of the throat
  • Fatigue

Adapted from references 7 and 8.

Managing and Treating Bronchitis

The main goals in treating both acute and chronic bronchitis are relieving symptoms, enabling the patient to breathe more comfortably, and improving overall quality of life.

Acute Bronchitis

Whereas acute bronchitis generally resolves quickly in healthy patients, cardiopulmonary or other comorbid conditions may exacerbate the condition.1 Typically, treatment for acute bronchitis is symptomatic and may entail the use of analgesics, antipyretics, antitussives, and/or expectorants.

The majority of acute bronchitis cases are caused by viruses; therefore, the use of antibiotics is typically not recommended.1,2,6 Due to the overuse of antibiotics and ongoing concerns about drug-resistant organisms, the CDC and other health organizations oppose the routine use of antibiotics in uncomplicated bronchitis unless the patient has a bacterial infection.1,8,9 Results from a recent study show that overuse of antibiotics in acute bronchitis rose by 70% between 1996 and 2010 despite CDC guidelines.10

Patients with acute bronchitis should be advised to quit smoking, avoid exposure to secondhand smoke, implement good hand washing techniques into daily routine, and maintain recommended immunizations, especially the yearly influenza vaccine.9

Chronic Bronchitis

The goals of treating chronic bronchitis are to alleviate symptoms, prevent further complications, and slow progression of the disease.1,3,9,11-13 Chronic bronchitis may require a combination of therapies, including the use of bronchodilator medications, inhaled steroids, antibiotics, vaccines, oxygen therapy, and pulmonary rehabilitation.1,3,9,11-13 The two major drug classes used to treat chronic bronchitis include bronchodilators and steroids.1,9,11-13 Short-acting beta-agonists such as ipratropium bromide are often used for controlling bronchospasms, dyspnea, and chronic cough in stable patients with chronic bronchitis. 1,9,11-13 In some cases, a long-acting beta-agonist in conjunction with an inhaled corticosteroid may be employed to control chronic cough.1,9,11-13 Results from some studies suggest that treatment with mucolytics has been associated with a small decrease in acute exacerbations in patients with chronic bronchitis.1,14 The use of antibiotics may be needed for chronic bronchitis exacerbations caused by bacterial infections; the mostly commonly used antibiotics include macrolides, quinolones, and amoxicillin/clavulanate.1,15,16

Some studies have concluded that the most effective measures for managing chronic bronchitis are smoking cessation and avoidance of irritants,especially tobacco fumes.1,9,11,13 Some patients with chronic bronchitis may require pulmonary rehabilitation (in which the patient is taught exercises and other ways to ease breathing), supplemental oxygen therapy, and lifestyle modifications such as quitting smoking, getting plenty of rest, and avoiding irritants such as aerosol sprays, dust, and chemicals.12 Because chronic bronchitis can increase a patient’s risk for pulmonary infection, patients should be encouraged to obtain a yearly influenza vaccination; to protect against pneumonia, patients should also consider the pneumococcal vaccination.1,17,18

Newly Approved Medications

In August 2014, the FDA approved olodaterol (Striverdi Respimat, Boehringer Ingelheim) inhalation spray, a long-acting beta2-agonist bronchodilator indicated for the treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema19 (Online Table 3). This long-term maintenance medication is administered once daily. The most commonly reported adverse reactions include nasopharyngitis, upper respiratory tract infection, urinary tract infection, cough, dizziness rash, diarrhea, back pain, and arthralgia.19

TABLE 3: PHARMACOLOGIC THERAPIES FOR BRONCHITIS

Drug Class

Indication

Examples

Antitussives/expectorants

These agents are used to treat minor cough resulting from bronchial and throat irritation. For patients with chronic bronchitis, central cough suppressants such as codeine and dextromethorphan

are recommended only for short-term symptomatic relief of cough.

· Dextromethorphan, codeine (antitussives)

· Guaifenesin (expectorant)

Bronchodilators

Bronchodilators aid in relieving the symptoms of chronic bronchitis by relaxing and opening the air passages in the lungs.

Beta2-adrenergic agonists, short-acting bronchodilators:

· Albuterol (Proventil HFA, Ventolin HFA, ProAir HFA)

· Levalbuterol (Xopenex, Xopenex HFA)

· Metaproterenol

Beta2-adrenergic agonists, long-acting bronchodilators

· Indacterol (Arcapta Neohaler)

· Salmeterol (Serevent Diskus)

· Formoterol (Performist, Foradil)

· Arformoterol (Brovana)

· Olodaterol (Striverdi Respimat)

Anticholinergics

· Tiotropium (Spiriva)

· Ipratropium (Atrovent HFA)

· Aclidinium (Tudorza Pressair)

· Umeclidinium (Incruse Ellipta)

Xanthine derivatives

· Theophylline (Elixophyllin, Theo-24, Theochron)

Long-acting bronchodilator/corticosteroid combinations

Combination therapy is suggested when a patient’s symptoms remain uncontrolled with bronchodilator monotherapy.

· Budesonide/formoterol (Symbicort)

· Fluticasone/salmeterol (Advair Diskus)

· Fluticasone/vilanterol (Breo Ellipta)

Beta-adrenergic agonist/anticholinergic agent combinations

These agents offer the quick onset of a beta-adrenergic agonist with the prolonged action of an anticholinergic agent.

· Umeclidinium/vilanterol (Anoro Ellipta)

· Ipratropium/albuterol (DuoNeb, Combivent Respimat)

Systemic corticosteroids

For patients with an acute exacerbation of chronic bronchitis, a short course of systemic corticosteroid therapy is sometimes administered; studies report positive results.

· Methylprednisolone

· Prednisone

Inhaled corticosteroids

An inhaled corticosteroid may provide symptom relief in some patients.

· Budesonide (Pulmicort, Pulmicort Flexhaler)

Phosphodiesterase-4 inhibitors

These anti-inflammatory drugs are used for acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease. They have been shown to decrease exacerbations, relieve dyspnea, and improve lung function.

· Roflumilast (Daliresp)

Analgesics/antipyretics

These agents are beneficial in providing symptomatic relief of fatigue, malaise, and fever associated with illness.

· Ibuprofen

· Acetaminophen

· Naproxen

Antibiotics

Occasionally, antibiotics are used to treat chronic bronchitis exacerbations caused by bacterial infections. Broad-spectrum antibiotics are often the choice.

· Penicillin

· Cephalosporins

· Fluoroquinolones

· Macrolides

· Sulfonamides

· Tetracyclines

Adapted from references 1, 3, 9, 10, 12-18, 21.

In April 2014, the FDA also approved umeclidinium inhalation powder (Incruse Ellipta, GlaxoSmithKline), a long-acting muscarinic antagonist monotherapy, a type of bronchodilator also known as a long-acting anticholinergic.20 It is indicated for the long-term, once-daily maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema.20 It is available as a powder for inhalation via a plastic inhaler.20 The most commonly reported adverse effects include cough, arthralgia, upper respiratory tract infection, and nasopharyngitis.20

The Pharmacist’s Role

Pharmacists can be an instrumental resource for patients with bronchitis via medication counseling, keeping them abreast of new developments in the treatment and management of bronchitis, and encouraging them to adhere to their recommended therapy. During couseling, patients should be educated on the proper use of inhalation devices to ensure appropriate dose delivery. If a patient is still smoking, pharmacists should stress the importance of smoking cessation and encourage the patient to discuss possible smoking cessation therapies with his or her primary health care provider. Studies show that 50% of patients with chronic bronchitis who have a history of smoking will no longer cough after 1 month of smoking cessation, and 80% will no longer cough after 2 months. 12 Patients should also be reminded to eat a balanced diet and get plenty of rest when needed. For more information, see Online Table 4 and visit ClinicalTrials.gov at http://clinicaltrials.gov/search/open/condition=%22Bronchitis,+Chronic%22.

TABLE 4: EDUCATIONAL RESOURCES REGARDING BRONCHITIS

· American Thoracic Society: http://patients.thoracic.org/?page_id=43

· COPD Foundation: www.copdfoundation.org/What-is-COPD/COPD-Facts/Glossary.aspx

· National Heart, Lung, and Blood Institute: www.nhlbi.nih.gov/health/health-topics/topics/copd/

· American Lung Association: www.lung.org/lung-disease/copd/about-copd/

Ms. Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.

References

1. Fayyaz J, Olade RB, Lessnau K-D. Bronchitis. Medscape website. http://emedicine.medscape.com/article/297108-overview#a0101?cc=aHR0cDovL2VtZWRpY2luZS5tZWRzY2FwZS5jb20vYXJ0aWNsZS8yOTcxMDgtb3ZlcnZpZXcjYTAxMDE=&cookieCheck=1. Updated March 28, 2014. Accessed October 6, 2014.

2. American Lung Association. Trends in COPD (chronic bronchitis and emphysema): Morbidity and mortality. American Lung Association website. www.lung.org/finding-cures/our-research/trend-reports/copd-trend-report.pdf. Updated March 2013. Accessed October 6, 2014.

3. Chronic bronchitis. PDRhealth.com website. www.pdrhealth.com/diseases/chronic-bronchitis. Accessed October 6, 2014.

4. Freid VM, Bernstein AB, Bush A. Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years. Centers for Disease Control and Prevention website. www.cdc.gov/nchs/data/databriefs/db100.htm. Updated July 31, 2012. Accessed October 6, 2014.

5. Chronic obstructive pulmonary disease (COPD) fact sheet. American Lung Association website. www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html. Updated May 2014. Accessed October 6, 2014.

6. What is COPD? National Heart, Lung, and Blood Institute website. www.nhlbi.nih.gov/health/health-topics/topics/copd/. Updated July 31, 2013. Accessed October 6, 2014.

7. What is chronic obstructive pulmonary disease (COPD)? American Thoracic Society website. www.thoracic.org/clinical/copd-guidelines/for-patients/what-is-chronic-obstructive-pulmonary-disease-copd.php. Accessed October 6, 2014.

8. What are the signs and symptoms of bronchitis? National Heart, Lung, and Blood Institute website. www.nhlbi.nih.gov/health/health-topics/topics/brnchi/signs.html. Updated May 1, 2009. Accessed October 6, 2014.

9. Bronchitis (chest cold). Centers for Disease Control and Prevention website. www.cdc.gov/getsmart/antibiotic-use/uri/bronchitis.html. Updated September 30, 2013. Accessed October 6, 2014.Barnett ML, Linder JA. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010. JAMA. 2014;311(19):2020-2022.

10. Braman SS. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):104S-115S.

11. Davis CP. Chronic bronchitis. MedicineNet.com website. www.medicinenet.com/chronic_bronchitis/page6.htm#what_is_the_treatment_for_chronic_bronchitis. Updated November 26, 2013. Accessed October 6, 2014.

12. Braman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):95S-103S.

13. Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2010;2:CD001287.

14. Budey MM, Weidemann HP. Acute bacterial exacerbation of chronic bronchitis. Cleveland Clinic website. www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/acute-bacterial-exacerbation-chronic-bronchitis/. Accessed October 6, 2014.

15. Siempos II, Dimopoulos G, Korbila IP, Manta K, Falagas ME. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J. 2007;29(6):1127-1137.

16. Chronic obstructive pulmonary disease (COPD). Merck Manuals website. www.merckmanuals.com/professional/pulmonary_disorders/chronic_obstructive_pulmonary_disease_and_related_disorders/chronic_obstructive_pulmonary_disease_copd.html. Updated June 2014. Accessed October 6, 2014.

17. Living with chronic bronchitis. National Heart, Lung, and Blood Institute website. www.nhlbi.nih.gov/health/health-topics/topics/brnchi/livingwith.html. Updated May 1, 2009. Accessed October 6, 2014.

18. FDA approves Boehringer Ingelheim’s Striverdi® Respimat® (olodaterol) inhalation spray for maintenance treatment of COPD. Boehringer Ingelheim website. http://us.boehringer-ingelheim.com/news_events/press_releases/press_release_archive/2014/08-01-14-fda-approves-boehringer-ingelheims-striverdi-respimat-olodaterol-inhalation-spray-maintenance-treatment-copd.html. Updated August 1, 2014. Accessed October 6, 2014.

19. GSK receives approval for Incruse™ Ellipta® (umeclidinium) in the US for the treatment of COPD. GlaxoSmithKline website. http://us.gsk.com/en-us/media/press-releases/2014/gsk-receives-approval-for-incruse-ellipta-umeclidinium-in-the-us-for-the-treatment-of-copdandnbsp/. Updated April 30, 2014. Accessed October 6, 2014.

20. Mosenifar Z, Harrington A, Nikhanj NS, et al. Chronic obstructive pulmonary disease treatment & management. Medscape website. http://emedicine.medscape.com/article/297664-treatment. Updated September 25, 2014. Accessed October 6, 2014.

Nebulizer Bronchitis Treatment – Primary Care Medicine – Irvine, CA

Acute bronchitis is caused by an inflammation of the mucous membrane in your bronchial tubes. It can be quite irritating, causing bronchospasms and coughing fits that last for extended periods. With medical supervision, however, the use of a nebulizer can greatly reduce this inflammation and lead to a better overall quality of life.

What causes bronchitis?

Inflammation of your lungs’ mucous membrane can be caused by a combination or lifestyle and environmental factors. Secondhand smoke, dust, pollution, and smoking all contribute to bronchitis, as do allergens like pollen and ragweed.
Proper hand washing has been shown to play a large role in reducing your odds of infection..

Diagnosis

Diagnosing bronchitis can only be done by a physician, however, he or she will likely ask about the following symptoms: blood in your sputum, excessive coughing, length of the cough, mucous, tight chest, and fever.
After listening to your lungs the doctor will either look for a chest x-ray to rule out any other problems like pneumonia or could culture your sputum to test for whooping cough, a bacterial infection, or allergies. Both of these tests help them narrow down what might be affecting you, thus allowing them to provide you with the best treatment possible.
Finally, a simple spirometry test will help the doctor assess your lung capacity to see how well they’re working. Using a basic disposable device, you’ll be asked to hold a mouthpiece to your lips and breathe out at hard as you can. A meter on the other end of the device will show what your lung capacity is.

Treatment

The most important part of treating bronchitis is to get enough rest and drink fluids. Your body relies heavily on being well hydrated to keeps its cells alive and functioning. Don’t neglect it.
A cough suppressant might be prescribed to help you catch some shut-eye since oftentimes bronchitis interrupts sleep schedules. If you’re in pain a pain reliever could be prescribed. Additionally, sleeping next to a humidifier will help keep your nose and lungs moist.

Nebulizer Treatment

Perhaps the single most effect method of treating bronchitis is the nebulizer. This method requires you to use a small machine to inhale steroids. These steroids calm the inflammation in your mucous membrane and allow your body to begin to heal. Nebulizer treatments drastically reduce coughing, sputum production, and chest tightness, allowing you to breathe easier.

If you’ve suffered from an excessive cough for weeks on end and haven’t experienced much relief from over the counter methods, nebulizer treatment might be just what you need to treat your bronchitis. It could offer the relief you’ve been searching for. Contact our experienced team to learn more about how we can help you decreased inflammation in your lungs and breathe easier, sooner.

What Helps You Feel Better When You Have Bronchitis?

Your bronchial tubes, which carry air to your lungs, can get infected and swollen. This is called bronchitis. When you’ve got it, you probably have a bad cough, lots of mucus, and maybe some general cold symptoms like body aches or chills.

In some cases, you might get medicine from your doctor. Since most bronchitis is caused by viruses that do not respond to antibiotics, your doctor may recommend over the counter medications to treat your symptoms. But more often you’ll just have to ride it out. As you do that, some good old-fashioned self-care can help you feel better.

How to Ease Your Symptoms

There are two types of bronchitis — “acute” and “chronic.” Acute bronchitis is more common and usually goes away on its own within a few weeks. Chronic bronchitis keeps coming back or doesn’t go away at all. It is almost always caused by smoking.

With either type, the best approach is to avoid things that irritate your lungs:

  • If you smoke, the most important thing you can do is stop. If you need help quitting, talk to your doctor about what might work best for you.
  • Avoid dust, chemical fumes, smoke from other people, and anything else that can bother your lungs. If you can’t avoid these things, try wearing a mask.
  • Wear a mask if cold air triggers your cough or makes you short of breath.
  • if you have seasonal allergies, take an antihistamine when your allergies are bed.

Steam is also helpful, since it can loosen up all that mucus. You also might want to:

  • Breathe in steam from a bowl of hot water.
  • Take a hot shower.
  • Use Vicks Vapor Rub on your chest
  • Use a humidifier (Make sure to clean it as directed so bacteria and fungi don’t grow inside it.).

Relief for Acute Bronchitis

You can start with these basic steps:

Continued

For your cough: It’s best to stay away from cough medicine unless your cough keeps you awake at night. Your cough helps clear that gunk out of your lungs. When it comes to kids, avoid cough medicine for those under 4 years old and check with your doctor about giving it to older children.

Instead of cough medicine, you can:

  • Take throat lozenges that don’t have medicine in them (Avoid these with young children as they could cause choking.).
  • Try a mixture of honey and lemon or a spoonful of honey (Don’t give honey to children under 1 year old).
  • if your cough is think and you are having trouble getting the phlegm out, try guaifenesin over the counter (it comes as a pill or liquid) to loosen it up.

Relief for Chronic Bronchitis

Chronicx bronchitis is long term inflammation of the bronchi and is common among smokers. In addition to quitting smoking, you can get relief by making some lifestyle changes, focus on your breathing, and do your best not to get colds or the flu. Some things to think about and do:

  • Diet: Eat plenty of fruits, vegetables, and whole grains. You can also eat meats low in fat, chicken, fish, and low-fat or nonfat dairy.
  • Exercise: Along with a good diet, exercise will keep your weight in check. This is a big deal, because more weight makes it harder to breathe. Also, the muscles you use for breathing get stronger when you exercise. You can start with a slow, 15-minute walk three times a week, then do a little more at a time. Your doctor can help you come up with a plan that works for you.
  • Pursed-lip breathing: This can help slow down the fast breathing that sometimes comes with chronic bronchitis. First, take a deep breath in. Then, purse your lips like you’re about to kiss someone and breathe out slowly through your mouth. This type of breathing props your airways open and may make it easier for you to clear out thick mucus with a good cough.
  • Try to avoid colds and flu: Do your best to keep your distance from people who have a cold or the flu, and wash your hands often. Get an annual flu shot.

When Should I Call My Doctor?

Call your doctor if your cough:

  • Turns up mucus that’s yellow or green
  • Keeps you awake at night
  • Lasts more than 3 weeks
  • Produces blood

You’ll also want to call your doctor if you have a cough and:

  • A foul-tasting fluid in our mouth — this could be reflux
  • Fever over 100.4 F
  • Wheezing or shortness of breath

If you have chronic bronchitis, your cough will go on for months. It’s best to check in with your doctor regularly.

You may also have times where your symptoms get worse. If you have chronic bronchitis, you can still get acute bronchitis with worsening cough and mucus. You’ll want to see your doctor then, too, to see if you need an antibiotic.

Acute Bronchitis in Adults – Drugs.

com

Medically reviewed by C. Fookes, BPharm. Last updated on May 24, 2019.

What Is Acute Bronchitis?

Acute bronchitis is an infection of the bronchi (large and medium-sized air tubes) in the lungs. The infection causes inflammation, swelling, and increased mucus production within the bronchi. Bronchitis is usually caused by the same viruses that cause a cold or the flu, although occasionally it may be caused by bacteria. Acute bronchitis may also be called a “chest cold”.

Common health questions about acute bronchitis include:

  • Who is more likely to get acute bronchitis?
  • What causes acute bronchitis?
  • What are the symptoms of acute bronchitis?
  • How is acute bronchitis diagnosed?
  • Is bronchitis contagious?
  • What is the difference between acute and chronic bronchitis?
  • Is there any way to prevent bronchitis?

Who is more likely to get acute bronchitis?

Acute bronchitis is common, affecting up to 5% of adults every year. It can occur at any time of the year but is most common in the colder, winter months. Acute bronchitis is most frequently seen in infants, younger children, and seniors. People who smoke; who are exposed to second-hand smoke or excessive air pollution, dust or lung irritants; with other lung diseases such as asthma, lung cancer or COPD, or with certain heart conditions are also at higher risk of acute bronchitis.

Some people with weakened immune systems or other major health problems are more at risk of developing severe problems such as pneumonia or respiratory failure from acute bronchitis. These include:

    • Young children
    • The elderly
    • People with pre-existing health conditions such as asthma, COPD, cancer, or diabetes
    • People who have not been immunized for the flu, pneumonia and whooping cough.

What causes acute bronchitis?

85% to 95% of cases are caused by viruses, such as rhinovirus, adenovirus, influenza A and B, and parainfluenza virus.

Bacteria can cause bronchitis in people with underlying health problems or complicate a pre-existing viral case. Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Bordetella pertussis are most commonly involved.

What are the symptoms of acute bronchitis?

The most common symptom is a nagging, cough that is usually productive. In 50% of people, the cough lasts for less than three weeks, but in 25% it may persist for more than 1 month. The color of the sputum may be clear, yellow or green; however, this does not predict whether the infection is viral or bacterial. Sometimes the sputum may be tinged with blood. Acute bronchitis typically develops within a week of a cold or the flu.

Other symptoms may include:

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Sore throat
  • Nasal congestion
  • Headache
  • Mild Fever (not common)
  • Feeling tired

If your cough is accompanied by a high or prolonged fever, seek medical advice. A high fever may indicate a more serious bacterial infection, such as pneumonia, or a viral infection such as influenza. Older patients may present with a low-grade fever but still have pneumonia. It is important to have a doctor examine you for secondary bacterial pneumonia, which may require an antibiotic. If influenza is diagnosed within 48 hours of symptom onset, an antiviral treatment like oseltamivir (Tamiflu) or zanamivir (Relenza) may be recommended.

Acute bronchitis is temporary and usually does not cause any permanent breathing difficulties. On average, adults with acute bronchitis usually take two to three days off work.

How is acute bronchitis diagnosed?

A doctor will diagnose acute bronchitis based on your collection of symptoms and history of illness. He or she will take a history of your symptoms, listen to your lungs, perform a physical examination, check your vital signs, and may order a chest x-ray or blood work to look for signs of infection.

There are no specific signs or laboratory tests that are diagnostic. The most important condition to rule out is acute pneumonia.

Spirometry (tests that measure your lung function and how well you can inhale/exhale air) may be conducted in some people, particularly those with underlying respiratory conditions such as asthma or COPD.

Use the Drugs.com Symptom Checker to Make A More Informed Decision With Your Doctor

Is Bronchitis Contagious?

Because acute bronchitis is a complication of a viral infection, usually the common cold or the flu, acute bronchitis is considered contagious. These viruses easily spread from person to person, particularly during winter when people are usually in close proximity to each other.

However, patients with asthma or chronic bronchitis who develop acute bronchitis as a complication of their primary condition are less likely to be contagious.

What Is the Difference Between Acute Bronchitis and Chronic Bronchitis?

Chronic bronchitis is a long-term condition. To be diagnosed with chronic bronchitis, you must have a cough with mucus on most days for at least 3 months.

Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD). Patients with chronic bronchitis can develop exacerbations of acute bronchitis.

How is acute bronchitis treated?

In 85% of people, acute bronchitis will resolve by itself within three to ten days, although the cough may persist for several weeks. Since most cases are viral, antibiotics are not usually necessary, or effective. However; medical treatment, antibiotics, and sometimes hospitalization may be necessary for people with a bacterial cause for their acute bronchitis, with certain pre-existing conditions, or who have developed pneumonia.

Other treatments may be used to relieve your symptoms, although these will not resolve underlying bronchitis any faster. Examples include:

It is also good to rest and drink plenty of fluids. Some people may find a humidifier helps.

Cough suppressants (dextromethorphan, codeine, benzonatate) have generally not been shown to be helpful. 

If you develop new symptoms or your cough worsens or is still present after 3 weeks, contact your physician again. In acute bronchitis, coughing and airway sensitivity can persist up to 4 to 5 weeks, even after other symptoms have improved; however, you may need further evaluation.

Is There Any Way to Prevent Bronchitis?

Since acute bronchitis typically occurs as a complication of the common cold or flu, some general prevention measures may help to prevent complications.

  • To reduce your risk of catching a viral infection, wash your hands frequently with soap and water and use alcohol-based hand sanitizers.
  • Avoid close contact with sick people.
  • Avoid touching your eyes, nose, and mouth. Viruses are easily transferred from your hands these parts of your body.
  • Get vaccinated against influenza (flu) virus every year in the early fall in the U.S. You may also consider vaccination against certain types of pneumonia as well as pertussis (whooping cough). Your pharmacist or doctor can help you determine if you are a candidate for these vaccines.
  • Don’t smoke, and stay away from secondhand smoke, dust, pollution, or chemicals.

Related Topics Under Bronchitis

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Join the Drugs.com Bronchitis Support Group to ask questions and share experiences with those who have similar questions and concerns about acute bronchitis. Share experiences with others about your medications, side effects, treatment effectiveness, and even cost. Ask the group questions to see if they have had a similar experience with their therapy or that of their child. Keep up with the latest bronchitis news and approvals on the Drugs.com bronchitis blog, too!

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Albuterol Oral Inhalation: MedlinePlus Drug Information

Albuterol comes as a solution (liquid) to inhale by mouth using a special jet nebulizer (machine that turns medication into a mist that can be inhaled) and as an aerosol or powder to inhale by mouth using an inhaler. When the inhalation aerosol or powder for oral inhalation is used to treat or prevent symptoms of lung disease, it is usually used every 4 to 6 hours as needed. When the inhalation aerosol or powder for oral inhalation is used to prevent breathing difficulty during exercise, it is usually used 15 to 30 minutes before exercise. The nebulizer solution is usually used three or four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use albuterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Call your doctor if your symptoms worsen or if you feel that albuterol inhalation no longer controls your symptoms. If you were told to use albuterol as needed to treat your symptoms and you find that you need to use the medication more often than usual, call your doctor.

Albuterol controls symptoms of asthma and other lung diseases but does not cure them. Do not stop using albuterol without talking to your doctor.

Each albuterol aerosol inhaler is designed to provide 60 or 200 inhalations, depending on its size. Each albuterol powder inhaler is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. Dispose of the aerosol inhaler after you have used the labeled number of inhalations, even if it still contains some liquid and continues to release a spray when it is pressed. Dispose of the powder inhaler 13 months after you open the foil wrapper, after the expiration date on the package, or after you have used the labeled number of inhalation, whichever comes first.

Your inhaler may come with an attached counter that keeps track of the number of inhalations you have used. The counter also tells you when to call your doctor or pharmacist to refill your prescription and when there are no inhalations left in the inhaler. Read the manufacturer’s instructions to learn how to use the counter. If you have this type of inhaler, you should not try to change the numbers or remove the counter from the inhaler.

If your inhaler does not come with an attached counter, you will need to keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Do not float the canister in water to see if it still contains medication.

The inhaler that comes with albuterol aerosol is designed for use only with a canister of albuterol. Never use it to inhale any other medication, and do not use any other inhaler to inhale albuterol.

Be careful not to get albuterol inhalation into your eyes.

Do not use your albuterol inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.

Before you use albuterol inhaler or jet nebulizer for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.

If your child will be using the inhaler, be sure that he or she knows how to use it. Watch your child each time he or she uses the inhaler to be sure that he or she is using it correctly.

To inhale the aerosol using an inhaler, follow these steps:

  1. Remove the protective dust cap from the end of the mouthpiece. If the dust cap was not placed on the mouthpiece, check the mouthpiece for dirt or other objects. Be sure that the canister is fully and firmly inserted in the mouthpiece.
  2. If you are using the inhaler for the first time or if you have not used the inhaler in more than 14 days, you will need to prime it. You may also need to prime the inhaler if it has been dropped. Ask your pharmacist or check the manufacturer’s information if this happens. To prime the inhaler, shake it well and then press down on the canister 4 times to release 4 sprays into the air, away from your face. Be careful not to get albuterol in your eyes.
  3. Shake the inhaler well.
  4. Breathe out as completely as possible through your mouth.
  5. Hold the canister with the mouthpiece on the bottom, facing you and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece.
  6. Breathe in slowly and deeply through the mouthpiece.At the same time, press down once on the container to spray the medication into your mouth.
  7. Try to hold your breath for 10 seconds. remove the inhaler, and breathe out slowly.
  8. If you were told to use 2 puffs, wait 1 minute and then repeat steps 3-7.
  9. Replace the protective cap on the inhaler.
  10. Clean your inhaler regularly. Follow the manufacturer’s directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler.

To inhale the powder using the inhaler, follow these steps. Do not use the Respiclick inhaler with a spacer:

  1. If you will be using a new inhaler for the first time, remove it from the foil wrapper. Look at the dose counter at the back of the inhaler and check that you see the number 200 in the window.
  2. Holding the inhaler upright, with the cap on the bottom and the inhaler pointing upwards, load the dose by opening the protective dust cap at the end of the mouthpiece until it clicks. Do not open the cap unless you are ready to use the inhaler. Every time the protective cap is opened, a dose is ready to inhale. You will see the number in the dose counter go down. Do not waste doses by opening the inhaler unless you are inhaling a dose.
  3. Breathe out as completely as possible through your mouth. Do not blow or exhale into the inhaler.
  4. Place the mouthpiece between your lips well into your mouth. Close your lips tightly around the mouthpiece. Inhale slowly and deeply through your mouth. Do not breath in through your nose. Make sure that your fingers or lips do not block the vent above the mouthpiece.
  5. Remove the inhaler from your mouth and hold your breath for 10 seconds or as long as you comfortably can. Do not blow or exhale through the inhaler.
  6. Close the cap firmly over the mouthpiece.
  7. If you are to inhale 2 puffs, repeat steps 2-6.
  8. Keep the inhaler clean and dry at all times. To clean your inhaler, use a clean, dry tissue or cloth. Do not wash or put any part of your inhaler in water.

To inhale the solution using a nebulizer, follow these steps;

  1. Remove one vial of albuterol solution from the foil pouch. Leave the rest of the vials in the pouch until you are ready to use them.
  2. Look at the liquid in the vial. It should be clear and colorless. Do not use the vial if the liquid is cloudy or discolored.
  3. Twist off the top of the vial and squeeze all of the liquid into the nebulizer reservoir. If you are using your nebulizer to inhale other medications, ask your doctor or pharmacist if you can place the other medications in the reservoir along with albuterol.
  4. Connect the nebulizer reservoir to the mouthpiece or face mask.
  5. Connect the nebulizer to the compressor.
  6. Place the mouthpiece in your mouth or put on the face mask. Sit in an upright, comfortable position and turn on the compressor.
  7. Breathe in calmly, deeply, and evenly for about 5-15 minutes until mist stops forming in the nebulizer chamber.
  8. Clean your nebulizer regularly. Follow the manufacturer’s directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your nebulizer.

Albuterol: Dosage & Side Effects

Albuterol is a type of adrenergic bronchodilator prescribed for people with asthma, emphysema, bronchitis and other lung diseases, according to the Mayo Clinic. It works by relaxing and opening air passages to the lungs to make breathing easier, which can prevent and treat so-called bronchospasms — wheezing, coughing, shortness of breath and chest tightening.

However, people should treat it as a rescue inhaler, not as a daily drug, said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

“It’s what you reach for when you really need something,” Horovitz told Live Science. “It’s an ‘I need it now’ drug.”

Inhaler and tablet dosage

Adults and kids over age 4 in need of albuterol to prevent or treat bronchospasms can take two puffs every four to six hours, Horovitz said. To prevent exercise-induced bronchospasm, the Mayo Clinic says adults and children over 4 can take two inhaler puffs about 15 to 30 minutes before exercise.

But “if you’re using albuterol more than twice a week, there’s something wrong with your regimen, and you need to consult a doctor,” he said. 

Albuterol can be taken as a nebulized solution (a liquid that has been turned into an inhalable mist via a nebulizer machine) or as an aerosol that can be inhaled by mouth through an inhaler. 

Aerosol inhaler albuterol comes in canisters designed to provide about 200 inhalations. After using the exact number of inhalations, it is important to throw the canister away, even if it still contains some liquid and continues to spray. Once the listed number of puffs has been exceeded, the inhaler may not provide the correct amount of medicine. Some inhalers come with a counter that keeps track of the number of sprays used. When the number reaches 020, it is time to call the doctor for a refill. If there is no counter, patients must keep track of inhalations on their own.

The National Institutes for Health (NIH) has step-by-step instructions for using an inhaler and a nebulizer.

Patients taking albuterol through tablets, extended-release tablets or liquid should follow their doctor’s instructions exactly. It is important to swallow the extended-release tablet whole and not to chew, crush or break it. Part of the extended-release tablet may appear in patients’ stools while using the medicine. This is not a problem and no cause for concern.

Side effects

Albuterol may cause side effects. The NIH lists the following as less serious, though a doctor should be consulted if they don’t go away:

  • uncontrollable shaking of a part of the body
  • nervousness
  • headache
  • nausea
  • vomiting
  • cough
  • throat irritation
  • muscle, bone, or back pain 

The following are more serious side effects and, if experienced, a doctor should be consulted immediately:

  • fast, pounding, or irregular heartbeat
  • chest pain
  • rash
  • hives
  • itching
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • increased difficulty breathing
  • difficulty swallowing
  • hoarseness

It is possible to overdose on albuterol. The following are symptoms of overdose:

  • seizures
  • chest pain
  • fast, irregular or pounding heartbeat
  • nervousness
  • headache
  • uncontrollable shaking of a part of the body
  • dry mouth
  • nausea
  • dizziness
  • excessive tiredness
  • lack of energy
  • difficulty falling asleep or staying asleep

Before taking albuterol, patients should tell their doctor if they suffer from any of the following symptoms:

  • heart disease, congestive heart failure, heart rhythm disorder, or high blood pressure
  • epilepsy or another seizure disorder
  • diabetes
  • overactive thyroid

Patients should tell their doctor if they are pregnant or are planning to become pregnant. However, “the most harmful thing to an embryo or fetus is lack of oxygen,” and women should take albuterol if they need it and if their doctor approves, Horovitz said. Between 4 percent and 12 percent of pregnant women in the U.S. have asthma; and 3 percent of pregnant women take asthma medications, including bronchodilators like albuterol, according to the CDC.

A study published in the January 2012 issue of the journal Pediatrics showed that using asthma medicines during pregnancy — albuterol was the most common such medicine used in the study — didn’t increase the risk for most birth defects studied. However, it showed that the medication might increase the risk for some birth defects, such as birth defects of the esophagus, anus and abdominal wall.

The FDA categorizes albuterol as a category C drug, meaning that it is unknown if it could harm a fetus. It’s also unknown about its effects during breastfeeding, so women should proceed with caution before taking it, according to the Mayo Clinic. 

Additional resources: 

This article is for informational purposes only and is not meant to offer medical advice. This article was updated on May 13, 2015 by Live Science Senior Writer, Laura Geggel, and again on Oct. 17, 2018 by Live Science Managing Editor, Jeanna Bryner.

90,000 Use of bronchodilators for bronchiolitis in infants with the first episode of wheezing

What is bronchiolitis?

Bronchiolitis is an acute, highly contagious (contagious) viral lung disease that affects children between the ages of 0 and 12 months. It occurs every year during the winter months. and causes inflammation of the small airways in the lungs (small bronchi) and filling them with mucus. The airways are narrowed and this leads to a blockage of the free passage of air.The infant develops a severe cough, runny nose, and usually a fever. He / she may begin to choke, wheeze and suffer from a lack of oxygen (hypoxia).

Why consider bronchodilators?

Bronchodilators are drugs that are often used as aerosols to widen the airways by relaxing the muscles of the bronchi. They are effective in treating asthma in older children and adults. However, unlike asthmatics, babies with bronchiolitis usually have wheezing for the first time.They wheeze for another reason, because their airways are filled with mucus. Thus, children with bronchiolitis are less likely to respond to bronchodilators.

Study characteristics

We reviewed the evidence for the effect of bronchodilators on bronchiolitis in infants. We found 30 clinical trials in which a total of 1922 children from several countries took part. Evidence is valid until January 2014. We analyzed outpatient and inpatient studies separately.All bronchodilators except epinephrine were included in the review because it was reviewed in another Cochrane review. Albuterol (otherwise known as salbutamol) is commonly used in research, so we also looked at this bronchodilator as a subgroup.

Key results

We found no effect of bronchodilators on the saturation of the airways with oxygen (oxygen saturation). In hospitalized infants with bronchiolitis, there was no significant benefit from bronchodilator treatment.This review also found that bronchodilators do not reduce the need for hospitalization, do not shorten the length of hospital stay and the duration of illness when treated at home. Looking at the subset of studies on albuterol (salbutamol), we found no effect of this bronchodilator on oxygen saturation or clinical performance. Side effects of bronchodilators include increased heart rate, decreased oxygen levels, and tremors. Given these side effects, little evidence that bronchodilators are effective, and the costs associated with these treatments, we concluded that bronchodilators are not helpful in treating bronchiolitis.

Quality of evidence

This review is limited to a small number of studies using the same criteria and methods. For example, only 22 studies included only infants experiencing wheezing (whistling) for the first time. Previous studies have included children who have had wheezing in the past and may have had asthma, and thus these earlier studies favor the use of bronchodilators. Newer studies that excluded infants with prior wheezing episodes and had a better study design did not show the benefit of bronchodilators.This review is also limited to the small number of participants included in each study. Finally, in some studies, the clinical indicators used to assess the effect of bronchodilators may differ from one investigator to the next, making this estimate unreliable. To determine the effectiveness of these drugs, studies are needed that include more infants, better scoring rates, and a more rigorous study design.

Inhalation for bronchitis at home: steam and nebulizer

Pulmonary pathologies are an acute problem in a fast-paced and dynamic world.Therapists now recommend inhalation with a nebulizer for bronchitis.

However, many mothers from generation to generation pass on the experience of “breathe boiling water over a saucepan, but with hot potatoes”, without asking about scientific achievements.

And yet, in what way is it better to use the recommended medicines, process features, read the article.

Features of inhalation

What methods are they divided into:

  1. With nebulazer.With it, it is possible to regulate the intensity of spraying and respect the stomach.
  2. Traditional. In this situation, you need heated water (not boiling water) and the necessary equipment. The difference with automatic treatment is obvious – pharmaceuticals and natural ingredients are used here.

What is the benefit:

  • nourishes the respiratory tract with the necessary moisture;
  • relieves dry and wet cough and leakage;
  • obstruction in the lungs disappears;
  • regeneration of lung tissue;
  • relieves the symptoms of bronchitis in various stages.

Why inhalation is necessary: ​​

  • does not harm the body. The exception is individual intolerance;
  • long-term treatment of the local area;
  • medicines are delivered to the lungs without reaching the stomach;
  • 90,047 steam is absorbed at maximum speed.

Inhalation for bronchitis in children

The child takes medication according to the age factor and after the doctor’s permission.

What can babies take:

  • Antrovent;
  • Ventolin;
  • Ambrobene;
  • Flavamed;
  • Bronchipred;
  • Pulmicort.

Children from 2 years old:

From 4 years old:

“Do not treat the child yourself! Only the attending pediatrician can determine the individual characteristics of the child’s body and prescribe those medications that will not only not harm him, but will also lead to a quick recovery. “

Adults

How to properly prepare for inhalation:

  • This method can only be prescribed by the attending doctor;
  • in case of individual intolerance to the drug, notify the doctor to avoid allergy symptoms;
  • in case of allergic manifestations, avoid essential essences and preparations based on herbal ingredients;
  • If a steam apparatus is used, then the operating rules must be strictly followed.After the procedure, rinse the container for the product, and pour out the remains;
  • do not eat or play sports an hour before inhalation;
  • inhalation of steam through the mouth will help speed up the treatment of bronchitis;
  • recommended alternation of medications prescribed by a doctor.

If a complex of drugs is prescribed, it is important to adhere to the following order:

  1. Bronchodilator.
  2. Wait fifteen minutes.
  3. Inhalation with mucolytic or dry cough medicine.
  4. Use other medications, including hormones.

Inhaler-nebulizer

It has been proven that while taking medications there is a risk of gastrointestinal diseases, but the amount of the main component cannot completely eliminate bronchitis. For this reason, device-based inhalers appeared. Their second name is nebulizers.

The main difference from water vapor is the formation of aerosol as a result of the interaction of the drug with air.Particles pass through the connecting hose and into the nosepiece or respirator. Aerosol substances reach all parts of the lungs, thereby accelerating recovery. This reduces the likelihood of negative pathologies.

The second advantage is the ability to fill any medication and conduct breathing over the gaseous state of water using nozzles.

Another of the positive qualities is accessibility, it is used by both infants and retirees.In the case of the development of a chronic form of bronchitis, you cannot do without it. It is also worth paying attention to mothers, whose children often fall ill with colds, or also have a lifelong dependence on lung diseases.

Some inhalation devices can be carried around as pocket devices, which are also ideal for transport.

If inhalation from steam in the kettle is limited if the temperature rises to 37 and a half degrees, then turn on the nebulizer.In it, you can adjust the power of the aerosol supply, and the boiled gaseous state of water can burn the nasopharynx and worsen the picture of the disease.

Without apparatus: recipes for an effective steam procedure at home

If you cannot get a good nebulizer, then there is an opportunity to use winning solutions and combinations of medicines in various containers with boiled water. This method also helps with tracheobronchitis.

Top 10 best recipes:

  • 1st place.Mix crushed eucalyptus leaves together with elderberry inflorescences. Squeezed Kalanchoe and five hundred milliliters of boiled water are added to the mixture. Set aside overnight. Heat before use. Alternate every 5 hours.
  • 2nd place. Prepare a decoction for the following ingredients: licorice (root part), chamomile, sage, calendula, string, eucalyptus leaves. Take no more than 1 tablespoon of each plant. Insist them in warm liquid, use during treatment. Inhalation 4 times a day.Breathe over the steam for five to ten minutes.
  • 3rd place. This composition is taken: chamomile, pine cones (all 2 tablespoons). Brew in the same way as the previous decoctions.
  • 4th place. Yarrow, mint (1 tablespoon), raspberry bark (1.5 tablespoons).
  • 5th place. Herbs sage, St. John’s wort, calendula, chamomile (each plant 1.5 tablespoons) and oak bark (2 tablespoons).
  • 6th place. 1 tsp onion juice, or garlic per 0.5 liters of water.
  • 7th place. 5 grams of baking soda.
  • 8th place. 3 tbsp salt of sea origin, essential essence of eucalyptus + 1 tsp. soda.
  • 9th place. A bath with aromatic oils (coniferous, menthol, floral soothing (lavender) are preferred.
  • 10th place. Warm up Borjomi or Essentuki to a warm state and inhale over vapors for no more than ten minutes.

List of preparations for inhalation for bronchitis

Bronchodilator

Medicines helping to expand the bronchial system:

  • Salgim;
  • Sterineb Salamol;
  • Astalin;
  • Berotek;
  • Berodual;
  • Atrovent;
  • mineral water.

Helping in the treatment of various types of expectoration

A lifesaver during a difficult cough:

Rescue from wet cough:

  • Ambroxol;
  • Fluimucil;
  • Pulmozyme.

Suppressing the growth of viruses

Fluimucil is used as an effective antibiotic. The active ingredients are acetylcysteine, which can get rid of wet expectoration, and thiamphenicol, which stops the growth of the virus. Helps with pus.

Stopping inflammation

The following medicines protect against complications of pulmonary diseases:

  • Miramistin;
  • Dioxidine;
  • Chlorhexidine;
  • Furacilin;
  • Chlorophyllipt;
  • Rotokan.

With the tolerance of aromatic oils, the following components become saviors:

  • eucalyptus;
  • fir;
  • pine;
  • sage.

They are allowed to regulate the functioning of the pulmonary system and protect against further spread of infection.

Immune Support

Derinat helps to improve local immunity. It helps to restore the body’s strength and accelerate the healing process of the bronchi. Apply in a 1: 3 ratio (part of concentration to saline).

During acute bronchitis

In this phase, it is necessary to moisten the bronchial parts, and then apply medications.A nebulizer comes to the rescue with the addition of saline or mineral water. After that, medications are added to relieve the different stages of cough. For a faster excretion of sputum, bronchodilators are used.

With obstructive bronchitis

In case of obstruction, the following scheme should be used: medicines that dilate the bronchi + medicines for dry or wet cough. During an allergy, the attending doctor may prescribe Cromohexal.

In this situation, the drug is taken for a long time and helps in relieving tension in the lungs caused by exposure to an irritating product.If you want to relieve them of an attack “here and now”, then this is not your medicine, since it develops a cumulative effect and effect after a long time of administration.

“Never combine Cromohexal with Bromhexine and Ambroxol in order to avoid dangerous consequences!”

If the obstruction in the bronchi has increased, the doctor recommends using Fluimucil in the form of an antibiotic to avoid infection with additional viruses.

Chronic

If bronchitis needs to be treated for life, it is necessary not to start the disease until pulmonary or heart failure.

If this form of bronchial damage has increased, it is necessary to take drugs according to the following scheme: the first nebulizer therapy is performed with salbutamol and fenoterol for 60 minutes, alternating them every half hour.

Then they are done less often – once every 60-240 minutes. They alternate with iprotropium bromide and glucocorticosteroid. Drugs that increase the patency in the bronchi also help out.

List of active drugs that support the lungs:

  • Seretide;
  • Symbicort Turbuhaler;
  • Foradil Combi;
  • Biasten.

During bronchial asthma

When asthmatic attacks occur, the following medications are used:

  • dilating bronchi;
  • relieves wet cough;
  • cromoglycic acid;
  • hormonal preparations.

Contraindications

When steam inhalation is limited:

  • Extraction of blood from the pulmonary sections;
  • obstruction in the pleura;
  • irregularities in the heartbeat in a severe stage;
  • sustained high blood pressure in the heart;
  • Allergy to a medicinal component.

Summary

How to carry out the treatment of bronchitis with the help of inhalation – with the apparatus or continue to use the “saucepan and boiling water” method? What methods to overcome the disease is up to you. The main thing is that the treatment is successful.

PreviousNext How to do inhalation at home with bronchitis Link to main publication

Inhalation for bronchitis at home – for children and adults

Hello dear readers.To get rid of diseases associated with the respiratory tract, not only general therapy plays an important role, but also local agents that act directly on the foci of infection.

The use of inhalations shows very good results. Especially when pathogens get further and further and the disease reaches the bronchi.

Consider inhalation for bronchitis at home – for children and adults, options for using inhalers, what medicines and folk remedies can be used here.

Inhalation for bronchitis for children and adults at home

Inhalation is one of the methods of a therapeutic approach to the treatment of diseases associated with the respiratory system.

This is a special form of drug delivery directly to the source of infection in order to destroy it, as well as relieve symptoms provoked by the development of the disease.

Various pharmacological and other substances are inhaled in the form of vapors, gases, smoke or even powder. If the bronchi are damaged, inhalation must be carried out through the mouth.

Due to the inhalation method of treatment, the preparations penetrate very deeply, providing the necessary local effect. But the benefits are twofold, since the drugs penetrate into the bloodstream, providing a general, systemic effect.

And they also carry out symptomatic treatment of actions at the site where they were directly delivered during the inhalation process.

Benefit from inhalation

  • Due to the action of drugs during inhalation, a number of positive results can be achieved:
  • Remove swelling.
  • Make breathing easier.
  • Improve tissue blood flow.
  • Facilitate mucus secretion, provide expectoration.
  • Get rid of cough and unpleasant, and often painful sensations in the bronchi.
  • Activate tissue regeneration.
  • Moisten dry breathing tubes.
  • In addition to such a direct effect of the process itself, the agent used for inhalation also plays a significant role.
  • Thanks to the use of various medications and non-medicinal preparations, a number of other positive effects can be achieved.

What inhalations can be done with bronchitis

In the process of carrying out inhalation exposure, both hot vapors and cooled aerosol solutions can be used. With the defeat of the bronchi and bronchioles, any type of inhalation can be used.

  1. But the appointment should be made by a doctor based on the specific disease, its severity, the symptoms and the general picture of the course of the disease.
  2. There are several types of inhalations.
  1. Steam mode – carried out in the old fashioned way, using a container with hot liquid and blankets (towels), steam is inhaled. Restrictions: the water temperature should not exceed 55 degrees, should not be performed in the presence of heat, not used to treat small children.
  1. Thermal-moist appearance – alkaline solutions or ready-made mineral waters are used. During the entire procedure, the temperature of the liquid should be maintained at 40 degrees.
  1. Wet appearance – aerosol medications are administered. The selection of drugs is carried out by a doctor. Anti-inflammatory and antimicrobial medications may be prescribed. This procedure is allowed for small children.
  1. Hardware view – a special device is used – a nebulizer. There are different subspecies. Some are used for steam injection of agents, while in others solutions are modified into aerosols with different sizes of microparticles.

Nebulizer inhalation

  • There are three types of inhalers:
  • Compressor.
  • Steam.
  • Ultrasonic.
  • Diaphragm.

A compressor nebulizer is considered not the best, but the safest.

The principle of operation is quite simple – a medicinal composition in the form of a liquid is placed in it, the device turns it into an aerosol of sufficiently fine dispersion.

In this form, the medicine can even reach the bronchioles and alveolar structures.That is why the use of such inhalers is effective for all types of lesions of the lower respiratory tract.

  1. This form of administration of medicinal products has a lot of positive aspects:
  2. Permitted for children.
  3. Can be used even at elevated temperatures.
  4. Low aerosol temperature (up to 30 degrees) does not carry the risk of burns.
  5. Allows the use of significant amounts of funds deposited.
  6. Has a systemic effect, not only fights symptomatic manifestations.
  7. Various drugs are applicable, due to which various effects are achieved (anti-inflammatory, decongestant, expectorant, antitussive, antimicrobial, antiviral).

But the use of inhalers also has its drawbacks. One of the main ones is the high cost of nebulizers.

And not all liquids can be used in them without the risk of ruining an expensive device.Also, each of the varieties has its own disadvantages.

  1. Ultrasound – not suitable for the administration of certain drugs, for example, antibiotics, as they destroy their huge molecules, which is why they lose their properties.
  1. Compressor rooms – dimensional and noisy. By the principle of work, they are divided into subspecies:
  • – Simple – uselessly spend the medicine, only about 10% reaches the bronchi;
  • – Manual dosage – are also uneconomical, but it is possible to regulate the amount of funds received;
  • – Dosimetric – expensive and the procedure is delayed for a long time.
  1. Membrane (mesh nebulizer) is the most effective, but also very expensive.

Steam

Despite the fact that this method is inconvenient, burn hazardous and is considered to be yesterday, it is available, quite popular and effective. It can be used already at the stage of the onset of the primary symptoms of the common cold, and even for prophylaxis.

  1. As an auxiliary method of treatment, it allows:
  2. Get rid of discomfort and pain in the chest.
  3. Improve coughing.
  4. Activate excretion and excretion of mucus formations.

But, of course, there are a lot of shortcomings. Since the vapor is exhaled, not all substances enter the body (only those that are capable of forming vapors), and they are not able to penetrate so deeply as to affect the lower respiratory tract.

  • In some cases, this method of exposure can harm health and worsen the patient’s condition:
  • – fever may increase;
  • – you cannot resort to steam inhalation in the presence of purulent lesions in the respiratory organs;
  • – the spread of edema is possible;
  • – there is a high risk of burn injuries to the mucous membrane, as well as body burns in case of overturning a container with boiling water.
  • The main effects achieved with steam inhalation are heating and moisturizing of the respiratory structures.

Rules of conduct

  1. The possibility of inhalation exposure, as well as its type, must be determined by the doctor.
  2. General rules for performing inhalation for bronchitis at home – for children and adults:
  3. Do not inhale immediately after eating, at least an hour must pass.
  4. Heat should only be used when there is no heat.
  5. Breathing movements are performed in normal mode, but with greater depth.
  6. Don’t talk.
  7. Inhale through the mouth and exhale through the nose.
  8. In the presence of asthmatic complications, medications should have an expanding effect on the bronchi.
  9. In nebulizers, only freshly prepared solution is used each time, and not the one that remained in the device from the last time.

With what you can do inhalation with a nebulizer at home

  • The possibility of using individual components for inhalation is indicated in the instructions for a specific type of nebulizer.
  • For therapeutic effects use:
  • Ready mortars.
  • Decoctions of medicinal plants.
  • Self-made solutions (soda, salt, ethereal).
  • Mineral waters.

With sea salt

  1. The simplest and most affordable remedy is sea salt. He helps:
  2. Eliminate swelling of the mucous membrane.
  3. Make breathing easier.
  4. Relieve paroxysmal cough.
  5. Provide antiseptic effect.
  6. Stimulate the regeneration of cough-worn mucous membranes.

This product severely dries out respiratory surfaces.

Therefore, the procedure should be accompanied by regular moistening of the mucous membrane.

How to prepare a solution: take 3 large tablespoons of sea salt per liter of warm boiled water. For ease of dissolution, it can be pre-crushed.

Wait until the liquid has cooled completely and inject about 3 ml of saline or 1-2 drops of essential oil (if it can be used in your inhaler). The procedure can be carried out up to 4 times a day (remember about moisturizing!).

With baking soda

  • It is recommended to prepare a mixture based on commercially available saline solution – 1 small spoon of soda powder per liter.
  • Saline is a 9% solution of kitchen salt, so you can prepare it yourself: 1 small spoon is stirred in a glass of boiled water.

Soda solution is used for children in a nebulizer for no longer than five minutes. The interval between procedures must be at least 4 hours.

With eucalyptus

Eucalyptus essential oil has antibacterial properties, acts as an antiseptic and has a regenerative effect.

It can be added to saline at the rate of 2 drops of ether extract per 200 ml of liquid.The procedure can be performed twice a day.

  1. There are a number of contraindications here:
  2. – the presence of bronchospasm;
  3. – damage to the respiratory mucosa;
  4. – whooping cough;
  5. – up to three years old;
  6. – combined use with antibiotic and hormonal drugs.

Oils

For bronchitis, you can use some essential oils, for example, tea tree, pine, lavender, juniper, eucalyptus, cedar.For this, 2-3 drops of ether extract are injected into 200 g of saline or filtered water.

If you have an allergic reaction to such additives, their use is prohibited. Also, not all types of nebulizers are “friendly” with such substances – they can fail from oily liquids.

Herbal

On condition of high-quality filtration, herbal infusions (water) and decoctions can be used in inhalers.

Useful plants for bronchitis: wild rosemary, sage, oregano, pine needles, coltsfoot, St. John’s wort, raspberry, calendula, lemon balm.To prepare the solution, you will need 1 large spoonful of raw materials and a glass of boiling water.

With garlic

Garlic and garlic-onion mixtures are good for colds as natural antiseptic components.

They can be administered from the liquid for the inhaler in the form of carefully strained juice. The proportions are 1:20, but in the presence of a dry cough, the concentration is halved.

Water for inhalation

Non-carbonated mineral water of alkaline composition, such as narzan and borjomi, can be used as an alternative to soda solutions.The drink is used undiluted up to 4 times a day.

The remedy is indicated for dry coughs to soften and improve coughing. There are no contraindications either for patients or for the devices themselves.

Preparations – medicines for inhalation

Appropriate medications are used for bronchitis. The possibility of their introduction using a nebulizer is agreed with the doctor. Some medicines cannot be used in certain types of inhalers, this is noted in the instructions.

Bronchodilators

These funds are necessary to relieve breathing, eliminate shortness of breath, fight choking. There are different types of bronchodilators, but they all help to relax the muscles of the bronchi.

Examples: magnesium sulfate, albuterol, tergil, fenoterol, contraspasmin, berodual. Some of them are effective within 15 minutes. They are used in nebulizers all the time.

Antibiotics

Antibiotic drugs are prescribed in the presence of purulent exudate, pneumonic complications, abscesses.They are treated with a short course to destroy pathogenic pathogens.

Funds are prescribed exclusively by a doctor. Examples: gentamicin, brulamycin, acetylcysteine ​​solution.

Antiseptics

At the beginning of the development of the disease, the use of antiseptic preparations is recommended. They are, in most cases, safe and have a small number of contraindications.

Examples: furacilin, miramistin, chlorhexidine, as well as herbal remedies – rotocan, chlorophyllipt solution.They are used up to three times a day.

Immunomodulators

Treatment of bronchitis is always associated with the need to increase the immune defense. For these purposes, immunostimulants such as interferon or deoxinate are used.

They are perfectly combined with various inhalation liquids and can be used up to 4 times a day.

Hormonal inhalation

In case of a particularly severe course of the disease and low effectiveness of other means, one has to resort to hormonal means.

They have many unpleasant consequences and should therefore be used as a last resort. Examples: dexometasone, budesonide. Do not use for self-medication!

For chronic bronchitis

If the nature of the disease is allergic, then the use of herbal decoctions, extracts and oils is contraindicated. The presence of various complications in the chronic course of the disease also imposes a number of restrictions. Therefore, the drugs are prescribed by the doctor.

For children

Steam inhalers should not be used for children.We need special children’s attachments, which are not always included with the device.

Only saline is used as a solvent for the components. Examples of medicines: lazolvan, itrop, berodual.

Contraindications

Inhalation is prohibited in some cases.

  1. Drug allergy.
  1. Asthmatic complications.

Read on the blog:

  • Inhalation for cough and runny nose.
  • Solutions for inhalations against the common cold, used in inhalers.
  • How to make cough inhalation at home.
  • Soda inhalation for coughing.
  • Inhalation over potatoes for dry cough and runny nose – for a child and an adult.
  • Causes of a runny nose.
  • Tablets for the common cold, drops or folk remedies – which is better.

Steam inhalation for bronchitis at home

Inhalation for bronchitis is carried out at home, to accelerate recovery and eliminate the symptoms of the disease.The method of treatment consists in the introduction of medicinal substances in the form of steam.

In the presence of a lower respiratory tract disease, inhalation is taken through the mouth. Medicines for inhalation penetrate well into the lungs, therefore they are successfully used for bronchitis.

Know which inhalation recipes work best for the disease.

Whether it is possible to do inhalations with bronchitis depends on the temperature indicators of the patient. If the temperature does not exceed 37.5 degrees, then inhalations will contribute to the removal of viscous secretions from the bronchi, increasing its liquefaction. This speeds up recovery.

Whether it is possible to do inhalation for bronchitis for an adult depends on the presence of other diseases. If the disease is accompanied by the release of pus in the sputum or there is an intolerance to some means for inhalation, then you should refrain from the procedure. Also contraindications include:

  • arrhythmia;
  • hemoptysis;
  • · severe pathologies of the cardiovascular system;
  • · tendency to hemorrhages.

Nebulizer products at home

  1. Various solutions are used for inhalation with a nebulizer for bronchitis. What to do with:
  2. antiseptics;
  3. inhalation bronchodilators;
  4. corticosteroids;
  5. mucolytics;
  6. · saline solution.

With the help of these means, inhalation is carried out for bronchitis at home. The drugs are purchased at the pharmacy.

Bronchodilators

Inhalation bronchodilators expand the bronchial lumen.Help with signs of obstruction. The list of bronchodilators for inhalation with a nebulizer: Berodual, Atrovent, Salbutamol.

Glucocorticosteroids

Corticosteroid drugs are hormonal agents that have a powerful anti-inflammatory and decongestant effect. Examples of names: Dexamethasone, Prednisolone, Pulmicort.

With preparations for sputum removal

Mucolytics are used to remove sputum. This group of drugs liquefies the viscous mucus in the bronchi, so it is easier to cough up.You can do inhalations for bronchitis with such medicines: Lazolvan, Ambroxol, Ambrobene.

Basophils increased with bronchitis

With saline

Inhalation for bronchitis with saline is useful for eliminating dryness and relieving sputum discharge. The saline solution does not cause side effects or allergies and is therefore suitable for children.

For bronchial candidiasis

Inhalation for bronchial candidiasis requires the use of antifungal agents.A list of medications is prescribed by a doctor.

What to do for adults

Adults are recommended to carry out inhalation with a nebulizer for bronchitis to accelerate recovery and remove viscous secretions from the lumen of the bronchi.

If there are signs of airway obstruction, bronchodilators are used. Salbutamol, Berodual and Atrovent help well. Magnesium sulfate has a relaxing effect, reduces the tone of the smooth muscles of the bronchi.

Inhalations for the removal of sputum from the bronchi in an adult include the use of mucolytics. Lazolvan, Ambrobene, or sodium chloride are commonly used.

Inhalation Treatment Reviews Review

As the reviews indicate, the inhaler for bronchitis can speed up the healing process. The patient quickly notes a general improvement in his condition. What is best for inhalation for bronchitis depends on the patient’s condition. Mucolytics and bronchodilators work well.

Berodual

Berodual for inhalation for bronchitis has good reviews. According to many users, the drug is good for dry cough, obstructive bronchitis and bronchospasm. Has a quick effect when used by inhalation.

The dosage of Berodual for inhalation for adults with bronchitis is 1 – 2.5 ml, depending on the severity of the condition.

Pulmicort

As the reviews show, Pulmicort for inhalation with bronchitis effectively helps.It is a synthetic corticosteroid that has anti-edema and anti-inflammatory effects. Relieves obstruction, normalizes breathing.

Steam inhalation

Steam inhalation for bronchitis allows you to quickly remove phlegm and remove dry cough. Suitable for using folk recipes and herbal remedies.

With eucalyptus

Inhalation with bronchitis with eucalyptus has anti-inflammatory and antiseptic properties, accelerates the excretion of phlegm.A decoction of the leaves is being prepared (a tablespoon for half a liter of water), infused for 15 minutes. Then you need to breathe over the eucalyptus steam for up to 10 minutes.

Herbs

Herbs for inhalation for bronchitis allow faster cure if pulmonary collections are used. The collection includes the roots of licorice, medicinal marshmallow, leaves of coltsfoot, thyme, oregano, conifers. The broth is brewed, infused and inhaled for up to 10 minutes.

Inhalation with garlic and soda for bronchitis has an irritating effect, which accelerates the excretion of phlegm.For cooking, a liter of water is boiled, 6 chopped garlic cloves and a teaspoon of soda are added. The mixture is stirred, infused for 5 – 10 minutes. The head is covered with a towel.

Inhalation with soda for bronchitis relieves the patient’s condition. They also accelerate the elimination of viscous secretions.

Essential oils

Essential oils for bronchitis for inhalation are used to improve well-being. The irritating effect of essential oils allows phlegm to flush out faster.It is better to use coniferous oils. A few drops of oil are added to the hot water.

Duration of procedures

The duration of inhalations in the treatment of bronchitis is 7-10 minutes. There will be no harm if the duration is increased.

Which is better – nebulizer or steam

Nebulizer for bronchitis is characterized by ease of use. No need to heat pots and burn your face over hot vapors.It is enough to dilute the product, pour it into the device and breathe until it ends.

The nebulizer is easy to use and does not require any special skills. Allows the use of special medications in the appropriate release form. The only drawback of the device is its high cost compared to steam inhalation.

Steam inhalation allows the use of essential oils and substances of natural origin (salts, herbs).

How to do inhalation for bronchitis – with a nebulizer or steam, depends on several factors.In terms of convenience, it is preferable to choose a nebulizer, and in terms of economy, steam inhalation.

Inhalation therapy for pregnant women

Inhalations from bronchitis to pregnant women are carried out only with medical permission, without the inclusion of extraneous plant components. Hot steam inhalation is allowed. You can add soda.

Prescriptions for inhalation for bronchitis with a nebulizer for pregnant women include the use of saline. The rest of the medications must be agreed with the attending physician.

Treatment of bronchitis

Inhalation therapy includes the use of medications with antiseptic, antimicrobial, expectorant or bronchodilatory properties. A solution for inhalation for bronchitis is selected depending on the specific problem that arose during the development of the disease.

Antibiotics

Used in case of a bacterial complication of bronchitis. A symptom of a complication is the appearance of pus in the sputum.Nebulizer preparations: Fluimucil, Dioxidin.

Bronchodilators

Bronchodilators are prescribed for airway obstruction. Berodual, Salbutamol, Berotek are commonly used.

Respiratory gymnastics

Exercises are aimed at improving blood circulation, restoring the work of the bronchi and removing viscous secretions. During gymnastics, air is inhaled through the nose and exhaled through the mouth.

Mustard plasters

The method of treatment consists in irritation of the skin in the chest area, which leads to an improvement in blood circulation.The body sweats, and the patient recovers faster. It is forbidden to use mustard plasters for bronchial inflammation against the background of hyperthermia.

Treatment of bronchitis in children

Therapy involves the use of medicines strictly according to medical prescriptions. The drugs are selected according to the age of the child and the specific problem.

Conclusion

1. Inhalation for bronchitis allows you to recover faster. However, they should only be done at normal body temperature.

2. The active substances of the drugs are delivered directly into the respiratory tract, therefore the use of a nebulizer is highly effective.

3. For inhalations with hot steam are suitable collections of medicinal herbs, recipes with soda and garlic.

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Clinical Study Asthma: Placebo Spiromax, Albuterol Spiromax – Clinical Trials Registry

Sponsors

Lead Sponsor:

Teva Branded Pharmaceutical Products R&D, Inc.

Source Teva Pharmaceutical Industries
Executive summary

This is a one-year study to investigate the safety of an albuterol dry powder inhaler.After one week, for the first 3 months, subjects will use an albuterol inhaler or dummy drug regularly four times a day. Then, over the last nine months of the study, all subjects will be given an albuterol dry powder inhaler and will only use it when necessary to help with breathing problems. Subjects will need to keep a daily diary (both paper and electronic) throughout the study, recording inhaler use and health problems.There will be visits to the research doctor about once a month throughout the year. This study is intended to show that the albuterol dry powder inhaler works well and is safe to use over an extended period. time.

Detailed description

Sponsor discontinued this study due to the need to modify the Spiromax device. used in this study; the identified problem does not affect the safety of the patient.Contact ranged from 3 to 49 days, with most subjects receiving ≤30 days of double-blind study. treatment.

General status Canceled
Start date October 2010
Completion date December 2010
Date of initial completion December 2010
Phase Phase 3
Study type Interventional
Primary result
Measure Time limit
Participants With Treatment-Emergent Adverse Events Day 1 to Day 49 (study termination)
Clinically significant changes in the results of physical examination according to the opinion of the investigator based on the results of screening Days -15 to -8 (screening), week 12, week 52
Clinically significant changes in laboratory test results, according to the investigator, based on screening results Days -15 to -8 (screening), week 12, week 52
Changes in screening results in electrocardiogram (ECG) results that are clinically significant in the investigator’s opinion Days -15 to -8 (screening), week 12, week 52
Clinically significant changes in vital signs, according to the researcher, based on the results of screening Days -15 to -8 (screening), week 12, week 52
Registration 331
Status
Intervention

Intervention type:

Drug

Intervention name:

Placebo spiromax

Description:

Placebo as a dry-powder inhaled orally using the Spiromax inhaler.During the 12-week double-blind period, participants take two (2) inhalations four times a day (QID) at approximately 7:00 AM, 12:00 PM, 5:00 PM, and bedtime.

Arm Group label:

Placebo spiromax

Intervention type:

Drug, remedy, medication

Intervention name:

Albuterol Spiromax

Description:

Albuterol in the form of a dry powder, administered orally using the Spiromax inhaler. Each inhalation delivers 90 micrograms (mcg).During the 12-week double-blind period, participants took two (2) inhalations four times a day (QID) at approximately 7:00, 12:00, 17:00, and at bedtime for a total dose of 720 mcg. per day for participants randomized to the albuterol treatment group.
The double-blind period is followed by a 40-week open period during which all study participants will receive 90 mcg (mcg) of albuterol Spiromax / inhalation as needed (PRN).

Another name:

ProAir® RespiClick, Multi-Dose Albuterol Dry Powder Inhaler (MDPI)

Eligibility

Criteria:

Inclusion criteria:

– Documented history of persistent asthma using albuterol as an emergency on average at least once a week for 4 weeks prior to screening.

– Female subjects with fertile potential (according to the researcher) should currently use and wish to continue to use a medically reliable method of contraception for the entire duration of the study

– General well-being

– Able to understand the requirements, risks and the benefits of participating in the study

– Non-smoker for at least one year prior to the screening visit and maximum annual packaging 10 years smoking history

– Other criteria apply

Exclusion criterion:

– Pregnancy, breastfeeding, plans to conceive or donation gametes (eggs or sperm) for in vitro fertilization during the study period or within 30 days after the last study visit

– Participation in any study of the study drug within 30 days before screening visit

– Known hypersensitivity spine to albuterol or any of the excipients in the composition.

– History of severe allergy to milk protein

– History of respiratory infection or illness (including but not limited to bronchitis, pneumonia, acute or chronic sinusitis, otitis media, flu, etc.) not resolved within 1 week before screening visit.

– Use of any prohibited concomitant asthma drug protocol or any prohibited non-asthma concomitant drug protocol

– Inability to tolerate or unwillingness to comply with protocol requirements.

– History of life-threatening asthma

– Any exacerbation of asthma within 3 months of the screening visit requiring oral or systemic corticosteroids

– History of life-threatening asthma

– Other criteria apply

Floor:

Everything

Minimum age:

12 years

Maximum age:

There is no data

Healthy volunteers:

Not

General Official
Surname Role Join
Clinical Project Leader Study Director Teva Respiratory R&D
Location
Object:
Teva Clinical Study Site
| Scottsdale, Arizona, United States
Teva Clinical Study Site
| Los Angeles, California, United States
Teva Clinical Study Site
| San Diego, California, United States
Teva Clinical Study Site
| Centennial, Colorado, United States
Teva Clinical Study Site
| Denver, Colorado, United States
Teva Clinical Study Site
| Miami, Florida, United States
Teva Clinical Study Site
| Gainesville, Georgia, United States
Teva Clinical Study Site
| Louisville, Kentucky, United States
Teva Clinical Study Site
| Wheaton, Maryland, United States
Teva Clinical Study Site
| Minneapolis, Minnesota, United States
Teva Clinical Study Site
| Plymouth, Minnesota, United States
Teva Clinical Study Site
| St.Louis, Missouri, United States
Teva Clinical Study Site
| Bellevue, Nebraska, United States
Teva Clinical Study Site
| Boys Town, Nebraska, United States
Teva Clinical Study Site
| Skillman, New Jersey, United States
Teva Clinical Study Site
| Rochester, New York, United States
Teva Clinical Study Site
| Rockville Center, New York, United States
Teva Clinical Study Site
| High Point, North Carolina, United States
Teva Clinical Study Site
| Raleigh, North Carolina, United States
Teva Clinical Study Site
| Canton, Ohio, United States
Teva Clinical Study Site
| Cincinnati, Ohio, United States
Teva Clinical Study Site
| Sylvania, Ohio, United States
Teva Clinical Study Site
| Eugene, Oregon, United States
Teva Clinical Study Site
| Portland, Oregon, United States
Teva Clinical Study Site
| El Paso, Texas, United States
Teva Clinical Study Site
| New Braunfels, Texas, United States
Teva Clinical Study Site
| San Antonio, Texas, United States
Teva Clinical Study Site
| Burke, Virginia, United States
Teva Clinical Study Site
| Seattle, Washington, United States
Teva Clinical Study Site
| Greenfield, Wisconsin, United States
Country Location

United States

Inspection date

May 2015

Responsible party

A type:

Sponsor

Keywords
Has extended access Not
Status View
Number of arms 2
Armament group

Label:

Albuterol Spiromax

A type:

Experimental

Description:

Albuterol multi-dose dry powder inhaler (Spiromax) at a dose of 720 micrograms per day administered as 2 inhalations of 90 mcg / inhalation four times a day for the 12 week double-blind period.Participants then continue into the 40 week open-label period in which they take albuterol multi-dose dry powder inhaler (Spiromax) inhalations of 90 mcg / inhalation as required (PRN).

Label:

Placebo Spiromax

A type:

Placebo comparator

Description:

The placebo was administered using a multi-dose dry powder inhaler (Spiromax) as 2 inhalations four times a day over a 12-week double-blind period. Participants then continue with a 40-week open period during which they administer a multi-dose inhaler with dry albuterol powder (Spiromax) in inhalations of 90 mcg / inhalation as needed (PRN).

Study design information

Distribution:

Randomized

Intervention model:

Parallel assignment

Primary purpose:

treatment

Disguise:

Quadruple (participant, healthcare provider, researcher, outcome evaluator)

instructions for use, analogs, composition, indications

At a temperature not exceeding 30 ° C, do not freeze, avoid exposure to sunlight.Keep out of the reach of children.

Like most other aerosol inhalers, Salbutamol may be less effective at low temperatures. When cooling the cartridge, it is recommended to take it out of the plastic case and warm it up with your hands for a few minutes. Can not be disassembled, punctured or thrown into fire, even if empty.

Pharmacy dispensing conditions

By prescription.

Manufacturer

Glaxo Wellcome Production, France

Legal address of the manufacturer:

Glaxo Wellcome Production, France

23 rue Lavoisier – Zone Industrielle No 2, Evreux, France /

Glaxo Wellcome Production, France

Industrial Zone 2, rue Lavoisier 23, Evreux, France.

For more information contact:

Representative office of GlaxoSmithKline Export Limited LLC (Great Britain) in the Republic of Belarus

Minsk, st. Voronyansky, 7A, office 400

Tel .: +375 17 213 20 16; fax + 375 17 213 18 66

Instruction for use of the inhaler

Checking the inhaler

Before using the inhaler for the first time or if the inhaler has not been used for 5 days or longer, remove the cap from the mouthpiece by slightly squeezing the cap from the sides, shake the inhaler well and press the aerosol valve to release two inhalation doses into the air to make sure it is working properly inhaler.

Using the inhaler

Remove the cap from the mouthpiece by gently squeezing the cap from the sides.

Inspect the inside and outside of the mouthpiece to make sure it is clean and free of debris.

Shake the inhaler well to mix the contents evenly and to remove foreign particles.

Hold the inhaler between your index and thumb in an upright position, bottom up, with your thumb resting on the base under the mouthpiece.

Breathe out slowly, deeply, grasp the mouthpiece with your lips without clenching it with your teeth.

Taking the deepest possible breath through the mouth, simultaneously press the top of the inhaler to release one inhalation dose of Salbutamol.

Hold your breath for a few seconds, remove the mouthpiece from your mouth, then exhale slowly.

For a second dose, hold the inhaler upright, wait about 30 seconds and then repeat steps 3–7.

Close the mouthpiece tightly with the protective cap.

Attention! There is no rush to complete stages 5, 6 and 7. You should start inhaling as slowly as possible, just before pressing the inhaler valve. The first few times it is recommended to practice in front of a mirror. If you see “fog” coming out of the top of the inhaler or the corners of your mouth, you should start over from step 3.

If the doctor has given you other instructions for using the inhaler, then strictly follow them.Contact your doctor if you have any difficulty using the inhaler.

Cleaning the inhaler

The inhaler must be cleaned at least once a week.

Remove the metal can from the plastic housing and remove the mouthpiece cover.

Thoroughly rinse the plastic housing and mouthpiece lid under running warm water.

Dry the plastic body and mouthpiece cover completely, both outside and inside. Do not overheat.

Place the metal can in the plastic housing and replace the mouthpiece cap.

DO NOT IMMERSE METAL CYLINDER IN WATER.

Trademark rights belong to the GSK group of companies.

© 2018 GSK Group or their copyright holder.

Acute uncomplicated bronchitis. The ABC of antibiotic therapy. Vidal reference book of medicines


Acute uncomplicated bronchitis

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Author: John G.Bartlett, MD

Pathogens:

  • Viruses: rhinovirus, parainfluenza virus, coronavirus, respiratory syncytial virus, metapneumovirus
  • Influenza: the only treatable virus
  • Chlamydophila pneumonia
  • Mycoplasma pneumonia
  • Whooping cough ( Bordetella pertussis )
  • Other factors: allergens, smoking, toxic fumes

Clinic:

  • Case history : acute respiratory tract infection, cough is the predominant complaint
  • Physical examination : Fever is predominant in influenza or parainfluenza.On examination of the lungs, wheezing or stridorious breathing may be found, but not a crunch or signs of damage to the lung tissue.
  • Differential diagnosis for cough: subclinical asthma, postnasal drip *, allergy, whooping cough, chronic heart failure, GERD, neoplasm, reaction to ACE inhibitors

Diagnostics

  • Clinical diagnosis is based on symptom complex and physical examination to rule out pneumonia.
  • Indications for carrying out Rg chest : abnormal symptoms (heart rate> 100, temperature> 38 91 632 o 91 633 C, NPV> 20) or wheezing and cough> 3 weeks.

Treatment

Etiological treatment:

  • Principles : diagnosis = upper respiratory tract infection + cough. The doctor needs to exclude asthma, GERD, cancer, postnasal syndrome.Rg-examination of the chest only to exclude pneumonia, when abnormal signs appear. No antibiotics in treatment except for whooping cough.
  • Indications for antimicrobial therapy : suspected pertussis or influenza. If influenza is suspected, the appointment of anti-influenza drugs no later than 48 hours from the serological determination of the type of pathogen.
  • Influenza (see related module): Avian influenza medications should be considered if symptoms do not appear
  • Exceptions to antibiotic prescribing guidelines ( NICE): Antibiotics are prescribed if:
  • §

Serious comorbidities,

§

for immunocompromised patients,

§

age> 65 plus diabetes,

§ heart failure

§

hospitalization within the last few years

  • Antitussives : codeine-containing drugs or dextromethorphan ( in the Russian Federation is presented as part of combined agents for symptomatic treatment / poisk_preparatov / lact_307.htm)
  • Colds: dexbrompheniramine (Russia is not represented, in the USA and Canada it is sold under the name Drixoral) and sedative antihistamines +/- decongestants (Actifed, Contac, Dimetapp are not presented in Russia, Actifed is available in Ukraine ), naproxen 500 mg 3 r / day PO x 5 days and / or atrovent nasal spray.
  • Allergic rhinitis: e.g. loratadine 10 mg PO once daily
  • Sinusitis: +/- antibiotic for severe symptoms or> 7 days of symptoms (efficacy unknown)
  • Exacerbation of chronic bronchitis : see relevant topic
  • Cough or bronchospasm (infection-induced): inhaled albuterol, 2 inhalations every 4 to 6 hours.
  • If the cough lasts more than 3 weeks: it is necessary to exclude asthma, GERD, whooping cough, cancer.

Suspected or confirmed whooping cough

  • Antibiotics should not be used for bronchitis unless there is a suspected or confirmed case of whooping cough.
  • Most adult patients do not have typical whooping cough symptoms due to partial immunity. The most important clue will be severe paroxysms of cough for more than 3 weeks, a convulsive noisy gasp after coughing, or post-cough vomiting.
  • Preferred tests: nasopharyngeal swab for PCR and / or culture (no sensitivity)
  • Whooping cough: erythromycin 500 mg PO 4 r / d x 14 days or azithromycin 250 mg PO 1 r / d x 4 days. Most people choose to use azithromycin because of the side effects of erythromycin.
  • Alternative: Trimethoprim-sulfamethoxazole 1 DS 2 po x 14 days or clarithromycin 500 mg PO 2 po x 14 days.

Conclusion:

  • For a patient who is planning antibiotic-free therapy, it is better to say that he has “chilled chest” and not to use the term “bronchitis”
  • If there are abnormal symptoms (t> 38 o C, heart rate> 100, respiratory rate> 20) and realizing that this is obviously not influenza, it is necessary to conduct Rg-lungs to exclude pneumonia.
  • However, the use of antibiotics is no less clear than their use according to the NICE criteria (mentioned above)

Additional information

  • Several well-controlled studies indicate that antibiotic use is not warranted.
  • Academics continue to argue that antibiotics are not effective, but the Cochrane Library has backed up this claim by careful analysis of the data.
  • NICE Review recommends antibiotics for patients with comorbidities and advanced age
  • Indications for antibiotics: severe exacerbations of chronic bronchitis, some cases of influenza and whooping cough

Literary sources :

  • Snow V, Mottur-Pilson C, Gonzales R; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine; Centers for Disease Control; Infectious Diseases Society of America .Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. 2001 Mar 20; 134 (6): 518-20 http: // annals. org / article. aspx? articleid = 714360 is only available with a paid subscription.
  • Irwin RS, Madison JM. The diagnosis and treatment of cough . N Engl J Med. 2000 Dec 7; 343 (23): 1715-21. Full text at ref. http://www.nejm.org/doi/full/10.1056/NEJM200012073432308

* postnasal drip – there is still no generally accepted term in Russian. The essence of the syndrome is in patients’ complaints about the sensation of accumulation of mucus in the posterior parts of the nasal cavity and its flowing down the posterior wall of the pharynx. More details can be read, for example, here – http://www.consilium-medicum.com/article/16060

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Ventolin (Ventolin): description, recipe, instruction

Ventolin

Analogs (generics, synonyms)

Salbutamol, Salamol, Aloprol, Asmadil, Astakhalin, Aerolin, Asmatol, Albuterol, Astalin, Ventodisk, Bronchovaleas, Volmax, Salbutan, Salben, Salbuvent, Sultanol Ventilan Proventil

Active ingredient

Salbutamol (Salbutamolum)

Pharmacological group

Beta-adrenomimetics

Recipe

International:

Rp.: Aer. “Ventolin” 100 mkg / d – 200 d

D.S: With an attack of suffocation, 1-2 breaths

Russia:

Rp .: Aer. Salbutamoli 100 mkg / d – 200 d
D.S: With an attack of suffocation 1-2 breaths

Prescription form 107-1 / y

Pharmacological action

Salbutamol affects beta2-adrenergic receptors and thereby causes bronchodilation in bronchospasm. The beta1-adrenergic receptors of the heart are slightly affected. Antiallergic action is to prevent the release of histamine and other mediators (a slow-reacting substance) from mast cells.10-20% of the dose is absorbed into the general bloodstream, with which it enters the liver and turns into simple compounds that are excreted by the kidneys. The remainder of the administered dose of the drug enters the digestive system and is also absorbed from the intestines into the blood. The onset of action of Ventolin for inhalation falls on the 5th minute. The effect of salbutamol lasts for 4 to 6 hours.

Method of application

For adults:

Ventolin for inhalation is prescribed for adults to eliminate an attack of bronchospasm, 100-200 mcg once.For preventive treatment, the daily dose is 200 mcg 3-4 times; before physical activity or contact with an allergen – 200 μg 15 minutes before exposure to the factor. For children to stop an attack of bronchospasm, it is recommended to use Ventolin: 1-2 mg of the drug at the age of 2 to 6 years, 2 mg of the drug at the age of 6 to 12 years, 2-4 mg at the age of 12 years. For prophylaxis – 100-200 mcg three times a day.

Syrup is prescribed for adults 2 ml 3-4 times a day. If absolutely necessary, the dose is increased to 4 ml.You can not use Ventolin for inhalation more than 4 times a day. For the elderly, the dose of the drug is 2 mg three times a day.
Ventolin Nebula is intended for inhalation: For adults, the dose is 2.5 mg (maximum up to 5 mg), use of a nebulizer up to 4 times a day.

Use of Ventolin Nebula:
1. Remove the nebula from the bag;
2. Shake it and, holding the top edge, turn to open;
3. Insert the open end down into the nebulizer and press lightly;
4.Collect the nebulizer;
5. Use a nebulizer with medication inside.
In general, the total daily dose for the use of Ventolin should not exceed 8 – 10 inhalations (in patients who do not use Serevent). In case of insufficient effectiveness in such patients, the treatment plan should be revised.
The use of spacers increases the efficiency of use.
Checking the inhaler Before using the inhaler for the first time or if the inhaler has not been used for a week or longer, remove the cap from the mouthpiece by slightly squeezing the cap from the sides, shake the inhaler well and make two sprays into the air in order to make sure the inhaler is working properly.

Using the inhaler
1. Remove the cap from the mouthpiece by slightly squeezing the cap from the sides.
2. Inspect the inside and outside of the mouthpiece to make sure it is clean.
3. Shake the inhaler well.
4. Hold the inhaler between the index and thumb in a vertical position, bottom up, with the thumb resting on the base under the mouthpiece. 5. Make a slow deep exhalation, clasp the mouthpiece with your lips, without squeezing it with your teeth. 6. Taking the deepest possible breath through the mouth, simultaneously press the top of the inhaler to release one inhalation dose of salbutamol.7. Hold your breath for a few seconds, remove the mouthpiece from your mouth, then exhale slowly. 8. To receive the second dose, keeping the inhaler in an upright position, wait for about 30 seconds and then repeat steps. 3-7.
9. Close the mouthpiece tightly with a protective cap. There is no rush to complete stages 5, 6 and 7.
You should start inhaling as slowly as possible, just before pressing the inhaler valve. The first few times it is recommended to practice in front of a mirror.
If “fog” is visible coming from the top of the inhaler or from the corners of the mouth, start over from step
2.If the doctor has given other instructions for using the inhaler, then the patient must strictly follow them. If the patient has difficulty using the inhaler, then he needs to see a doctor.

Cleaning the inhaler The inhaler must be cleaned at least once a week.
1. Remove the metal can from the plastic body and remove the mouthpiece cover.
2. Thoroughly rinse the plastic body and mouthpiece lid under running warm water.
3. Dry the plastic body and mouthpiece cover completely both outside and inside.Avoid overheating.
4. Place the metal can in the plastic housing and replace the mouthpiece cap. Do not immerse metal cans in water.

For children:

Ventolin Nebula is intended for inhalation:
For children, the dose is 2.5 mg, applied up to 4 times a day.

Readings

Bronchial asthma: – relief of symptoms of bronchial asthma when they occur;
– Prevention of attacks of bronchospasm associated with exposure to an allergen or caused by exercise;
– use as one of the components in long-term maintenance therapy of bronchial asthma.
Other chronic lung diseases accompanied by reversible airway obstruction, including chronic obstructive pulmonary disease (COPD), chronic bronchitis, pulmonary emphysema.
Bronchodilators should not be the only or main component of treatment for unstable or severe bronchial asthma. In the absence of a response to salbutamol in patients with severe bronchial asthma, it is recommended to carry out glucocorticosteroid therapy in order to achieve and maintain control of the disease.Failure to respond to salbutamol therapy may indicate the need for urgent medical advice or treatment.

Contraindications

– children’s age up to 1.5 years;
– hypersensitivity to any component of the drug.
The drug is used with caution if there is a history of tachyarrhythmia, severe chronic heart failure, arterial hypertension, thyrotoxicosis, pheochromocytoma, as well as during pregnancy and lactation.

Side effects

mild hand tremor, headache, agitation and hyperactivity in children, vasodilation and increased heart rate, heart rhythm disturbances, paradoxical bronchospasm, allergic reactions (arterial hypotension, angioedema, bronchospasm).

Form of issue

Tablets – 20, 50 and 100 pcs. in 1 package, 1 tab. contain 2 and 4 mg of salbutamol. 150 ml syrup in a bottle – 2 mg in 1 ml. Two-layer tablets 0.008 g, 20 or 50 pcs. packaged.

Ventolin for inhalation:
– Ventolin nebula (metered aerosol in plastic ampoules) – 200 doses in 1 bottle. 2.5 ml in a nebula. – Dosed aerosol without CFCs (chlorofluorocarbons that destroy the ozone layer) – 200 doses in 1 bottle. 100mcg salbutamol in 1 dose.
Syrup for internal administration – 2 mg in 2 ml, in a bottle of 50 ml.

Foradil Combi | Sandoz in Russia

Pharmacodynamics

Formoterol

Formoterol is a selective agonist of beta 2 -adrenergic receptors. It has a bronchodilatory effect in patients with reversible airway obstruction. The action of the drug occurs quickly (within 1-3 minutes) and lasts for 12 hours after inhalation.When using therapeutic doses, the effect on the cardiovascular system is minimal and is noted only in rare cases.

Formoterol inhibits the release of histamine and leukotrienes from mast cells of passively sensitized human lungs. In preclinical studies, some of the anti-inflammatory properties of formoterol have been shown, such as the ability to inhibit the development of edema and the accumulation of inflammatory cells.

In preclinical studies in vitro , it was shown that racemic formoterol and its (R, R) and (S, S) enantiomers are highly selective agonists of beta 2 β-adrenergic receptors.The (S, S) enantiomer was 800-1000 times less active than the (R, R) enantiomer and did not adversely affect the activity of the (R, R) enantiomer in relation to tracheal smooth muscle. There was no pharmacological evidence of the superiority of using one of these two enantiomers over the racemic mixture.

Clinical studies have shown that formoterol is effective in preventing bronchospasm caused by inhaled allergens, exercise, cold air, histamine or methacholine.Since the bronchodilatory effect of formoterol remains pronounced for 12 hours after inhalation, the use of the drug 2 times a day for long-term maintenance therapy allows in most cases to provide the necessary control of bronchospasm in chronic lung diseases during the day and at night.

In patients with chronic obstructive pulmonary disease (COPD) of a stable course, formoterol, used in the form of inhalation with the Aerolizer in doses of 12 or 24 μg 2 times a day, causes a rapid onset of a bronchodilatory effect that lasts for at least 12 hours and is accompanied by an improvement quality of life.

Budesonide

Budesonide is a glucocorticosteroid (GCS) with a pronounced local effect and practically does not have a systemic effect. Like other inhaled corticosteroids, budesonide exerts pharmacological effects by interacting with intracellular glucocorticosteroid receptors, as a result of which the production of various cytokines, chemokines, enzymes and cell adhesion molecules is suppressed.

The maximum therapeutic effect of the drug in patients requiring treatment with GCS develops on average within 10 days after the start of therapy.With regular use in patients with bronchial asthma, budesonide reduces the severity of chronic inflammation in the lungs and thus improves their function, relieves the symptoms of bronchial asthma, reduces bronchial hyperreactivity and prevents the development of an exacerbation of the disease.

Pharmacokinetics

Formoterol

The therapeutic dose range for formoterol is 12 mcg to 24 mcg 2 times a day. Data on the pharmacokinetics of formoterol were obtained in healthy volunteers after inhalation of formoterol at doses higher than recommended, and in patients with COPD after inhalation of formoterol at therapeutic doses.

Intake

After a single inhalation of 120 μg by healthy volunteers, formoterol is rapidly absorbed into the blood plasma, the maximum plasma concentration (C max ) was 266 pmol / l and was reached 5 minutes after inhalation.

In patients with COPD who received the drug at a dose of 12 or 24 μg 2 times a day for 12 weeks, the concentration of formoterol in blood plasma, measured 10 minutes, 2 hours and 6 hours after inhalation, was in the ranges 11.5-25 , 7 pmol / l and 23.3-50.3 pmol / l, respectively.

In studies examining the total excretion of formoterol and its (R, R) and (S, S) enantiomers in the urine, it was shown that the amount of formoterol in the systemic circulation increases in proportion to the dose (12-96 μg).

After inhalation of formoterol at a dose of 12 or 24 mcg 2 times a day for 12 weeks, the excretion of unchanged formoterol by the kidneys in patients with bronchial asthma increased by 63-73%, and in patients with COPD – by 19-38%. This indicates some accumulation of formoterol in the blood plasma after repeated inhalations.At the same time, there was no greater cumulation of one of the formoterol enantiomers in comparison with the other after repeated inhalations.

Just as it has been reported for other drugs used in the form of inhalation, most of the formoterol in this case, is swallowed and then absorbed from the gastrointestinal tract (GIT). When 80 μg of 3H-labeled formoterol was administered orally, at least 65% of the dose was absorbed in two healthy volunteers.

Distribution

Binding of the drug to blood plasma proteins is 61-64%, binding to serum albumin – 34%.

Saturation of binding sites is not achieved in the range of concentrations observed after application of therapeutic doses of the drug.

Metabolism

The main pathway of formoterol metabolism is direct conjugation with glucuronic acid. Another metabolic pathway is O-demethylation followed by conjugation with glucuronic acid (glucuronidation).

Minor metabolic pathways include the conjugation of formoterol with sulfate followed by deformylation.Many isoenzymes are involved in the processes of glucuronidation (UGT1A1, 1A3, 1A6, 1A7, 1A8, 1A9, 1A10, 2B7 and 2B15) and O-demethylation (CYP2D6, 2C19, 2C9 and 2A6) of formoterol, which suggests a low probability of drug interactions. or an isoenzyme involved in the metabolism of formoterol. At therapeutic concentrations, formoterol does not inhibit cytochrome P450 isozymes.

Derivation

In patients with bronchial asthma and COPD who received formoterol at a dose of 12 or 24 μg 2 times a day for 12 weeks, approximately 10% and 7% of the dose, respectively, was determined in the urine as an unchanged substance.The calculated proportions of (R, R) and (S, S) enantiomers of the unchanged substance in urine are 40% and 60%, respectively, after applying a dose of formoterol (12-120 μg) once in healthy volunteers and after a single and repeated use in patients with bronchial asthma. …

The active substance and its metabolites are completely excreted from the body: about 2/3 of the dose administered orally is excreted by the kidneys, about 1/3 through the intestines. The renal clearance of formoterol is 150 ml / min.

In healthy volunteers, the terminal half-life from blood plasma after a single inhalation of formoterol at a dose of 120 μg is 10 hours; the terminal half-life of (R, R) and (S, S) enantiomers, calculated from urinary excretion, was 13.9 and 12.3 hours, respectively.

Pharmacokinetics in certain groups of patients

Floor

After adjusting for body weight, the pharmacokinetic parameters of formoterol in men and women do not differ significantly.

Patients ≥ 65 years old

The pharmacokinetics of formoterol in patients ≥ 65 years of age have not been studied.

Patients ≤ 18 years old

In a clinical study in children aged 5-12 years with bronchial asthma, who received the drug at a dose of 12 or 24 μg 2 times a day for 12 weeks, the excretion of unchanged formoterol in the urine increased by 18-84% compared with the corresponding indicator. measured after the first dose.

In clinical studies in children, about 6% of unchanged formoterol was determined in urine.

Patients with impaired liver and / or kidney function

Pharmacokinetics of the drug in patients with impaired liver and / or kidney function has not been studied.

Budesonide

Intake

Budesonide is rapidly and completely absorbed in the lungs, the maximum concentration of the drug in the blood plasma is achieved immediately after application.After inhalation of budesonide, taking into account sedimentation on the mucous membrane of the oropharynx, the absolute bioavailability is 73%. Due to the pronounced presystemic metabolism in the liver, only 10-13% of budesonide is absorbed into the gastrointestinal tract .

Distribution

The binding of budesonide to blood plasma proteins is 85 to 90% at a concentration of 1 to 100 nmol. Budesonide is widely distributed in tissues. The volume of distribution of budesonide at equilibrium is about 183 – 301 liters.In preclinical studies, budesonide accumulated in high concentrations in the spleen, lymph nodes, thymus, adrenal cortex, reproductive organs and bronchi, and also penetrated the hematoplacental barrier. Budesonide passes into breast milk. The mean maternal milk / blood ratio was 0.46. The estimated daily dose received by a child with milk is 0.3% of the daily maternal dose. Even under the condition of absolute bioavailability in a child after oral administration with milk, the concentration in the infant’s blood is 600 times less than that of the mother.

Metabolism

Budesonide is not metabolized in the lungs.

After absorption, the drug is metabolized in the liver to form several inactive metabolites, including 6ß-hydroxybudesonide and 16α-hydroxyprednisolone.

The main pathway of budesonide metabolism in the liver using the CYP3A4 isoenzyme of the P450 system can be changed under the influence of inhibitors or inducers of the CYP3A4 isoenzyme.

Derivation

In healthy volunteers, after inhalation of radiolabeled budesonide (via a metered dose inhaler), approximately 32% of the dose was detected in the urine, and 15% of the dose in the feces.After inhalation, 16α-hydroxyprednisolone was detected in urine, but not budesonide.

Budesonide has a high systemic clearance – 84 l / h and a short half-life – 2.8 – 5 hours.

Pharmacokinetics in certain groups of patients

Floor

After adjusting for body weight, the pharmacokinetic parameters of budesonide in men and women do not differ significantly.

Patients <18 years old

The pharmacokinetics of budesonide in children has not been studied.At the same time, data on other inhaled drugs containing budesonide suggest that drug clearance in children over 3 years of age is approximately 50% higher than in adult patients.

Patients with impaired liver and / or kidney function

The pharmacokinetics of budesonide in patients with impaired liver and / or kidney function have not been studied.

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