Side effects of breathing treatments: Albuterol (Inhalation Route) Side Effects

18.10.197819.11.2021 by alexxlab

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Albuterol (Inhalation Route) Side Effects

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Fast, irregular, pounding, or racing heartbeat or pulse

shakiness in the legs, arms, hands, or feet

trembling or shaking of the hands or feet

Less common

Bladder pain

bloody or cloudy urine

chest discomfort, tightness, or pain

chills

cough

cough producing mucus

diarrhea

difficult or labored breathing

difficulty with swallowing

dizziness

feeling of warmth

fever

frequent urge to urinate

hives, itching, or skin rash

hoarseness

loss of appetite

lower back or side pain

nausea

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

redness of the face, neck, arms, and occasionally, upper chest

runny nose

sore throat

stomach pain

swollen, painful, or tender lymph glands in the neck, armpit, or groin

unusual tiredness or weakness

Rare

Hives or welts

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals

noisy breathing

swelling of the mouth or throat

Incidence not known

Agitation

arm, back, or jaw pain

chest heaviness

confusion

decreased urine

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

drowsiness

dry mouth

extra heartbeat

fainting

flushed, dry skin

fruit-like breath odor

headache

increased hunger

increased thirst

increased urination

irritability

lightheadedness

muscle pain or cramps

nervousness

nightmares

numbness or tingling in the hands, feet, or lips

pounding in the ears

rapid, deep breathing

restlessness

seeing, hearing, or feeling things that are not there

seizures

slow or fast heartbeat

stomach cramps

sweating

unexplained weight loss

unusual feeling of excitement

vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Body aches or pain

congestion

voice changes

Less common

Difficult, burning, or painful urination

earache

headache, severe and throbbing

muscle or bone pain

pain

redness or swelling in the ear

redness, swelling, or soreness of the tongue

sneezing

stuffy nose

swelling

tenderness

trouble in holding or releasing urine

trouble sleeping

Rare

Sleepiness or unusual drowsiness

Incidence not known

Bad, unusual, or unpleasant (after) taste

change in taste

feeling of constant movement of self or surroundings

gagging

rough, scratchy sound to voice

sensation of spinning

tightness in the throat

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Portions of this document last updated: Oct. 01, 2021

Albuterol side effects and interactions, and how to avoid them

If you’re prescribed albuterol, you might have questions about its safety and effectiveness. What side effects should you expect from this medication? Is it safe to use every day? Should you be concerned if you are taking other medicines? Learn the warnings and precautions, potential interactions with other drugs, and what you can do to minimize or avoid side effects.

What is albuterol?

Albuterol, also called salbutamol in Canada, is a non-steroidal, short-acting beta2-agonist (SABA) medication used to treat wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases, such as asthma, emphysema, and chronic obstructive pulmonary disease. It is also used to prevent bronchospasm in those with reversible obstructive airway disease and to help with shortness of breath and other breathing problems during exercise. It is in a class of medications called bronchodilators and works by relaxing muscles in the airways, thereby opening air passages.

Types of albuterol
Albuterol HFA	Inhalation aerosol	4+ years old
Proair HFA	Inhalation aerosol	4+ years old
Proventil HFA	Inhalation aerosol	4+ years old
Ventolin HFA	Inhalation aerosol	4+ years old
Proair Respiclick or Digihaler	Powder for oral inhalation	12+ years old
Albuterol	Syrup or tablets	2+ years old
Albuterol	Nebulizer solution	None
Albuterol ER	Extended-release tablets	6+ years old

RELATED: FDA approves first ProAir HFA generic

Common side effects of albuterol

Many people do not experience any side effects of albuterol, and, if they do, the side effects are mild. “Approximately 10%-20% of people using albuterol experience some side effects,” says Douglas P. Jeffrey, MD, a family physician in Oregon and medical advisor for eMediHealth. The most common adverse effects, according to the Food and Drug Administration (FDA) include:

Rapid heart rate or palpitations
Chest pain
Tremors
Nervousness

Some people also experience wheezing or trouble breathing immediately after using an albuterol inhaler, but this usually goes away after a short time.

Serious side effects of albuterol

There are also more severe side effects, including:

Headache
Nausea
Vomiting
Cough
Throat irritation
Muscle, bone, or back pain
Uncontrollable shaking in some part of your body

Serious side effects are considered those that interfere with daily functioning. Side effects can last for four to six hours. They typically resolve within a few days or weeks after starting the medication. However, you should contact your doctor if you experience severe or persistent side effects.

It is a good idea to discuss with your healthcare provider whether you should continue taking the medication or if you should discontinue using it immediately if you experience side effects. Your doctor might provide information about your symptoms to the adverse event program at the FDA. You can also complete the online form to report your symptoms.

Although allergic reactions are rare they can be life-threatening. Allergic symptoms include:

Fast, pounding heartbeat
Chest pain
Rash
Hives
Itching
Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
Even more difficulty breathing or swallowing
Hoarseness

Another possible side effect is paradoxical bronchospasm, according to a report published in the American Journal of Case Reports. The condition is the unexpected constriction of the smooth muscle walls of the airways. It can cause shortness of breath, difficulty breathing on exertion, and temporarily decreased lung function. The report authors believe that paradoxical bronchoconstriction is an underreported side effect of beta2-agonist inhalers, including albuterol. According to this research, this side effect impacts up to 8% of people using this treatment. Changing to a different medication might help.

Albuterol warnings

The FDA approved albuterol inhalers for people aged four and older for those with asthma and exercise-induced bronchospasm.

Before taking albuterol, or any other prescription, you should tell your doctor about your medical conditions. This medication should be used with caution if you have heart disease, according to prescription information, which includes:

Coronary insufficiency
Cardiac arrhythmias
High blood pressure
History of irregular heartbeat

The American Heart Association lists albuterol as one of the drugs that may cause or exacerbate heart failure.

You should also discuss the following health conditions with your healthcare professional before taking albuterol:

Hyperthyroidism
Diabetes
Seizure disorder
Hypokalemia (low potassium)

Although rare, there have been reports of death in association with excessive use of inhalation asthma medications, according to the FDA. The exact cause of these deaths is unknown; however, researchers suspect cardiac arrest and the resulting lack of oxygen to the body.

Pregnancy and breastfeeding

If you are pregnant or planning to become pregnant, you should tell your doctor. According to information from the manufacturer, there are no direct studies of albuterol in pregnant women but the risk to a fetus appears low. The lack of oxygen caused by asthma might be more harmful to the fetus. Somewhere between 4% and 12% of women who are pregnant in the United States have asthma, and 3% of those take asthma medications, including albuterol, according to the Centers for Disease Control and Prevention (CDC).

A study published in Pediatrics found that using asthma medications did not increase the risk for most congenital disabilities. Albuterol was the most common medication used by people participating in the study. There might, however, be an increased risk for congenital disabilities of the esophagus, anus, and abdominal wall.

The possible effects on a baby when you are breastfeeding are also not known. Using a bronchodilator will probably not cause high enough levels in your breast milk to cause a problem, according to MothertoBaby. However, you should speak with your doctor and proceed with caution, weighing the risks and benefits if you are pregnant, planning to be pregnant, or breastfeeding.

Albuterol interactions

Albuterol can cause interactions with other medications. Interactions vary depending on the drugs you are taking, but can include:

Increased blood pressure
Increased heart rate
Irregular heartbeat
Increased risk of a cardiovascular event

You should tell your doctor if you are taking any other medicines, including prescription drugs, over-the-counter, supplements, and vitamins. “Certain medications are known to interact with albuterol and should be avoided,” according to Dr. Jeffrey. Prescriptions that could have dangerous drug interactions with albuterol include:

“There are many other medications that require monitoring or dose adjustments when used with albuterol. The list of potential interactions is quite long, with over 100 medications that might interact adversely with albuterol. It is best to consult with your health provider regarding potential interactions,” explains Dr. Jeffrey.

Some of the drugs that could potentially interact with albuterol (although not as seriously as the ones listed above) include:

Tenormin (atenolol)
Trandate (labetalol)
Lopressor, Toprol XL (metoprolol)
Corgard (nadolol)
Inderal (propranolol)
Lanoxin (digoxin)
Epipen, Primatene Mist (epinephrine)
Xopenex (metaproterenol and levalbuterol)
Hygroton (chlorthalidone)
Diuril (chlorothiazide)
Esidrix, Hydrodiuril, Microzide (hydrochlorothiazide)
Lozol (indapamide)
Mykrox, Zaroxolyn (metolazone)
Lasix (furosemide)
Elavil (amitriptyline)
Asendin (amoxapine)
Anafranil (clomipramine)
Norpramin (desipramine)
Silenor (doxepin)
Tofranil (imipramine)
Pamelor (nortriptyline)
Vivactil (protriptyline)
Surmontil (trimipramine)
Marplan (isocarboxazid)
Nardil (phenelzine)
Eldepryl, Emsam (selegiline)
Parnate (tranylcypromine)

You should also avoid cold medicine, including over-the-counter products; however, there are no known drug interactions with albuterol and cough medicine.

If you are taking any of these medications, your doctor might need to adjust your dose or monitor you carefully for side effects.

Albuterol overuse

Overuse of albuterol is relatively common, according to a report published in the Journal of Allergy and Clinical Immunology. This medication is meant for occasional use when you have acute asthma symptoms. However, about a quarter of people prescribed albuterol use it as a daily asthma-control medication instead of as a rescue inhaler for quick relief. Many doctors suggest one inhaler canister should last approximately one year. If you are using your inhaler more often or if it only lasts a few months, it might indicate your asthma is not well-controlled, and you might want to speak with your doctor about a daily medication.

Overuse of albuterol can be dangerous and could have potential health consequences. You might notice you have asthma symptoms more often or the symptoms are worsening. People who overuse inhalers report more coughing, wheezing, nighttime awakenings, and more frequent symptoms than those who use albuterol only occasionally. They also stated they had a lower quality of life and higher rates of depression.

Overuse can also lead to albuterol overdose, according to the report. Symptoms of an overdose include:

Chest pain
Rapid or irregular heartbeat
Headache
Tremors
Nervousness
Dizziness
Dry mouth
Nausea
Fatigue
Seizures

If you believe you, or someone else, is having an overdose, you should contact the poison control center at 1-800-222-1222 or seek immediate medical care.

How to avoid albuterol side effects

1. Take it as directed. The best way to avoid side effects from albuterol is to use it as directed. Your doctor should discuss the proper dosage and how often you should take the medication. For adults using a metered-dose inhaler, the recommended dose is one to two puffs every four to six hours. For tablets and syrup, the recommended dose is 2-4 mg every six to eight hours. The extended-release formula lasts 12 hours and can be taken twice a day.

2. Use a spacer. The Medical Associates Clinic suggests using a spacer, which is an extension placed on the inhaler that can slow the inhalation of your medication. Using a spacer increases the amount of medicine that gets into your lungs, and might decrease the taste of the drug in your mouth while also reducing side effects such as sore throat and hoarseness. Another method that’s especially convenient for children is by taking (or administering) a breathing treatment through a nebulizer machine.

3. Supplement with different daily asthma medications. Albuterol is a quick-acting rescue medication for asthma symptoms. You should take it only if you are experiencing acute symptoms and only according to the recommended guidelines. If you find that you are still having symptoms or if the recommended dose does not seem to be relieving symptoms, you should talk to your doctor. A daily asthma medication might be best, with the albuterol reserved for acute attacks.

4. Switch medications. If you are still experiencing side effects after a few days or weeks, talk to your doctor. “There are steps that can be taken if side effects are severe. You might need to stop the medication, but you should only do so after consulting your healthcare provider. A switch to an alternate medication used for the same purpose might help. Or your doctor might suggest lowering your dosage,” according to Dr. Jeffrey, “Side effects are less likely when using an inhaler instead of pills or liquid.”

5. Make small lifestyle changes. Taking control of your asthma symptoms will also lessen your need for albuterol, therefore, reducing your side effects. Some ways to better control your asthma are:

Understanding and avoiding triggers, such as pollen, pet dander, cold air, intense exercise, odors such as perfume or hair spray, and cigarette smoke
Regular exercise
Using a dehumidifier at home
Frequent washing of sheets and blankets
Regular vacuuming

Coupons for albuterol are available on singlecare. com or the app, available for Android and iOS. You can use the coupons at most major pharmacies as well as some regional ones. Once you type in your zip code, you can see the available pharmacies in your area.

albuterol inhalation | Michigan Medicine

What is the most important information I should know about albuterol inhalation?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What is albuterol inhalation?

Albuterol inhalation is a bronchodilator that is used to treat or prevent bronchospasm in people with reversible obstructive airway disease. Albuterol is also used to prevent exercise-induced bronchospasm.

Albuterol inhalation is for use in adults and children at least 4 years old.

Albuterol inhalation may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before using albuterol inhalation?

You should not use this medicine if you are allergic to albuterol.

You should not use ProAir RespiClick if you are allergic to milk proteins.

Tell your doctor if you have ever had:

heart disease, high blood pressure;
a thyroid disorder;
seizures;
diabetes; or
low levels of potassium in your blood.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether albuterol will harm an unborn baby. However, having uncontrolled asthma during pregnancy may increase the risk of premature birth, low birth weight, or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of preventing bronchospasm may outweigh any risks to the baby.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of albuterol on the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

How should I use albuterol inhalation?

Follow all directions on your prescription label and read all medication guides. Use the medicine exactly as directed.

Do not allow a young child to use albuterol inhalation without help from an adult.

To prevent exercise-induced bronchospasm, use this medicine 15 to 30 minutes before you exercise. The effects of albuterol inhalation should last about 4 to 6 hours.

Seek medical attention if your breathing problems get worse quickly, or if you think your asthma medications are not working as well.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

ProAir HFA, Proventil HFA, or Ventolin HFA must be shaken before each use. You do not need to shake ProAir RespiClick before using.

Do not try to clean or take apart the ProAir RespiClick inhaler device.

Always use the new inhaler device provided with your refill. Do not float a medicine canister in water to see if it is empty.

Your dose needs may change due to surgery, illness, stress, or a recent asthma attack. Do not change your dose or dosing schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, or cold temperatures.

Keep the cover on your ProAir RespiClick inhaler when not in use. Store Proventil or Ventolin with the mouthpiece down.

Keep the inhaler canister away from open flame or high heat. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of albuterol can be fatal.

Overdose symptoms may include dry mouth, tremors, chest pain, fast heartbeats, nausea, general ill feeling, seizure, feeling light-headed or fainting.

What should I avoid while using albuterol inhalation?

Rinse with water if this medicine gets in your eyes.

What are the possible side effects of albuterol inhalation?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

wheezing, choking, or other breathing problems after using this medicine;
chest pain, fast heart rate, pounding heartbeats or fluttering in your chest;
severe headache, pounding in your neck or ears;
pain or burning when you urinate;
high blood sugar –increased thirst, increased urination, dry mouth, fruity breath odor; or
low potassium –leg cramps, constipation, irregular heartbeats, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common side effects may include:

chest pain, fast or pounding heartbeats;
upset stomach, vomiting;
painful urination;
dizziness;
feeling shaky or nervous;
headache, back pain, body aches; or
cough, sore throat, sinus pain, runny or stuffy nose.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect albuterol inhalation?

Tell your doctor about all your other medicines, especially:

any other inhaled medicines or bronchodilators;
digoxin;
a diuretic or “water pill”;
an antidepressant –amitriptyline, desipramine, imipramine, doxepin, nortriptyline, and others;
a beta blocker –atenolol, carvedilol, labetalol, metoprolol, propranolol, sotalol, and others; or
an MAO inhibitor –isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

This list is not complete. Other drugs may affect albuterol inhalation, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your pharmacist can provide more information about albuterol inhalation.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2021 Cerner Multum, Inc. Version: 10.01. Revision date: 11/18/2020.

Dyspnea (Shortness of Breath) – Managing Side Effects

Chemocare.com

Care During Chemotherapy and Beyond

What Is Dyspnea?

Dyspnea is a condition where you are experiencing shortness of breath, or breathlessness.

Dyspnea is also the uncomfortable sensation of breathing. Normally, our bodies will
regulate the act of breathing without even having to think about it.

You may experience dyspnea at rest, or on exertion (when you perform any activity
no matter how small), if you have certain conditions. Common causes of dyspnea include:

Heart problems – including:
- Irregular heart beats
- Fluid accumulation around the heart due to certain forms of cancer (pericardial
  effusion)
- A recent heart attack which may be blocking blood flow
- Heart failure- when your heart is not working as well as it should

Lung problems – including:
- A blockage by a foreign body in your upper or lower airway passages, by tumor, infection,
  or even may be caused by choking on a piece of food
- People with cancer of the lymph nodes in your chest may get a blockage of blood
  flow through the blood large vessels. This is called superior vena cava (SVC) syndrome.
  People with Hodgkin’s disease, lung or breast cancer are most susceptible.
- Constriction of your lung passages caused by secretions are common in acute (happening
  suddenly), or chronic (occurs for a long time) bronchitis, asthma, and Chronic Obstructive
  Lung Disease (COLD).
- Fluid accumulation in your lungs due to a tumor or infection (pleural effusion)
- Pneumonia – caused by one of many types
- Upper Respiratory Infection (URI) – either caused by a virus or bacteria
- Pulmonary fibrosis – lung damage from radiation, chronic diseases, or chemotherapy
- Pulmonary toxicity – lung damage from chemotherapy, radiation therapy, or chronic
  diseases
- Pneumothorax – a collapsed lung from tumor or trauma (like a car accident, or a
  gunshot wound)
- Blood clots in your lungs (pulmonary emboli)

Other causes:

Anemia – Low blood hemoglobin (Hgb) counts that may occur with blood loss, if you
are low in iron stores, or after chemotherapy

If you are hyperventilating, or breathing really fast due to fear, anxiety, or unknown
causes

Things that may also put you at risk (called risk factors) for developing dyspnea
may include:
- Smoking cigarettes
- Environmental irritants, such as pollution, chemicals and hair spray
- If you are elderly, or have an altered immune system from chemotherapy, long-term
  steroid use, or chronic diseases
  - You may be treated with antibiotics if there are bacteria present in a sputum sample,
    or if your healthcare provider is concerned that bacteria caused your infection.
  - If your bronchitis, pneumonia or other cause of dyspnea are due to a virus, your
    symptoms may take 2 or more weeks to resolve, but antibiotics won’t help. Treatment
    of a virus includes cough medications, drinking lots of fluids, and avoiding irritants.
- Your dyspnea may be due to a chronic, or a long-term disease, such as pulmonary
  fibrosis, or chronic bronchitis. You may go through periods when you feel well,
  and then go through periods when you feel ill.
- With some causes of dyspnea, such as chronic bronchitis, and pulmonary fibrosis,
  severe outbreaks of cough, shortness of breath and congestion (called exacerbations),
  may last for a few months at a time, and occur a few times a year.

Dyspnea Symptoms:

You may notice chest tightness, difficulty getting a good breath, feelings of breathlessness,
or that you is hungry for air.

You may notice that you are wheezing, when you breathe.

You may have fever, chills, or a headache.

You may have pain in your muscles, or pain in your lungs when you take a deep breath,
especially if you are coughing really hard, for long periods of time.

You may be overly tired, or very weak (fatigued). It may be hard for you to do any
kind of your normal activities.

You may have sudden onset of coughing spells or a long-term (chronic) cough.
You may or may not be able to bring up any secretions (sputum), or you may bring
up greenish-yellow, or rusty-colored sputum.

You may experience shortness of breath, either at rest or while performing any type
of activity. This may include walking to the door, or climbing stairs.

You may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows.
Your shortness of breath may cause you to wake up in the middle of the night.

If your heart may not be working as well, your legs may be swollen, especially in
your feet and ankles. You may gain “water” weight easily, or feel bloated.

Things You Can Do:

Make sure you tell your doctor, as well as all healthcare providers, about any other
medications you are taking (including over-the-counter, vitamins, or herbal remedies).

Remind your doctor or healthcare provider if you have a history of diabetes, liver,
kidney, or heart disease. If you have a family history of heart disease, stroke,
high blood cholesterol, or high blood pressure, in a first or second-degree relative,
you may be at risk for certain problems. Notify your healthcare provider if you
have any of these diseases in your family.

If you are smoking, you should quit. If you do not smoke, avoid smoke-filled rooms.
Smoking first or second-hand can damage lung tissue, and make your dyspnea worse.
Discuss with your healthcare provider techniques that can help you quit.

Avoid people who are sick. Wash your hands often, with soap and water, for at least
15 seconds at a time. Use tissues when you sneeze or cough.

Do not share eating or drinking utensils with anyone.

If you are over the age of 65 years, or have an altered immune system due to chemotherapy,
chronic disease or steroid use, the Centers for Disease Control (CDC) recommends
that you receive a flu vaccine every year, and a pneumonia vaccine every 5 years.
Discuss this with your healthcare provider if this is right for you.

People with lung problems need to circulate air from the bottom of their lungs and
out of your lungs (oxygenation), to prevent infection and pneumonia. Using an incentive
spirometer for 15 minutes a day, twice a day, can help promote oxygenation.

Controlling secretions through coughing and deep breathing will help you to breathe
easier. Remember, if you are dehydrated, your secretions will be thicker, and harder
to bring up. Make sure to drink 2 to 3 liters of fluids (non-alcoholic, non-caffeinated)
per day, to remain well hydrated.

Taking warm showers or baths, and using a vaporizer, may help to thin out your secretions.

Try to exercise, as tolerated, to promote air exchange (oxygenation), and to maintain
your optimal level of functioning. Walking, swimming, or light aerobic activity
may also help you to lose weight, and feel better. Make sure to exercise, under
the supervision of your healthcare provider, and discuss with your healthcare provider
how you can create a specific exercise program to suit your needs.

If you are experiencing heart failure, which may have caused your breathing problems,
you may be told to reduce the amount of salt you are eating in a day. Many times,
it may be restricted to about 2 grams of sodium per day. A diet lower in salt may
decrease the amount of work that is placed on your heart. You should discuss this
with your healthcare provider how you can specifically use your diet to control
your symptoms.

Try to avoid “environmental allergens” (such as smoke, pollution, and common causes
of seasonal allergies), as well as things that may cause allergies in your home
(hair sprays, mold, dust mites, and pets). These may trigger an episode of coughing
and dyspnea, and make your symptoms worse.

Keep a diary of your any abnormal symptoms, such as excessive fatigue, shortness
of breath or chest pain, if these are occurring regularly. Write down the foods
that you have eaten, the exercise or activity you were undergoing when the symptoms
occurred, and how you felt before they occurred. This diary may be valuable in determining
the cause of your symptoms, and help you to identify certain “triggers” of your
symptoms.

Questions to ask yourself, may include:
- Did my symptoms occur gradually, or did this episode come on all of a sudden? Was
  I feeling anxious? Did I perform any kind of activity, or was I resting?
- Did I eat any different kinds of foods? Was I around any pets? Did I travel recently?
  What did I do differently?

With severe breathing problems, sleeping at night with your head of the bed elevated
may make it easier to breathe. You may do this by sleeping on 2 or 3 extra pillows.
This will help lung expansion (spreading out), as well as promote the drainage of
secretions.

Use relaxation techniques to decrease the amount of anxiety you have. If you feel
anxious, place yourself in a quiet environment, and close your eyes. Take slow,
steady, deep breaths, and try to concentrate on things that have relaxed you in
the past.

You should restrict the amount of alcohol you take in, or avoid it all together.
Alcohol may adversely interact with many medications.

Participating in support groups may be helpful to discuss with others what you are
going through. Ask your healthcare provider if he or she is aware of any support
groups that would benefit you.

If you are ordered a medication to treat this disorder, do not stop taking any medication
unless your healthcare provider tells you to. Take the medication exactly as directed.
Do not share your pills with anyone.

If you miss a dose of your medication, discuss with your healthcare provider what
you should do.

If you experience symptoms or side effects, especially if severe, be sure to discuss
them with your health care team. They can prescribe medications and/or offer
other suggestions that are effective in managing such problems.

Keep all your appointments for your treatments.

Drugs That May Be Prescribed by Your Doctor for Dyspnea:

Depending on your lung function, and your overall health status, your doctor may
recommend that certain drugs be used to help your lungs function more effectively,
and decrease symptoms. Some of the common drugs that are used to treat lung
problems may include:
- Antianxiety medications: If you are experiencing anxiety with your
  dyspnea, depending on the cause, your healthcare provider may prescribe an anti-anxiety
  medication, called an anxiolytic. These medications will help you to relax.
  These may include lorazepam (Ativan^®), or alprazolam
  (Xanax^®). It is important to take these medications
  only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile
  while taking these. These medications must be used very cautiously if you have severe
  dyspnea. Discuss the risks and benefits of taking this medication with your doctor
  or healthcare provider.
- Antibiotics – If your doctor or healthcare provider suspects that
  you have a lung infection, he or she may order antibiotic pills or intravenous (IV),
  depending on how severe your illness is, and your overall health status. Commonly
  prescribed antibiotics for bronchitis, pneumonia and respiratory (breathing) problems
  include azithromycin (Zithromax^®), and levofloxacin
  (Levaquin^®). If you are prescribed antibiotic pills,
  take the full prescription. Do not stop taking pills once you feel better.
- Anticoagulants – These medications prevent your blood from clotting,
  or may be ordered by your healthcare provider if you have a blood clot. Each of
  them works in a variety of ways. Depending on your overall health status, the kind
  of chemotherapy you are receiving, and the location of the blood clot, your healthcare
  provider may suggest warfarin sodium (Coumadin^®),
  or enaxoparin (Lovenox^®).
- Anticholinergic agents – these drugs are given to persons with
  chronic bronchitis, emphysema, and chronic obstructive lung disease (COLD). Anticholinergic
  agents work in a complex manner by relaxing the lung muscles, which will help you
  to breathe easier. A commonly prescribed drug is ipatropium bromide (Atrovent^®).
- Bronchodilators – These drugs work by opening (or dilating) the
  lung passages, and offering relief of symptoms, including shortness of breath. These
  drugs, typically given by inhalation (aerosol), but are also available in pill form.
- Beta-adrenergic receptor agonists (beta-agonists) – Beta-agonists
  can be considered bronchodilators, as these drugs relax airway smooth muscle, and
  block the release of substances that cause bronchoconstriction, or narrowing of
  your lungs, if you are having a lung “spasm.” Drugs such as albuterol (Proventil^®), or terbutaline (Brethine^®),
  are commonly used.
- Corticosteroids: Steroids work by decreasing inflammation and swelling,
  which may be present with certain lung disorders. People may benefit from steroids,
  either inhaled, by pill form, or in the vein (IV).
- Beclomethasone (Beclovent^®), an
  inhaled steroid, is useful in the treatment of chronic asthma and bronchitis.
  Inhaled steroids act directly on the lung tissue, so there are fewer long-term side
  effects, compared with a pill or IV form.
- People who have an outbreak of severe shortness of breath and airway inflammation
  may be ordered a steroid pill, such as prednisone, for a short period of time. This
  is usually given with inhaled steroids.
- Patients with severe asthma may require IV administration of another steroid, methylprednisolone
  (Solumedrol^®).
- Cough medications/Decongestants – may help you to be more comfortable
  if you are coughing a lot. Guaifenesin is an active ingredient in many cough medications,
  may be given alone, but is often combined with other drugs, such as codeine, to
  help your cough. Guaifenesin may also be combined with pseudoephedrine (Sudafed^®) as a decongestant, or any one of many medications,
  depending on your symptoms. Another common medication you may receive is Hydrocodone
  Bitartrate-Homatropine Methylbromide (Hycodan^®).
  This is a narcotic antitussive (anti-cough medication), which will help relieve
  your cough.
- Diuretics – may be known as “water pills” as they work to prevent
  or treat lung congestion by making you urinate out extra fluid. Some examples of
  this medication may include furosemide (Lasix^®),
  and Hydrochlorothiazide. You may receive this medication alone or in combination
  with other medications.
- Oxygen therapy – If you are experiencing shortness of breath at
  rest, or on exertion, your healthcare provider may see if oxygen therapy is right
  for you. You may take oxygen when your symptoms are at their worst. For example,
  some people are only on oxygen at nighttime, and not during the day. Some take oxygen
  when they are performing activities, but not all the time.

Your healthcare provider will discuss with you which treatments are helpful to you.

Do not stop any medications abruptly, as serious side effects may occur.

When to Contact Your Doctor or Health Care Provider:

Fever of 100. 5º F (38º C), chills, sore throat (possible signs of infection if you
are receiving chemotherapy).

If you cough up blood

Shortness of breath, chest pain or discomfort; swelling of your lips or throat should
be evaluated immediately

Feeling your heart beat rapidly, or have palpitations

Any new rashes on your skin

Any unusual swelling in your feet and legs

Weight gain of greater than 3 to 5 pounds in 1 week.

Any symptoms that worsen and do not improve

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org

Shortness of Breath

Cancer and its treatment may cause shortness of breath or a feeling of not being able to catch your breath (breathlessness). This is called dyspnea. Sometimes you can become short of breath quickly
, and it can be quite frightening. Other times, it can be mild and bothersome when doing daily activities . When people have trouble breathing, the body might not be getting enough oxygen because the lungs can’t take in enough air or the body can’t get enough oxygen through the bloodstream.

For many people with advanced cancers, shortness of breath comes on over time rather than quickly. There are things that can be done to help make people with advanced cancers more comfortable.

People with cancer can have different causes of shortness of breath, such as:

Tumors in or near the lung
Other lung or breathing disorders
Side effects of cancer treatment (such as surgery, chemo, targeted therapy, immunotherapy, or radiation)
Fluid in or around the lungs or heart
A blocked airway
Pneumonia (a lung infection)
Weakened breathing muscles
Lack of regular physical activity
Obesity
Pain
Poor nutrition
Stress or anxiety
Allergic or infusion reactions
Anemia or changes in blood counts

What to look for

Shortness of breath, or a feeling of breathlessness
Trouble breathing when resting, eating, talking, or with exercise
Chest pain
Faster breathing
Faster heartbeat
Pale or bluish-looking skin, fingernail beds, and mouth
Cold and clammy feeling skin
Nostrils flaring when inhaling
Wheezing

Sometimes a patient may have chest discomfort or difficulty breathing but may not show obvious symptoms like exertion or rapid breaths and pulse.

What the patient can do

Stay calm.
Call 911 if new shortness of breath starts suddenly and doesn’t get better; your skin, mouth, or nail beds look pale or blue; or if you have chest discomfort, trouble speaking, dizziness, or weakness.
Sit up or raise your upper body to a 45° angle by raising the bed or using pillows.
Take medicine or treatments prescribed for breathing (for example, oxygen, medicine for relief of wheezing, inhalers, or nebulizers).
If you’re not in a lot of distress, check your temperature and pulse.
Inhale deeply through your nose and exhale through pursed lips for twice as long as it took to inhale. (This is called pursed-lip breathing.)
If you’re still not breathing easier after 5 minutes, sit up on the side of the bed, with your feet resting on a stool, arms resting on an overbed table (tray table) or side table with pillows on it, and your head tilted slightly forward.
If you’re coughing and spitting, note the amount of sputum and what it looks and smells like.
Tell your cancer care team how your breathing problem affects you, especially if you avoid some of your usual activities to keep from getting out of breath.
Try muscle relaxation to reduce anxiety. Anxiety makes breathing problems worse.
If you keep having trouble breathing, ask about medicines that might help.

What caregivers can do

Using a watch with a second hand or timer to check the patient’s pulse, count the number of beats per minute. (If you also count the number of breaths per minute, do it without telling the patient. If the patient knows you’re counting, they may slow down or speed up breathing without realizing it.)
Call 911 if new shortness of breath starts suddenly and doesn’t get better; if the patient’s skin, mouth, or nail beds look pale or blue; or if they have chest discomfort, trouble speaking, dizziness, or weakness.
Check the patient’s temperature to see if they have a fever.
Offer medicines or inhalers prescribed for shortness of breath.
If home oxygen is prescribed, be sure you know how to set it up, use it safely, and what flow rate to use. (Do not change the flow rate without first talking to the health care team.)
When the patient feels short of breath, remove or loosen tight clothing.
Have the patient sit up in a resting position that feels comfortable to them.
Remind them to breathe in slowly and deeply, then exhale slowly.
Remove the patient from extreme temperatures, especially heat, which can make it harder to breathe.
Notice when the patient gets out of breath. (During normal activity, while talking, or when they are at rest?) Also note if it happens when they’re standing, sitting, or lying down.

Call 911 if new shortness of breath starts suddenly and doesn’t get better; if the patient’s skin, mouth, or nail beds look pale or blue; or if they have chest pain or pressure trouble speaking, dizziness, or weakness.

Call the cancer care team if the patient

Has trouble breathing or chest pain
Has thick, yellow, green, and/or bloody sputum
Develops pale or bluish skin, nail beds, or mouth; or if their skin feels cold and clammy
Has a temperature not related to a cold or the flu, that’s above what’s considered normal for the patient or above a certain level as instructed by the cancer care team
Has flared nostrils during breathing
Becomes confused or restless
Has trouble speaking
Has dizziness or weakness
Has swelling of the face, neck, or arms
Starts wheezing

Bronchodilators – NHS

Bronchodilators and corticosteroids

Inhaled corticosteroids are the main treatment to reduce inflammation and prevent flare-ups in asthma.

But some people may also benefit from taking bronchodilators to keep the airways open and enhance the effects of corticosteroids.

Long-acting bronchodilators should never be taken without corticosteroids.

In COPD initial treatment is with short- or long-acting bronchodilators, with corticosteroids added in some severe cases.

Treatment with corticosteroids and bronchodilators may require the use of separate inhalers, but increasingly these medications are provided together in single inhalers.

Types of bronchodilator

The 3 most widely used bronchodilators are:

beta-2 agonists, such as salbutamol, salmeterol, formoterol and vilanterol
anticholinergics, such as ipratropium, tiotropium, aclidinium and glycopyrronium
theophylline

Beta-2 agonists and anticholinergics are available in both short-acting and long-acting forms, whereas theophylline is only available in a long-acting form.

Beta-2 agonists

Beta-2 agonists are used for both asthma and COPD, although some types are only available for COPD.

They’re usually inhaled using a small handheld inhaler, but may also be available as tablets or syrup.

For sudden, severe symptoms, they can also be injected or nebulised.

A nebuliser is a compressor that turns liquid medication into a fine mist, allowing a large dose of the medicine to be inhaled through a mouthpiece or face mask.

Beta-2 agonists work by stimulating receptors called beta-2 receptors in the muscles that line the airways, which causes them to relax and allows the airways to widen (dilate).

They should be used with caution in people with:

an overactive thyroid (hyperthyroidism) – a condition that occurs when there’s too much thyroid hormone in the body
cardiovascular disease – conditions that affect the heart or blood vessels
an irregular heartbeat (arrhythmia)
high blood pressure (hypertension)
diabetes – a lifelong condition that causes a person’s blood sugar level to become too high

In rare cases, beta-2 agonists can make some of the symptoms and possible complications of these conditions worse.

Anticholinergics

Anticholinergics (also known as antimuscarinics) are mainly used to treat COPD, but a few can also be used for asthma.

They’re usually taken using an inhaler, but may be nebulised to treat sudden and severe symptoms.

Anticholinergics cause the airways to widen by blocking the cholinergic nerves.

These nerves release chemicals that can cause the muscles lining the airways to tighten.

They should be used with caution in people with:

benign prostate enlargement – where the prostate gland becomes enlarged, which can affect how you pee
a bladder outflow obstruction – any condition that affects the flow of urine out of the bladder, such as bladder stones or prostate cancer
glaucoma – a build-up of pressure in the eye

If you have benign prostate enlargement or a bladder outflow obstruction, anticholinergics can cause problems, such as difficulty peeing and not being able to empty your bladder fully.

Glaucoma can get worse if anticholinergic medication unintentionally gets into the eyes.

Theophylline

Theophylline is usually taken in tablet or capsule form, but a different version called aminophylline can be given directly into a vein (intravenously) if your symptoms are severe.

It’s unclear exactly how theophylline works, but it seems to reduce any inflammation (swelling) in the airways, in addition to relaxing the muscles lining them.

The effect of theophylline is weaker than other bronchodilators and corticosteroids.

It’s also more likely to cause side effects, so is often only used alongside these medicines if they’re not effective enough.

Theophylline should be used with caution in people with:

an overactive thyroid
cardiovascular disease
liver problems, such as liver disease
high blood pressure
open sores that develop on the stomach lining (stomach ulcers)
a condition that affects the brain and causes repeated fits (seizures) (epilepsy)

Theophylline may make these conditions worse. In people with liver problems, it can sometimes lead to a dangerous build-up of medication in the body.

Other medicines can also cause an abnormal build-up of theophylline in the body. This should always be checked by your doctor.

Elderly people may also need additional monitoring while taking theophylline.

Interactions with other medicines

Bronchodilators may interact with other medicines, which could affect the way they work or increase your risk of side effects.

Some of the medicines that can interact with bronchodilators (particularly theophylline) include:

some diuretics, a type of medication that helps remove fluid from the body
some antidepressants, including monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs)
digoxin, a medication used to treat arrhythmias
benzodiazepines, a type of sedative that may sometimes be used as a short-term treatment for anxiety or sleeping problems (insomnia)
lithium, a medication used to treat severe depression and bipolar disorder
quinolones, a type of antibiotic medication

This is not a complete list of all the medications that can interact with bronchodilators, and not all of these interactions apply to each type of bronchodilator.

Always carefully read the patient information leaflet that comes with your medication.

You may be able to find a specific leaflet on the medicines A to Z on the MHRA website.

If in doubt, speak to a pharmacist or GP.

Are there data to support the use of oral albuterol for acute respiratory symptoms when inhalation treatment is unavailable or inappropriate? | Drug Information Group

1

Introduction

The rapid spread of a coronavirus disease 2019 (COVID-19) has led to shortages of personal protective equipment (PPE) and critical medications.¹ Albuterol metered-dose inhaler (MDI) is one of the many drugs used to manage the symptoms of COVID-19 that is currently on shortage due to increased demand and supplier allocation.² In the first two weeks of March 2020, hospitals in the United States ordered more than twice as many albuterol MDIs compared to January and February. ³ A disruption to the supply of this medication not only impacts patients with COVID-19 but also has the potential to impact patients with chronic respiratory conditions such as asthma.⁴

Bronchodilator use in COVID-19 disease

Respiratory symptoms including difficulty breathing and cough are commonly seen in patients with COVID-19 infection, and most patients have required inhaled bronchodilator medications (mostly albuterol) for acute symptom relief.⁴ The clinical effects of bronchodilator medications delivered by nebulization vs MDI are similar.⁵ However, since nebulization may generate respiratory droplets that can linger in the air for 1 to 2 hours after treatment, this route of administration is not recommended for hospitalized patients with suspected or confirmed COVID-19 infection due to the increased risk for viral transmission.⁶ Therefore, MDIs are the preferred devices for the delivery of quick-acting bronchodilator therapies in this population. ^5,6 According to the American College of Allergy, Asthma and Immunology, nebulized therapy can potentially be used by patients with COVID-19 disease in the home setting, as long as treatments are administered in places where the air is not recirculated into the home (ie, a porch, patio, or in a garage) or areas with easy to clean surfaces or surfaces that do not need cleaning.⁶ Nonetheless, in the inpatient setting, administration of drugs via nebulizer would require additional use of already critically low supplies of PPE.

A less explored alternative to albuterol MDIs that also bypasses concerns of aerosol generation seen with nebulizer treatment is orally administered albuterol. The remainder of this review will summarize data on the use of oral albuterol for acute respiratory symptoms common to COVID-19 infection.

Oral albuterol for acute respiratory symptoms

No studies have evaluated the use of oral albuterol for patients with COVID-19 associated respiratory symptoms. To evaluate the feasibility of using oral albuterol in this setting, a literature search was performed to identify publications summarizing efficacy outcomes related to the use of oral albuterol for the acute relief of respiratory symptoms seen in COVID-19 disease, including cough and shortness of breath.⁴ Data for the use of oral albuterol for respiratory symptoms not seen in COVID-19 infection (wheezing, etc) are not summarized.

In 2015, Dr. O’Reilly and colleagues published a paper summarizing results of a literature search focused on the use of oral albuterol for improvement in clinical outcomes and surrogate markers of lung function in children with asthma in resource-poor settings.⁷ Six unique studies were identified, all of which had methodological differences concerning study design and populations included. Overall, a faster onset of action was seen with inhaled formulations, while oral formulations resulted in a more sustained response. Both formulations demonstrated improvements in lung function compared with no treatment. Additional publications describing the use of oral albuterol in infants with bronchiolitis have not demonstrated significant improvements in symptoms vs placebo.^7-10 For the treatment of non-asthmatic acute cough, one trial each in adults and children did not find oral albuterol effective for reducing the frequency, duration, or severity of the cough.^11,12

Discussion

The COVID-19 disease pandemic has led to shortages of critical drugs and supplies needed to adequately treat patients with this potentially life-threatening and highly contagious infection.¹ Albuterol (internationally referred to as salbutamol) is a beta2 agonist available as an MDI, solution for nebulization, and oral tablet and syrup.¹⁴ It is widely recognized that inhaled formulations of albuterol are preferred to oral dosage forms due to their quicker onset of action (<5 vs <30 minutes) and lower risk for systemic adverse events. Generally, the choice between nebulization or MDI delivery of short-acting bronchodilators is driven by patient preference, convenience, and ease of administration. ⁵ However, MDI administration is preferred for patients with COVID-19 disease, especially in the inpatient setting, due to a lower risk for viral transmission and a lesser need for additional PPE.^5,6

There are no studies evaluating the use of oral albuterol for patients with respiratory symptoms due to COVID-19 infection. Clinical trials comparing oral and inhaled albuterol are generally conducted in resource-poor settings where oral formulations of albuterol are implemented as a potentially effective and low-cost treatment for children with asthma.⁷ However, since not all symptoms of asthma overlap with those of COVID-19 disease, the application of these data to patients with COVID-19 is unclear.⁴

The use of oral albuterol in infants with bronchiolitis did not result in symptomatic or clinical improvements vs placebo.^8-11 Similar to COVID-19 disease, symptoms of bronchiolitis include coughing and difficulty breathing. ¹⁵ However, bronchiolitis generally does not cause fever or only a slight fever and wheezing may be present. Most cases of bronchiolitis are caused by respiratory syncytial virus, but the illness can also be caused by viruses that cause the common cold or flu. No reports of COVID-19 associated bronchiolitis have been reported at this time. Therefore, the application of this data to patients with COVID-19 is also unclear.

Two trials found oral albuterol ineffective for reducing the frequency, duration, or severity of non-specific cough.^12,13 Based on this information, oral albuterol may not be helpful for cough due to COVID-19.

Best practices for mitigation of MDI shortages

In response to the ongoing shortage of albuterol MDIs and potential risks of using nebulized albuterol in patients COVID-19 infection, the Institute for Safe Medication Practices (ISMP) has recently proposed several measures for conserving available MDI supply, including:^16,17

implementation of “common canister” protocols where a disinfection procedure is established in order to be able to administer doses from the same MDI to multiple patients using a patient-specific spacer
use of a patients’ home MDIs throughout hospitalization
sending patients home with the MDI that was used throughout hospitalization to prevent unnecessary waste

The approval of the first generic albuterol inhaler on April 8, 2020, is also expected to help mitigate the increased demand for this product. ⁶

Conclusion

The feasibility of using oral albuterol for COVID-19 associated respiratory symptoms has yet to be determined. Clinicians looking to mitigate the shortage of albuterol MDIs may refer to recent ISMP publications for recommended strategies to conserve the current supply of these products. The recent approval of a generic albuterol inhaler will also help to boost supply.

References

Coronavirus (COVID-19) supply chain update. Food and Drug Administration (FDA). February 27, 2020. Accessed April 10, 2020. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update
Drug shortages list. American Society of Health-System Pharmacists (ASHP). Accessed April 10, 2020. https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=647
Dodge B. Hospitals and pharmacies risk running our of inhalers as the coronavirus strains supplies. Business Insider website. March 24, 2020. Accessed April 10, 2020. https://www.businessinsider.com/hospitals-may-run-out-of-inhalers-as-coronavirus-strains-supply-2020-3
Important COVID-19 information for those with asthma and/or allergies. American College of Allergy Asthma and Immunology (ACAAI). Updated April 9, 2020. Accessed April 10, 2020. https://acaai.org/news/important-covid-19-information-those-asthma-andor-allergies
A message to asthma sufferers about a shortage of albuterol metered-dose inhalers. American College of Allergy Asthma and Immunology (ACAAI). Updated April 9, 2020. Accessed April 10, 2020. https://acaai.org/news/message-asthma-sufferers-about-shortage-albuterol-metered-dose-inhalers
O’Reilly DA, Awale A, Cartledge PT. Question 2: Blast from the past: is oral salbutamol useful in resource-poor settings? Arch Dis Child. 2015;100(8):806-809. doi: 10.1136/archdischild-2015-309141.
Gupta P, Aggarwal A, Gupta P, Sharma KK. Oral salbutamol for symptomatic relief in mild bronchiolitis a double blind randomized placebo controlled trial. Indian Pediatr 2008;45(7):547–53.
Patel H, Gouin S, Platt RW. Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis. J Pediatr. 2003;142(5):509-514.
Cengizlier R, Saraçlar Y, Adalioğlu G, et al. Effect of oral and inhaled salbutamol in infants with bronchiolitis. Acta Paediatr Jpn. 1997;39(1):61-63. doi: 10.1111/j.1442-200x.1997.tb03557.x.
Gadomski AM, Aref GH, el Din OB, et al. Oral versus nebulized albuterol in the management of bronchiolitis in Egypt. J Pediatr. 1994;124(1):131-138.
Bernard DW, Goepp JG, Duggan AK, Serwint JR, Rowe PC. Is oral albuterol effective for acute cough in non-asthmatic children? Acta Paediatr. 1999;88(4):465-467.
Littenberg B, Wheeler M, Smith DS. A randomized controlled trial of oral albuterol in acute cough. J Fam Pract. 1996;42(1):49-53.
Lexicomp. Wolters Kluwer; 2020. Accessed April 9, 2020. https://online.lexi.com/lco/action/home
Silver AH, Nazif JM. Bronchiolitis. Pediatr Rev. 2019;40(11):568-576.
Revisiting the need for MDI common canister protocols during the COVID-19 pandemic. Institute for Safe Medication Practices (ISMP). March 26, 2020. Accessed April 10, 2020. https://ismp.org/resources/revisiting-need-mdi-common-canister-protocols-during-covid-19-pandemic
Shared MDIs: can cross-contamination be avoided. Institute for Safe Medication Practices (ISMP). April 9, 2020. Accessed April 10, 2020. https://www.ismp.org/resources/shared-mdis-can-cross-contamination-be-avoided

Prepared by:
Katherine Sarna, PharmD, BCPS
Clinical Assistant Professor Drug Information Specialist
University of Illinois at Chicago College of Pharmacy

May 2020

The information presented is current as April 9, 2020. This information is intended as an educational piece and should not be used as the sole source for clinical decision-making.

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90,000 norms and decoding, prices – Clinic of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow

Function of external respiration is a diagnostic method developed for assessing the state of the respiratory organs of a person, their functionality, obtaining speed and volume indicators. When performing different respiratory actions, the characteristics are graphically recorded and further processed by a special program.

What the study shows

The analysis makes it possible to:

Determine the causes, degree and types of impairment of the functionality of the respiratory system;
Prescribe a course of treatment measures;
Evaluate the effectiveness of treatment;
To identify the possibility of reversibility of pathology while taking bronchodilators;
Track the dynamics of changes.

The study of the function of external respiration is the most informative method for diagnosing lung diseases, which includes two main procedures.

Spirography – fixing changes in the amount of inhaled and exhaled air.
Pneumotachography – continuous recording of air volume and flow rate at different breathing modes. The most indicative is the graph plotted during the formed expiration.

The combination of the above two techniques is called spirometry.

Indications for FVD

Diagnostics are prescribed if there is a suspicion of pathological changes in the respiratory function and the presence of concomitant symptoms:

Shortness of breath;
Chest pain:
Prolonged cough for a long time.

The purpose of research is:

Obtaining data on the effect of pulmonary pathologies on respiratory function;
Identification of patients with a high risk of developing pathology – in many cases these are smokers and persons who are in contact with hazardous substances by the type of activity;
Control of the course of lung diseases;
Expertise of FDV in determining the work ability;
Examination before surgery;
Selection of drugs that expand the bronchi for the course of treatment.

Spirometry shows not only the degree of impaired respiratory function, but also allows:

Identify the affected area;
Determine the rate of progression of the pathological process;
Select the optimal treatment measures.

A general practitioner, allergist or pulmonologist can refer patients to the study.

Contraindications

A contraindication to the diagnosis of the function of external respiration can be:

Severe respiratory failure.
Recent heart attack or stroke.
Protrusion of the walls of the arteries or aorta.
High blood pressure;
Pregnancy;
Epilepsy.

Preparation for examination

Diagnosis is carried out on an empty stomach.
Before the study, do not smoke, drink alcohol, strong tea or coffee for a day.
Just before the procedure, you need to relax and sit quietly for half an hour.
Clothing should not hinder movement.
It is important to agree in advance on taking medications that affect lung function.
When using the inhaler, you should have it handy.

How the study is conducted

The patient’s height and weight are recorded. The doctor explains how to breathe, in what sequence. The spirometer constantly records the amount of air exhaled and inhaled. The patient is pinched the nose and asked to perform several actions.

1. To determine the indicators during normal breathing, you need:

Take a deep breath;
Hold your breath;
Exhale evenly and calmly.

2. Actions are repeated, carrying out exhalation with effort – a reserve expiratory volume is obtained for calculating the vital capacity of the lungs.

3. The patient inhales with effort (to obtain an indicator of the forced vital capacity of the lungs).

Each of these actions is performed several times. The allergist analyzes the information received and draws up a conclusion.

Diagnosis with bronchodilator

A bronchodilator is a drug that dilates the bronchi. The study takes place in the traditional way, but the indicators are recorded after inhalation of an aerosol bronchodilator.

The results allow determining the presence of bronchospasm and prescribing optimal drugs for their expansion.There is no harm to health and discomfort. It takes twice as long as with traditional diagnostics.

Decryption of the received information

Spirometry results are assessed by several main indicators obtained during normal and forced breathing. If the patency of the bronchi is reduced, the cause of the changes that have occurred is determined.

Where to make FVD

Respiratory function diagnostics can be done in Moscow, in the clinic of the Russian Academy of Sciences.Diagnostics are performed by qualified specialists. The work is carried out on the most modern equipment using advanced diagnostic and therapeutic developments.

You can make an appointment with an allergist for a consultation on the website. You can get additional information and find out the prices of services by calling the specified phone number.

90,000 Most common adverse reactions to local anesthetic drugs

Novocaine, also known as procaine hydrochloride, is a local anesthetic used in dental procedures such as filling teeth.It works fairly quickly, but its effect does not last long. The FDA considers it safe for most patients, however there are some common and not very common side effects of novocaine that you should be aware of in advance.

According to Drugs.com, the most common adverse reactions to these drugs are numbness, tingling sensations, and mild pain around the injection site.Such reactions are usually not severe and often resolve within a few hours after drug administration. In some cases, more serious adverse reactions are observed, such as shortness of breath, swelling, hives, and blocked airways. Such disorders are signs of an allergic reaction and require urgent treatment. Other rare side effects include chest pain and uneven heartbeat, dizziness and drowsiness, anxiety, restlessness, nausea, vomiting, tremors, and seizures.Serious cases are much less common, but due to their increased danger, it is important to tell your dentist right away if you experience a similar condition.

The dentist must determine the optimal dose of local anesthetic for you. It is very important to tell your dentist about all prescription and over-the-counter medicines you are taking and any medical conditions you may have. In some cases, these drugs can interact with other drugs, causing dangerous side effects and complicating the patient’s underlying medical conditions.Warning the dentist about all medications taken and existing diseases will minimize the risk of dangerous adverse reactions to the action of local anesthetics.

Your dentist should advise you of all the risks and benefits of using local anesthetics during dental procedures. For more information on dental visits, visit the Colgate Dental & Cavity Center.

90,000 Possible applications of the helium-oxygen mixture in acute respiratory pathology and in the context of the COVID-19 pandemic

Introduction

The epidemic / pandemic of the new coronavirus infection COVID-19 has forced medical professionals around the world to seek new approaches to the treatment and prevention of this respiratory infection.This is primarily due to the fact that some patients may develop severe pneumonia and acute respiratory distress syndrome (ARDS). Pneumonia associated with COVID-19, complications of the respiratory viral infection itself, as well as chronic pathology, can lead to irreversible consequences and death. In addition, the duration of the course of the disease determines the long periods of stay of patients in the hospital, which, in an epidemic, can impede the timely and complete provision of medical care to new patients with limited health resources. The consequences of severe forms of the disease can not only lead to long-term disability and rehabilitation, but also to disability. These circumstances can be fully attributed to other acute respiratory pathology, for example, a severe flu epidemic.

In April 2020, assumptions were formed about the prospects for the use of helium-oxygen mixture (heliox) in the complex therapy of patients with COVID-19. This was reflected in the 6th version of the Federal Interim Guidelines for the Diagnosis, Prevention and Treatment of COVID-19 [1].In our country and abroad, heliox has been used for many years for the prevention and treatment of tissue hypoxia, ischemia and reperfusion syndrome, not only in patients with acute and chronic diseases of the respiratory system, cardiovascular, nervous and endocrine systems, but also for anemia, trauma, intoxications, in urgent situations and rehabilitation programs [2-4]. In addition, heliox is used in healthy people [5]. In open sources there are many hundreds of publications on the use of helium-oxygen mixture in various fields of medicine, on experimental models. However, no publications with the results of clinical studies evaluating the use of Heliox in COVID-19 were found as of 05/08/2020, the disease is “too young”.

The purpose of this work is to analyze scientific publications devoted to evaluating the use of helium-oxygen mixture in respiratory pathology and in a healthy person to describe possible options for using Heliox during an epidemic of acute respiratory viral infection, including COVID-19.

Materials and methods

This review reviews articles on the use of helium in ARDS, severe exacerbation of chronic obstructive pulmonary disease (COPD) or asthma, severe acute damage to the larynx (croup, dysfunction of the vocal cords due to other reasons).We analyzed English-language sources from the PubMed database, selected for the following keywords: helium or heliox, as well as in combination of these words with respiratory disease, acute respiratory distress syndrome, pneumonia, asthma, COPD.

Results

I.

General characteristics of the mixture of oxygen with helium

The gas mixture of helium and oxygen is odorless, has no bronchodilatory and narcotic effects, is not toxic, is not carcinogenic and does not have a long-term effect on the human body [6].It is inert and not metabolized and can be used safely in most patients [4].

The use of Heliox was documented about 100 years ago. Since the 1930s, the mixture has been used for upper airway obstruction [3]. Inhalation of oxygen with helium can facilitate the flow of gases through narrowed airways due to its density less than air or oxygen, which reduces turbulence and leads to more free flow of laminar flow, lower overall airway resistance [7].Reducing airway resistance with helium has been shown to reduce dyspnea and effort to maintain respiration [8-11]. Clinically, the effect of Heliox is manifested as a significant decrease in the frequency and work of breathing [11] and a decrease in the use of accessory muscles to facilitate breathing [12]. The use of Heliox has been reported to reduce patient anxiety [13]. The effects of the use of Heliox develop rapidly, usually within an hour of treatment. At the same time, the helium-oxygen mixture is not intended to replace another type of therapy.In emergency situations, it is usually used to “buy time” while the obstruction to normal breathing is removed (edema, foreign body, acute airway obstruction from another cause, etc.) [14]. A mixture of oxygen with helium can help treat, for example, symptoms of respiratory distress, but without affecting the cause [2, 12]. There is no known direct anti-inflammatory effect of helium.

II. Model experiments and studies with healthy volunteers

Preconditioning

There is interesting experimental data on ischemic preconditioning of helium inhalations.Blood plasma taken from healthy volunteers (20 men aged 20–55 years) 6 hours after inhalation of helium had a protective effect against hypoxia in experiments in vitro ; the plasma taken after 30 minutes and 24 hours did not show such an effect. A model of human umbilical vein endothelial cells was used. Biological markers of cell damage (lactate dehydrogenase activity, levels of caveolin-1 and endothelial nitric oxide synthase) were assessed. The authors concluded that helium (more precisely, blood plasma from healthy volunteers, which was taken 6 h after inhalation of helium) “can protect” organs from ischemic / reperfusion injury in a clinical setting [5].

Prior to this study, experimental data also showed early and late preconditioning of the endothelium with helium in healthy volunteers (10 patients, inhalation of helium-oxygen mixture at a ratio of 21:79 15 minutes or 24 hours before ischemic effect on the arm) [15].

Scientists from South Korea published in 2020 the results of evaluating the effect of Heliox on the cardiovascular system and cognitive functions in 10 divers (men, average age 35 years).Divers performed two dives per week to a depth of 26 m for 20 minutes, alternating the use of a gas mixture of compressed air (21% O ₂, 79% N ₂) and Heliox (21% O ₂ and 79% He ). The results showed that “helioxic immersion” significantly increased blood oxygen saturation (by 1.15%) and decreased blood lactate levels (by 57%) compared to “air” immersion ( p <0.05). There were no significant differences in resting heart rate, systolic or diastolic blood pressure, and pulse wave velocity.The Stroop test showed that diving with Heliox increased cognitive function compared to air diving ( p <0.05). It was concluded that diving with Heliox can help reduce hypoxia in divers, reduce the risk of loss of consciousness and fatigue, and increase the duration of the dive. In addition, the cognitive enhancement due to heliox may aid judgment and coping in the water, compared to diving with air mixture [167].

Other effects of using helium

It is the addition of helium to the mixture with oxygen that is preferred over the use of other inert gases. Comparison of different gases for mechanical ventilation of the lungs in an experimental engineering model of a newborn showed the advantage of low-density Heliox with and without airway obstruction compared to using xenon (high density), argon or nitrous oxide (density similar to ordinary air) in a mixture. The loss of the gas mixture with helium was less, and the productivity of mechanical ventilation was higher [17].

In addition, the use of Heliox is also beneficial in reducing the pressure in the peripheral airways, for example, with high-flow ventilation through nasal cannulas with a comparable decrease in CO ₂ (compared with the use of air or oxygen) [18]. This property of the gas mixture described is very important, since it reduces the risk of damage to the lung tissue directly from the respiratory support itself.

III. The use of helium-oxygen mixture in emergency conditions in children and adults, post-extubation stridor and vocal cord dysfunction

Emergency

Acute respiratory distress syndrome. Based on the fact that mechanical ventilation in neonatal respiratory distress syndrome and ARDS in adults, which is necessary to treat hypoxia, can cause or worsen lung damage caused by respiratory failure, C.Beurskens et al. [19] conducted an analysis of publications on this topic in 2015. The result was a review of preclinical and clinical studies of the use of Heliox for ventilation in acute lung injury with respiratory failure. Helium in a gas mixture with oxygen (Heliox), which has a low density, can reduce gas flow and reduce airway pressure without compromising blood oxygenation. The review authors performed a systematic search of the PubMed and EMBASE databases, the search terms referring to ARDS or acute lung injury associated with respiratory failure and related intervention.20 papers were selected: 6 articles described animal models (3 “pediatric” and 3 adult models), 14 – clinical studies (12 “pediatric” and 2 in adults). In general, both work on experimental models (preclinical) and clinical studies have shown that in children and adults, the use of Heliox improved gas exchange, providing less invasive ventilation under different modes and with the help of different equipment: artificial lung ventilation (ALV), various types of non-invasive ventilation of the lungs (NIV), including CPAP, etc.

Neonatal animal models showed improved gas exchange, less invasive ventilation with reduced lung inflammation. In adult models of ARDS, the use of Heliox has improved ventilation in both ventilation pressure control and spontaneous breathing. However, it remains unclear why the inflammation is reduced when Heliox is used – by improving ventilation with a decrease in its intensity or due to the direct anti-inflammatory effect of the mixture? In addition, the review authors noted that the effect of using Heliox for ventilation develops immediately.All clinical trials with ARDS have shown promising effects of Heliox on short-term outcomes: minute volumetric ventilation, pressure applied, and gas exchange.

Studies with children have shown a decrease in respiratory work and the need for mechanical ventilation. Long-term outcomes with the use of Heliox in adult patients have not been studied. At the same time, a small number of patients (from 1-2 when describing clinical cases, up to a maximum of 51 patients in studies with children and only 7 in an observational study of adult patients), differences in study design, in the causes of ARDS, lack of original data and their quality limit interpretation of available information. Among the limitations of the review, the authors pointed out that there is a lack of information on the “parameters” of outcomes and that, in their opinion, the effect of Heliox in patients with asthma and COPD is likely to be different from that in ARDS. The main findings were: Heliox improves gas exchange and may reduce mechanical ventilation in ARDS with short-term benefits; limited data on clinical outcomes [19].

A systematic review of studies [20] evaluating the addition of Heliox to standard therapy for bronchiolitis in children under 2 years of age with ARDS showed no significant reduction in intubation rate in the ICU (RR 2.73; 95% CI 0.96-7.75 ) in 4 studies with 408 patients, as well as in one study with 69 patients – the rate of discharge from the emergency department (RR 0.51; 95% CI 0.17-1.55).At the same time, the authors of the review noted that inhalation of Heliox significantly reduced clinical manifestations in non-intubated children. Given the good safety profile, the authors concluded that heliox therapy could be added to standard therapy for children admitted to the intensive care unit with acute bronchiolitis. In addition, scientists believe that large randomized clinical trials (RCTs) of Heliox inhalation in children with acute bronchiolitis are needed; suggest the potential benefit of using Heliox for CPAP and high-flux nasal cannula oxygen therapy to shorten the duration of ARDS treatment.

Croup. A large review of studies using Heliox for croup in children by I. Moraa et al. [21] showed some short-term benefit of Heliox inhalation in the treatment of severe or moderate croup in children treated with oral or intramuscular dexamethasone. However, the authors pointed to low-quality evidence and suggested that in some cases, the use of Heliox does not offer much benefit over conventional treatment.

Inhalation therapy for emergency conditions. In a review article by D. Jayesh et al. “Fundamentals of aerosol therapy in critical conditions” (Russian translation) (2016), the authors indicated that further and large-scale studies of the effect of Heliox in critical conditions are needed [22]. This conclusion was based on an analysis of data from 4 works and, possibly, due to both the small number of patients studied (10 patients) and the experimental nature of the studies (3 works with an artificial model):

1.In one of the presented works involving 10 patients, it was shown that the combination of helium and oxygen increases the deposition of aerosol labeled with indium 111 (¹¹¹ In), especially in the alveolar part of the lungs, compared to inhalation of aerosol with ordinary air. In addition, the authors testified that inhalation of drugs in a helium-oxygen mixture may have therapeutic value in the treatment of patients with severe airway obstruction [23].

2. In another study, scientists using an artificial model ( in vitro ) determined that a mixture of helium with oxygen (80:20 ratio) increases aerosol delivery with b ₂ -agonist albuterol by 50% compared to oxygen without helium ( p <0.001) and when using a metered-dose aerosol inhaler (MDI), and when using a nebulizer. And the amount of nebulized drug was inversely correlated with the gas density ( r = 0.94; p <0.0001). The work concluded that with mechanical ventilation of the lungs with a certain flow (in this case, the flow was 6 L / min) and the concentration of the helium-oxygen mixture in the circuit, the delivery of aerosol with a drug can be improved in patients with severe airway obstruction [24 ].

3. In a third study, also on an artificial model, it was determined that the use of Heliox for a nebulizer affects the inhaled dose of the drug and the size of the aerosol particles.The gas flow rate through the nebulizer when using Heliox should be increased (due to its low density) [25].

4. In an experiment on piglets (10 healthy and 10 with experimental bronchopneumonia caused by P. aeruginosa ) inhalation of ceftazidime through a nebulizer 5-30 times increased the concentration of the drug in the lung tissue with pneumonia compared with its intravenous administration ( p <0. 0001). However, the use of a helium-oxygen mixture (ratio 65:35) increased the concentration of the drug in the lung tissue only in healthy pigs and did not affect it in patients [26].

Post-extubation stridor. To date, post-extubation stridor is a serious medical and social problem. Treatment failure is often associated with reintubation. The role of Heliox in the treatment of this pathology has not been studied. There are only examples of successful treatment of post-extubation stridor using Heliox in BiPAP therapy due to the ineffectiveness of standard treatment in 2 patients [27].

Vocal cord dysfunction. A systematic review of studies using Heliox for vocal cord dysfunction found that all studies reported positive results with Heliox as an adjunctive therapy, but no study was of sufficient methodological quality to support their findings. The review concludes that further research is needed in this area [28].

IV. Application of Heliox for severe exacerbations of COPD and bronchial asthma

COPD. A 2003 systematic review found that there was insufficient evidence to support the benefits of helium-oxygen mixtures in different gas ratios for the treatment of severe exacerbations of COPD, both in ventilated and non-ventilated patients [29]. 15 years later, in a multicenter international randomized open study of the use of helium-oxygen mixture in severe exacerbations of COPD (6 countries, 16 emergency centers, 445 patients), it was proved that heliox reduces respiratory acidosis, encephalopathy and respiratory rate faster than air / O ₂, but does not prevent NIV failure.Overall, the failure rate of NIV was low.

Heliox was injected continuously for 72 hours during and between NIVL sessions. Included were patients with exacerbation of COPD and PaCO ₂ ≥45 mm Hg, pH≤7.35 and at least one of the following conditions: respiratory rate ≥25 per minute, PaO ₂ ≤50 mm Hg. and oxygen saturation, arterial (SaO ₂) or measured by pulse oximetry (SpO ₂), ≤90%. The patients were followed up for 6 months. The primary endpoint was NIV failure (intubation or death without intubation in intensive care).Secondary endpoints were physiological parameters, duration of ventilation, duration of resuscitation and hospital stay, 6-month assessment period for COPD exacerbations, and readmission rates. The study was terminated prematurely due to a low overall rate of NIV failure: air / O ₂ – 32 cases (14.5%) versus Heliox – 33 cases (14.7%), p = 0.97; the time to failure of NIV was 93 hours in the Heliox group, and 52 hours in the air / O ₂ group ( p = 0.12).Improvement in respiratory rate, pH, PaCO ₂ and regression of encephalopathy were noted much faster with the use of Heliox. Length of ICU stay was comparable between groups. Patients who were intubated after a “failure” of NIV had a shorter duration of ventilation when using Heliox (7.4 ± 7.6 days versus 13.6 ± 12.6 days; p = 0.02) and a shorter stay in intensive care unit (15. 8 ± 10.9 days versus 26.7 ± 21.0 days; p = 0.01).There was no difference in the frequency of deaths, either in the intensive care unit or at 6-month follow-up [30]. This is perhaps the first large RCT of the use of Heliox in COPD patients with an assessment of short-term and long-term outcomes.

Asthma. The results of the 2006 review showed that the use of the bronchodilator b ₂ -agonist albuterol through a nebulizer with simultaneous administration of Heliox in patients with bronchial asthma has a positive effect in severe exacerbations compared with inhalation of the drug with atmospheric air: a more pronounced increase in FEV ₁ and peak expiratory flow rate (PEF), a faster improvement in PEF in adults, as well as a more pronounced clinical effect and a decrease in the frequency of hospitalizations in children.Other studies in such patients did not reveal significant benefits of albuterol inhalation with heliox or showed a more pronounced decrease in symptoms without affecting the parameters of respiratory function [31].

The Italian Society of Pediatrics Guidelines for the Treatment of Acute Asthma in Children indicates that Heliox can be used for life-threatening attacks. It is based on an analysis of the scientific literature from the Cochrane Library and Medline / PubMed databases [32].

At the same time, there are studies that have not demonstrated significant benefits of Heliox.However, these were studies that included too few patients, for example, 8 patients with asthma and 5 patients with COPD who had severe airway obstruction. In addition, the ratio of helium and oxygen could be different (65–70% He and 30–35% O ₂) [33].

V. General conclusion on the use of a gas mixture of oxygen with helium

The information can be summarized as follows. The use of Heliox gas mixture for acute respiratory diseases, including COVID-19, may not be contraindicated and may be associated with beneficial effects in the form of improved treatment and disease outcomes.The use of helium is not associated with fundamental difficulties, since it has no side effects. The lower density of helium allows for easier tissue penetration in turbulent gas / gas mixtures flowing through airway obstructions. This also contributes to a better delivery of oxygen to the body during inhalation of Heliox. Such a mechanism can be used to improve the delivery of inhaled drugs and increase their bioavailability.

At the same time, we join the opinion of other scientists who believe that, in general, the evidence base for the medical use of helium-oxygen mixture is rather weak – there are very few RCTs, most studies included few patients, and there is not enough data on long-term outcomes.Despite this, the use of helium during an epidemic of a respiratory infection, for example, COVID-19, seems to be justified due to the likely benefits in different clinical situations and methods of use.

Possible indications for the use of Heliox can be not only therapy of ARDS , post-extubation stridor , but also, apparently, any severity of COVID-19. It can be assumed that with mild course and moderate severity , the use of Heliox can also accelerate recovery, reduce the likelihood and severity of complications, including those from existing chronic diseases.

Theoretically, blood plasma from healthy donors (unimmunized) and those who have been ill with COVID-19 (immunized) , taken after a certain time after inhalation of Heliox, can be used as a component of treatment by analogy with the experimental work mentioned above [5].

Apparently, a wider application of helium for inhalation of various drugs is possible due to its chemical inertness, including when connected to the circuit of equipment for respiratory support.Among such drugs, it is advisable to evaluate a surfactant. Increasing the bioavailability of drugs when administered by inhalation in patients with respiratory injury is one of the important approaches to treatment [23-26].

It should be noted the potential benefits of using Heliox for the rehabilitation of patients at an early (stationary) stage and in a later recovery period. Perhaps this approach is already being used by COVID-19 convalescents.

Effect of preconditioning (hypoxic, ischemic, etc. ) the gas mixture under consideration allows us to think about the possibility of a preventive effect of Heliox inhalations in relation to patients not infected with SARS-CoV-2 or another potentially dangerous respiratory infection (reducing the likelihood of developing the disease? The likelihood of a less severe course?): a) in healthy individuals; b) in patients with chronic diseases (non-infectious and infectious), especially at risk groups for severe course; c) for all categories of medical workers (doctors, nurses, nurses), volunteers and non-medical personnel working in difficult conditions of the epidemic, including ambulance stations, disinfection teams.

For people working in personal protective equipment (PPE) Heliox inhalation can be useful not only before a work shift. By analogy with the research data of Korean scientists [16], it seems expedient to develop safe portable and lightweight systems with heliox, which could be used directly during long-term work in PPE such as an anti-plague suit. In this case, the best tolerance to work in PPE is likely, including physical condition and cognitive abilities, the ability to make correct decisions.

Of course, we speak with a high degree of caution. None of these options for the use of Heliox for the treatment / prevention of COVID-19 or other acute respiratory infection have strong scientific justification (or we did not find sources). In addition, at present, the most optimal ratio of gases in the mixture, the preferred equipment for inhalation / ventilation, cannot be noted. Most likely, it is necessary to be guided by the accumulated experience of specialists in the relevant fields of medicine.In every possible option for using Heliox, of course, it is necessary to adhere to all general rules and requirements, including sanitary and anti-epidemic ones.

It seems extremely important to form a reliable evidence base on the efficacy and safety of Heliox in different clinical situations, with different methods and “doses” of administration (ratio of gases in the mixture, flow rate, temperature of the gas mixture, duration and frequency of administration, intermittent / continuous, etc. .). To this end, it is necessary to conduct scientific clinical trials with different designs, including RCTs and registries, with correct methodological planning, accurate data collection, and assessment of short-term and long-term outcomes.Since the likelihood of benefits from the use of Heliox is assumed, in our opinion, it is more ethical to conduct observational studies without a procedure for randomizing patients when studying severe conditions (the comparison group can be patients from institutions where Heliox has not been used; it is possible to use the pairing method).

In the current epidemic of a new coronavirus infection, a unified electronic database on COVID-19 patients and healthy carriers of SARS-CoV-2 with detailed socio-demographic, anthropometric , anamnestic and other information, details of treatment and examination results at all stages of medical care.Within the framework of scientific works, approaches can also be considered for analyzing the effect of Heliox on healthy carriers of SARS-CoV-2. For example, to evaluate the effect of Heliox on the rate of elimination of the pathogen, the nature and rate of formation of antibodies to SARS-CoV-2.

The limitation of of our work is the analysis of a small number of publications, mainly foreign ones, the lack of our own experience of working with helium-oxygen mixture.

Conclusion

Helium-oxygen mixtures have been used for many years in clinical practice and scientific work, are safe, have a definite place for use in respiratory medicine, including emergency conditions.Their use appears to be broader and include COVID-19. However, a reliable evidence base is required – conducting clinical trials at the level of modern knowledge of evidence-based medicine.

Contribution of authors: concept and design – M.I. Smirnova; collection and processing of material – M.I. Smirnova, D.N. Antipushin; text writing – M.I. Smirnova, D.N. Antipushin; editing – O.M. Drapkin.

The authors declare no conflicts of interest.

Elimination of wrinkles with botulinum toxin “Terme Krka

Frequently Asked Questions

What results can you expect?

If you notice that mimic, dynamic wrinkles age you, then regeneration with botulinum toxin will allow you to noticeably rejuvenate, because Botox effectively smooths such wrinkles. If your skin is damaged by factors such as exposure to sunlight or smoking, or if your wrinkles are the result of natural aging of the skin, then it is better to complement the procedure with other methods, for example, correctly selected chemical peels and the introduction of skin fillers.However, botulinum toxin is not a substitute for a facelift as it does not correct sagging skin.

How is botulinum toxin intervention performed?

Botulinum toxin injection is a simple and safe procedure. With the help of an ultra-thin needle, small doses of the drug are injected into precisely defined places. They are determined taking into account your facial expressions and possible asymmetry, which it is desirable to eliminate or soften with botulinum toxin.

Is botulinum toxin injection painful?

The sensations arising from this intervention, some compare with a mosquito bite, some patients experience only mild discomfort.The drug is stored in a sterile solution – as a rule, it is a physiological solution without preservatives. The combination of the pH neutral drug and its injection with an ultra-thin needle minimizes sensations.

What is this drug – botulinum toxin?

BOTOX® and VISTABEL are two botulinum toxin type A formulations obtained from the culture of Clostridium botulinum bacteria. This bacterium synthesizes a protein that inhibits the action of acetylcholine, which makes it impossible for the muscle to contract or relaxes it.Type A is just one of seven types of botulism toxin (A, B, C1, D, E, F, and G), each with its own properties and spectrum of action. Botulinum toxin is produced under controlled laboratory conditions and is used in minimal doses for cosmetic procedures.

What are the side effects of using botulinum toxin?

In patients with cervical dystonia (contractures of the cervical and shoulder muscles), dysphagia most often occurs (difficulty in swallowing, in 19% of cases), there may also be upper respiratory tract infections (12%), neck pain (11%) and headache (11%).People with blepharospastic manifestations (tics of blinking) can develop a drooping eyelid (21%), superficial punctate keratitis (corneal inflammation, 6%) and dry eye mucosa (6%) as a side effect. At typical doses, the potential for systemic reactions, such as severe swallowing or breathing problems, increases in patients with neuromuscular problems. Botulinum toxin should not be applied to areas of inflammation. With the simultaneous administration of aminoglycoside antibiotics or other drugs that affect neuromuscular activity, the risk of side effects may increase.

Can botulinum toxin be considered a new drug?

No. It has been in use for over two decades and has helped millions of patients around the world. Its use is approved by the competent authorities in more than 70 states, including the US Neurological Academy (in 1990) and the US National Institutes of Health.

What is the effect of botulinum toxin?

In order for the muscle to contract and move, a signal from the brain is required in the form of an electrochemical impulse, which is transmitted to the muscle along nerve fibers using a substance called acetylcholine.When it is released in significant amounts, the muscles tense up and spasm occurs. Botulinum toxin prevents the transfer of acetylcholine from the nerve to the muscle, which relieves or minimizes muscle spasm, thus also relieving the symptoms of excessive muscle activity.

Is the result lasting?

No. 3 months after the drug is administered, the nerve will again be able to secrete acetylcholine, and the symptoms of excessive muscle activity will return. Therefore, it is recommended to repeat the introduction of a dose of botulinum toxin after 3 – 6 months.This makes sense if there have been no previous allergic reactions or other side effects.

What are the most common complications?

Complications, although they are rare, do occur: first of all, bleeding and bruising. A bacterial infection is also possible – for example, pain and redness occurring within 24 to 72 hours after the intervention. In this case, the doctor will take a smear and prescribe an antibiotic based on the results. Viral infections are also possible, including herpes rashes, numbness of local tissues – due to secondary blockage of cutaneous arterioles, here you can resort to warm lotions, massage and nitroglycerin paste; cystic reactions to the implant and abscesses caused by foreign matter are also possible.

Does botulinum toxin really have an effect in eliminating excessive sweating?

Yes. Clinical studies show that botulinum toxin reduces sweating levels in almost 95% of patients by 4-9 months. Therefore, botulinum toxin will be your right choice if this problem bothers you so much that you are willing to give up normal human interaction with others.

Where is the drug administered in order to eliminate sweating?

As a result of the starch test, which allows to determine the location of the sweat glands, 12 – 15 points are outlined on the problem area, where botulinum toxin is then injected with an ultra-thin microneedle.After such a procedure, it is necessary to refrain from physical activity for several hours.

When does the effect of reducing sweating occur?

Approximately 48 hours after the procedure, sweating is reduced by 95 percent, and its complete cessation is noted after a week.

How soon should the procedure be repeated to avoid sweating again?

Botulinum toxin, administered to limit perspiration, lasts approximately 6 to 9 months.Then the procedure should be repeated.

How often should botulinum toxin be repeated?

The effect of a particular procedure can be stable for 3 – 6 months. You can repeat the procedure as long as there is a symptomatic reaction to it and there are no cases of allergies or side effects. The procedure is usually repeated three to four times during the first year, and when certain muscle groups are weakened, it will not be necessary to repeat it as often, in addition, the effective dose of the drug will decrease.The effect of the procedure appears after about 14 days, since after the introduction of the drug, it takes several days for it to take effect. The drug works for most patients, but some of them may decrease their reactivity over time.

Isn’t it dangerous to use botulinum toxin for a long time?

The use of Botox is safe and does not cause undesirable consequences. This is indicated by an analysis of studies conducted over 12 years on 2000 patients.In favor of the fact that the use of botulinum toxin is safe, it is also said that it has also been used for the treatment of a number of neurological and ophthalmic diseases for 20 years.

When is the use of botulinum toxin not recommended?

When consulting a doctor before prescribing a procedure, be sure to inform if you are currently pregnant, lactating or need to take any medications. Caution is also needed in neurological diseases, when taking aminoglycoside antibiotics and other drugs that affect neuromuscular transmission of information.Before the procedure, make sure that the doctor knows the entire list of medications you are taking (both prescription and over-the-counter medicines. In addition, the procedure is excluded if there are manifestations of infection (inflammation) in the area where you plan to inject botox.)

Laser therapy

Laser treatment methods occupy one of the leading places in the list of the most promising areas of modern medicine.When applied externally, laser treatment occurs by the action of the emitting terminal on certain areas and points of the body. Light penetrates the tissues to a great depth and stimulates the metabolism in the affected tissues, activates healing and regeneration, there is a general stimulation of the body as a whole. In intravenous laser therapy, through a thin light guide, which is inserted into a vein, the laser beam acts on the blood. The intravascular action of low-intensity radiation allows the entire mass of blood to be affected.This leads to the stimulation of hematopoiesis, increased immunity, increased blood transport function, and also promotes increased metabolism. Such treatment is completely painless and comfortable. There is a clear scheme for combining laser therapy with drug therapy, in accordance with which the best therapeutic effect is achieved.

Laser therapy is effective and indicated in the following cases:
– For diseases of the cardiovascular system (IHD, angina pectoris, vegetative vascular dystonia, arterial hypertension).
– For diseases of peripheral vessels (obliterating vascular lesions of the extremities, phlebitis, thrombophlebitis, varicose veins).
– For respiratory diseases (pneumonia, pleurisy, bronchitis, bronchial asthma, pulmonary tuberculosis).
– For diseases of the gastrointestinal tract (gastritis, gastric ulcer and duodenal ulcer, pancreatitis, cholecystitis, colitis).
– For diseases of the genitourinary system: kidneys (acute and chronic pyelonephritis, urolithiasis), cystitis, prostatitis, urethritis, weakening of sexual function.
– For gynecological diseases (postpartum endometritis, nonspecific salpingitis, bartholinitis).
– For diseases of the nervous system (neuralgia, neuritis, trauma to the nerve trunks and plexuses, the consequences of craniocerebral trauma, the consequences of a stroke, the consequences of neuroinfection).
– For ENT diseases (otitis media, sinusitis, frontal sinusitis, rhinitis, tonsillitis, tonsillitis, laryngitis, tracheitis).
– For diseases of the musculoskeletal system (arthritis, arthrosis, osteochondrosis, myositis, soft tissue bruises, periostitis).
– For sluggish granulating wounds, peritonitis, boils, carbuncles, postoperative and post-traumatic scars, burns.
– For skin diseases (dermatitis, neurodermatitis, herpes, erosion, ulcers of the mucous membranes).

On average, the course of treatment is designed for 10 sessions. In some cases, to consolidate the achieved effect, the procedure is repeated six months later.

Phlebology

Everyone is familiar with the external manifestations of varicose veins of the lower extremities – in common parlance varicose veins – swollen blue knotty vessels on the legs.Varicose veins cause significant inconvenience, pain, and in the end – it’s just unaesthetic! What are the ways to get rid of this scourge? At this stage in the development of medicine, there are only three of them: surgical (removal of veins by surgery), laser coagulation and phlebosclerosis therapy. With the exception of the surgical procedure, the procedure is painful and used in extreme and deeply neglected cases, other methods have long been successfully used for treatment in our Center.

FLEBOSCLEROSING THERAPY
The most common treatment for varicose veins in the world. The rapid achievement of a good aesthetic result, painlessness, the possibility of outpatient use, and quick rehabilitation make this type of treatment attractive for both doctors and patients.

TECHNIQUE OF PHLEBOSCLEROSING TREATMENT
With intravenous administration of drugs, the so-called detergents, obliteration of the varicose vein occurs on the 8-10th day, and immediately after the procedure, immediate elastic compression is required – special compressive dressings that promote “sticking” intended for the round-the-clock vein and wearing for 10-14 days.The choice of the concentration of the phlebosclerosing drug is determined by the diameter of the varicose vein.
Intravascular administration of drugs is practically painless, and the method of treatment itself is safe, effective and radical.

LASER COAGULATION
It is used in the treatment of reticular varicose veins (a network of small vessels on the legs), when it is technically impossible to make an injection into a vein with a diameter of 0. 1-1 mm. When exposed to a laser, part of the dilated vessels disappears directly during the treatment process already during the first session, but removal of most of the vessels may take up to 3-4 sessions at 4-week intervals.
And, of course, no elastic bandages are required for laser treatment.
Thus, the optimal effect is observed with the combined use of sclerotherapy and a laser for treating vessels of various diameters. Well, what method to choose will be decided together with you by highly qualified phlebologists of our Center after examination and, if necessary, carrying out diagnostic tests.

Laser cleaning of blood and vessels

We offer you a very effective and efficient technique – INTRAVASCULAR LASER BLOOD IRRADIATION (ILBI).This method is based on the introduction of a light guide through a needle through which the flowing blood is irradiated with a laser beam. In this case, the activation of respiratory enzymes, an increase in the saturation of hemoglobin with oxygen, stimulation of the production of blood corpuscles, an improvement in its microcirculation and a decrease in viscosity, an increase in the bactericidal properties of blood occur. As a general consequence – detoxification of the body, an increase in its resistance to infections.
Indications for ILBI use:
– Chronic liver and kidney diseases
– Chronic bronchitis, pneumonia, bronchial asthma
– Ischemic heart disease, postinfarction conditions
– Skin diseases (psoriasis, neurodermatitis, furunculosis)
– Medicinal types of allergies
– Chronic, incl.including viral infections
The high efficiency of ILBI has been clinically proven in the following diseases:
– Thrombopliterating diseases of limb arteries
– Acute and chronic thrombophlebitis, phlebothrombosis
– Stomach ulcer and duodenal ulcer – Diabetes mellitus
– pancreatitis
– Rheumatoid arthritis
– Infertility, adnexitis
Treatment with ILBI can be carried out in combination with drug therapy, and under the influence of laser therapy, the sensitivity to drugs increases, which makes it possible to reduce the dosage of drugs and, accordingly, reduce their side effects.
Duration of clinical effect.
After the first course of ILBI, the result of treatment is maintained for 4 months or more. After a second course of laser therapy, remission increases to 6-8 months.

Hardware spinal traction

Axial traction and vibration-mechanical action on the musculo-ligamentous apparatus of the spine and joints, carried out on the device for dosed traction “ORMED-3 M” in combination with laser therapy, gives a remarkable effect in the treatment of osteochondrosis of the cervical, shoulder and lumbar spine, sciatica, sciatica, lumbago, brachial-scapular periarthritis, intervertebral hernias, intercostal neuralgia.

90,000 Sleep apnea – together

What is sleep apnea?

Sleep apnea is a breathing disorder in which a sleeping person stops breathing for short periods. Breathing becomes irregular, with repeated stops. There are two main types of this condition: obstructive sleep apnea and central sleep apnea.

Obstructive sleep apnea (OSA) develops when the throat or upper airway narrows or closes during sleep. This is the most common type of sleep apnea.
Central sleep apnea occurs when the brain causes the respiratory muscles to malfunction.

Among children with cancer, the highest risk of sleep apnea is observed with brain tumors. Apnea can shorten the duration of sleep or negatively affect the quality of sleep.

Poor sleep quality can cause problems with thinking, emotion and behavior. Children may have difficulty thinking, paying attention or remembering and performing poorly in school.In addition, sleep apnea can cause physical problems such as heart disease, high blood pressure, and stunted growth.

Sleep apnea symptoms

Causes of sleep apnea

Apnea occurs due to narrowing of the upper airway or pharynx during sleep. Most often, the closure of the airways occurs due to the relaxation of the muscles of the pharynx and tongue. In children, the main cause of apnea is the enlargement of the palatine or pharyngeal tonsils.Being overweight and obese can also lead to the development of sleep apnea.

Children with brain tumors have a higher risk of sleep apnea than children with other cancers.

An increased risk of apnea is associated with certain pathological conditions, including Down syndrome, sickle cell anemia, cerebral palsy, and neuromuscular diseases.

Sleep apnea diagnosis

Sleep apnea diagnostics may include the following:

Medical history study and physical examination
Conversation with the patient and his family or completing a questionnaire to clarify symptoms
Sleep study or polysomnography to measure respiration, heart rate and activity during sleep

Sleep apnea treatment

Treatment for apnea depends on the cause and severity of the condition and the age of the child. Some children may have surgery to remove their enlarged tonsils. This allows you to expand the lumen of the pharynx and provide more free passage of air.

Continuous positive airway pressure for the treatment of apnea

Continuous Positive Airway Pressure (CPAP) is a common treatment for obstructive sleep apnea. The CPAP system provides a constant flow of room air (not oxygen) through a mask or nasal adapter attached to the device.The air pressure keeps the airway open while you sleep.

There are devices that automatically adjust the air pressure during sleep. Such systems are called self-adjusting CPAP, auto-CPAP, or APAP.

Additional treatments for sleep apnea:

Posture change
Refusal to take sedatives and alcohol
Weight loss
Using a dental device to position the tongue or lower jaw
Supplemental oxygen during sleep (more commonly used for central sleep apnea)
Medications to stimulate breathing (central sleep apnea) or reduce swelling of the nasal passages (obstructive sleep apnea)
Nerve stimulation with a surgically implanted device (currently not used in children)

Sleep apnea treatment: guidelines for patients and families

Lifestyle changes can reduce manifestations of sleep apnea and improve sleep quality:

Exercise regularly.
Take control of your allergies and asthma.
Stop smoking.
Avoid alcohol, especially before bed.
Reduce body weight.
Sleeping on your side rather than on your back is recommended. Use a wedge-shaped pillow to lift your head and upper body.

Additional materials for studying the problem of apnea

90,000 Darsonvalization | Laser therapy | Medicinal electrophoresis

Physiotherapy in the sanatorium “Lazurny”

Physiotherapy has long established itself as an effective method of treatment, prevention and recovery after various diseases.The main advantages of physiotherapy procedures include, firstly, the fact that most of them are not invasive, secondly, they are painless and, thirdly, they have a minimum number of contraindications.

Sanatorium “Lazurniy” offers its patients the most popular methods of physiotherapy:

laser therapy,
magnetic therapy,
amplipulse therapy,
drug electrophoresis,
darsonvalization.

In the sanatorium you can achieve high results in the treatment of the musculoskeletal system, diseases of the cardiovascular system, respiratory system, nervous system, ENT organs.

Laser therapy: features of the method, indications for use

This physiotherapy method of treatment is based on the use of radiation in the optical range generated by a laser. Laser therapy has found wide application in modern restorative medicine, and interest in it is only growing every year.

The action of the laser beam helps to reduce the inflammatory process in tissues, enhance regeneration, and enhance the protective functions of the body. Laser therapy is used to relieve pain, reduce microbial contamination at the site of laser exposure.

Indications for the use of this method of physiotherapy can be various cardiovascular diseases, neurological disorders, diseases of the gastrointestinal tract, genitourinary system, diseases of the joints and spine, pathology of the respiratory system, dermatological problems.

As a rule, sessions are held daily, the course is designed for 8-10-15 procedures. If you are interested in laser therapy sessions, the price of these procedures can be clarified with the staff of the Lazurny sanatorium by calling the indicated phone numbers.

What are the features of magnetotherapy?

The therapeutic effect of magnetotherapy is based on the use of a constant or alternating magnetic field. The nervous, cardiovascular and endocrine systems are most susceptible to magnetotherapy.Also, this physiotherapy method is used in many sanatoriums for the treatment of diseases of the musculoskeletal system and the gastrointestinal tract.

Magnetotherapy is known for its powerful anti-inflammatory and analgesic effects. It helps to accelerate tissue regeneration and reduce swelling. The magnetic field normalizes the autonomic functions of the body, stabilizes the vascular tone, has an antioxidant, calming, immunomodulatory effect.

Another undoubted plus possessed by such a physiotherapeutic method of treatment as magnetotherapy is the price.The procedures are quite accessible to every patient. Usually, magnetotherapy is prescribed in courses of 8-10-15 procedures, which the patient must attend daily.

Who will benefit from amplipulse therapy?

Another method of physiotherapy available to vacationers of the Lazurny sanatorium is amplipulse therapy. Its essence lies in the effect on different parts of the patient’s body with sinusoidal currents. Amplipusterapy is often called the most gentle electrotherapy technique, which allows it to be used in a wide range of diseases accompanied by a pronounced pain syndrome.

The alternating impulse current of medium frequency easily passes through the skin and penetrates deeply into the tissues. The patient does not feel any burning or tingling sensation on the skin. Depending on the indications, different amplipulse therapy modes are used.

This method of physiotherapy has a powerful analgesic and anti-inflammatory effect, effectively relieves muscle spasms or works as a muscle stimulator (depending on the selected mode), normalizes blood circulation in tissues, and stabilizes the autonomic nervous system.

The healing effect accumulates gradually, so the procedures are prescribed by the course. The course can include 5-7-10 sessions.

Amplipulse therapy today includes in their list of therapeutic techniques medical institutions and sanatoriums specializing in diseases of the musculoskeletal system, peripheral nervous system, gastrointestinal tract, and the genital area.

To find out the price of the amplipulse procedure in Lazurnoe, take a look at our price list published on the website.

Medicinal electrophoresis: what are the features and benefits of this physiotherapeutic method?

This method of physiotherapeutic treatment combines the effects on the body of galvanization (direct current of low strength and voltage) with the effects of drugs. Thus, the medicinal product enters the body through the skin and mucous membranes, then entering deeper tissues. And after that, the blood carries the medicinal substance throughout the body, to organs and tissues.

The use of drug electrophoresis in treatment minimizes side effects that may occur if the drug is administered by other means. The substance enters directly into the lesion focus if it is located in the surface tissues.

The procedure lasts from 10 to 30 minutes. The course may include 8-10-20 procedures.

Medicinal electrophoresis is prescribed in our sanatorium for patients with diseases of the musculoskeletal system, alimentary tract, cardiovascular system, and nervous system.This method of physiotherapy is effective in the treatment of broncho-pulmonary diseases, some allergic and skin diseases.

Darsonvalization as a common method of physiotherapy

Currently, darsonvalization is successfully used in various fields of medicine.