Albuterol delivered by metered-dose inhaler to treat acute bronchitis

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Clinical Trial

. 1994 Nov;39(5):437-40.

W J Hueston 
¹

Affiliations

Affiliation

• ¹ Department of Family Medicine, University of Wisconsin, Eau Claire.

• PMID:

  7864949

Clinical Trial

W J Hueston.

J Fam Pract.

1994 Nov.

. 1994 Nov;39(5):437-40.

Author

W J Hueston 
¹

Affiliation

• ¹ Department of Family Medicine, University of Wisconsin, Eau Claire.

• PMID:

  7864949

Abstract

Background:

Previous research has suggested that cough associated with acute bronchitis is more likely to subside within 7 days when treated with albuterol than with an antibiotic. This study examines the effectiveness of aerosolized albuterol for the treatment of acute bronchitis in patients treated with erythromycin or placebo.

Methods:

A double-blind, randomized placebo-controlled trial of albuterol delivered by metered-dose inhaler (MDI) was conducted in a primary care setting with healthy adult patients who presented with a productive cough of fewer than 30 days’ duration. In addition to randomization for albuterol, patients were also randomized to receive erythromycin or placebo. Outcomes were assessed at follow-up after 7 days.

Results:

Patients treated with albuterol MDI were less likely to be coughing after 7 days of treatment than were patients using a placebo inhaler (61% still coughing vs 91%, P = .02). When analysis was stratified by cigarette smoking status and the use of erythromycin, the differences observed between albuterol MDI patients and controls persisted.

Conclusions:

Albuterol appears to reduce the likelihood that patients with acute bronchitis will be coughing after 7 days following initiation of treatment. This effect appears to be independent of cigarette smoking or the concomitant use of antibiotics.

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Types of Inhalers and Nebulizers

Just when you think you’ve gotten over that respiratory infection, bronchitis hits. The coughing, chest soreness, and fatigue can really get you down.

While acute bronchitis will usually go away without prescription treatments, chronic or an especially nasty case of acute bronchitis may require some extra help.

We explain inhaled treatments for bronchitis, including nebulizer and inhaler treatments, and how they may help.

Inhalers are medications that are delivered through the mouth and to the lungs.

Usually this is a device with a short mouthpiece that connects to a small canister you press down on. When you press down and inhale, the medication enters your mouth and goes down into your lungs.

A doctor may prescribe a few different types of inhaler medications for bronchitis. These include the following:

Beta-2 agonists

Some of the most common inhaler medications are short-acting beta-2 agonists. These include medications like albuterol and salbutamol.

Doctors prescribe beta-2 agonists to treat:

• asthma
• chronic obstructive pulmonary disease (COPD)
• severe coughing that can come with acute bronchitis

These medications work by relaxing airway passages in the lungs, which can make it easier to breathe.

The Cochrane Database of Systematic Reviews analyzed the results of five different studies of beta-2 agonists as a treatment for acute bronchitis in adults.

They concluded that there’s little evidence to support the use of beta-2 agonists in adults with acute bronchitis.

However, they did find that inhalers helped people who tended to wheeze frequently, even when they weren’t sick.

Inhaled corticosteroids

Inhaled corticosteroids help to reduce airway inflammation. This can be helpful when you have bronchitis, because it’s usually after an upper respiratory infection and your lungs are already very irritated.

These medications won’t relieve a wheezing attack immediately, but they can help to reduce:

• airway swelling
• excess mucus
• tight airways

Examples of inhaled corticosteroids doctors prescribe include:

• beclomethasone
• budesonide
• fluticasone

Long-acting beta-2 agonists (LABAs)

These medications are similar to short-acting beta-2 agonists like albuterol. They aren’t meant for acute attacks of wheezing, but rather reduce the risk of wheezing all day.

Examples of LABAs include arformoterol tartrate (Brovana) and formoterol fumarate (Oxeze, Foradil).

Doctors usually prescribe these with inhaled corticosteroids.

Nebulizer treatments are another form of inhaled medications. Instead of a short mouthpiece, nebulizer treatments usually have a longer mouthpiece and an air compressor that helps convert the medication to a fine mist.

Doctors often prescribe nebulizers to children who may have a harder time using an inhaler properly.

Instead of having to time the pumps to breathe medication in, a person just takes deep breaths in and out to take in the medication.

Nebulizers are also useful for people who may require larger amounts of inhaled medications, such as those for:

• acute asthma attacks
• pneumonia
• COPD

A doctor would usually prescribe nebulized medications to treat acute bronchitis in children or for chronic bronchitis in adults.

Examples of nebulized medications include:

• Long-acting beta-2 agonists (LABAs). These medications are usually the same as those available for inhalers.
• Long-acting muscarinic agents (LAMAs). These medications work on different receptors in the lungs than beta-agonists to help open up the airways so you can breathe better. Examples of these medicines include umeclinium (Ellipta) and tiotropium (HandiHaler, Respimat).
• Short-acting beta-agonists (SABAs). Like with traditional inhalers, a person can use albuterol in a nebulizer. These are mostly for acute attacks in bronchitis, such as wheezing.
• Short-acting muscarinic antagonists (SAMAs). These are medications like ipratropium bromide (Atrovent). Doctors prescribe them to treat chronic bronchitis and COPD.

Many of these medications are available in combination, such as SABA-SAMA or LABA-LAMA.

Nebulized medications may not be as good a fit for adults without COPD, because nebulizers require special equipment and teaching to use.

Ideally, a person with acute bronchitis wouldn’t need this type of equipment.

In addition to nebulizers and inhalers, some people may inhale warm, humidified air (steam) at home to improve their breathing.

Sometimes cold air can irritate the lungs and worsen coughing when you have bronchitis. Warm, moist air may help you feel better and reduce coughing.

Here are some ways you can incorporate steam or mist therapy into your bronchitis treatments:

• inhale steam from a bowl of boiling water, while hovering at least 8 to 12 inches away with a towel over your head to hold the steam in
• take a hot shower
• use a humidifier in your room, but be sure to carefully clean it after use

Many drugstores also sell plugin steam inhalers.

The side effects from inhalers and nebulizer treatments depend upon the type used. Examples of side effects include the following:

• Beta-2 agonists may cause tremors, nervousness, and shakiness.
• Corticosteroids can causesore mouth, cough, hoarse voice, or nosebleeds. Oral thrush can develop if a person doesn’t rinse their mouth out after use.
• LABAs can cause heart palpitations and tremors.
• LAMAs may cause constipation, dry mouth, and urinary retention.

If you experience any of these when you use an inhaler or nebulizer, talk to your doctor about ways to minimize these side effects. You can also find out if other medications are available.

They may suggest using a spacer device, which maximizes the delivery of the medication to the lungs. This minimizes the settling of medication to the back of the throat, which can lead to side effects.

With treatment and rest, you’ll ideally recover within about 1 to 2 weeks. It may take a bit longer for some people.

If your symptoms, especially your cough, persist beyond 3 weeks, consider scheduling another appointment with your doctor.

A doctor can evaluate you for other potential coughing causes, such as:

• asthma
• sinusitis
• COPD
• gastroesophageal reflux disease (GERD)
• heart failure
• pulmonary embolism

According to StatPearls, doctors may misdiagnose as many as one-third of patients with bronchitis when the patients actually have asthma.

You should talk with a doctor if you have a cough that persists after an upper respiratory infection, and it keeps you from completing everyday activities or starts to make your chest hurt.

If you have a fever that accompanies your symptoms, your infection may be bacterial. A doctor can prescribe antibiotics that can help bronchitis go away.

If your cough persists after 3 weeks, you may need to make another appointment with your doctor. Bronchitis will usually subside by this time, so you could have another medical condition.

Sometimes, bronchitis can lead to pneumonia. This is a severe lung infection.

Seek emergency medical treatment if you have worsening symptoms like:

• shortness of breath
• blue-tinted lips or fingernails
• confusion

Doctors usually treat bronchitis by treating its symptoms.

If your symptoms include wheezing and coughing, your doctor may prescribe an inhaler or nebulizer. These may help you manage your symptoms until you start feeling better.

Where does bronchial asthma come from and what to do about it?

Asthma is a condition in which the airways (bronchi) become swollen, narrow, and produce excess mucus. This makes it difficult to breathe, and also causes coughing, shortness of breath and wheezing. For some people, asthma causes only mild discomfort. For others, it is a serious problem that interferes with daily activities and leads to life-threatening seizures. This disease cannot be cured, but it is extremely important to control it.

The symptoms of this disorder vary from person to person. Some people have seizures occasionally, while others only have symptoms under certain conditions – for example, during exercise. Some patients experience asthma symptoms all the time.

Signs of this disorder include:

• Shortness of breath
• Heaviness or pain in the chest s in children),
• Cough or shortness of breath that gets worse with a cold or flu.

The following signs may indicate disease progression:

• Symptoms are more frequent and more pronounced,
• Breathing becomes even more difficult,
• The need for more frequent use of a quick-acting inhaler.

For some people, asthma symptoms flare up only in certain situations:

• During exercise, especially when the air is dry and cold,
• Exposure to workplace irritants such as chemical vapours, gases or dust (occupational disease),
• Exposure to airborne allergens (allergic asthma). These include pollen, mold spores, cockroach waste products, as well as skin particles and dried saliva of pets.

It is not yet clear why only some people suffer from this disease, since we are all exposed to irritants from time to time. According to the World Health Organization (WHO), about half of cases are due to genetic susceptibility, and the other half to environmental factors.

Possible asthma triggers include:

• Substances that affect the respiratory tract – pollen, dust mites, mold spores, pet dander or cockroach waste,
• Respiratory infections – colds or flu. Respiratory infections are responsible for four out of five asthma attacks,
• Cold or dry air,
• Smoke, including tobacco, car exhaust and other air pollutants,
• Certain medications, including beta blockers, aspirin, ibuprofen and naproxen
• Severe emotional distress
• Sulfites and preservatives added to certain foods and drinks, including shrimp, dried fruit, french fries, potato chips, beer and wine
• Gastro esophageal reflux disease (GERD) is a condition in which stomach acid backs up into the esophagus.

Classification of bronchial asthma by severity

To determine the severity, doctors ask how often and how badly the patient has symptoms. Together with the results of diagnostic procedures, this information helps develop the most effective asthma management plan.

This violation is classified into 4 categories:

How to treat asthma?

Prevention and continued control of symptoms are key factors that help prevent flare-ups. The patient must learn to recognize triggers in time and take all necessary measures to avoid them. You also need to constantly monitor your breathing. This helps make sure your asthma medications are working and your symptoms are under control. In the event of an attack, the patient may need a fast-acting inhaler, such as albuterol.

Medicines used to treat asthma

The choice of medicine depends on a number of factors – age, symptoms, triggers, and what is most effective in controlling symptoms.

For long-term control, drugs are prescribed that reduce inflammation in the airways. Inflammation is what causes asthma symptoms to flare up. Bronchodilators are used to quickly relieve an attack. They instantly relieve swelling in the bronchi, which restricts breathing. In some cases, you can not do without antiallergic drugs.

The cornerstone of asthma management is daily medication. They help keep symptoms in check and also reduce the likelihood of seizures.

For long-term control of symptoms, the following drugs are prescribed:

• Inhaled corticosteroids . These drugs relieve inflammation and include: fluticasone, budesonide, flunisolide, ciclesonide, beclomethasone, mometasone, and fluticasone furoate. To achieve maximum effect, they must be taken from several days to several weeks. Unlike oral corticosteroids, inhaled corticosteroids are safe for long-term use. They have a relatively low risk of side effects.
• Leukotriene receptor antagonists . These oral remedies, including montelukast, zafirlukast, and zileuton, help relieve asthma symptoms for up to 24 hours. In rare cases, their use causes psychological reactions – agitation, aggression, hallucinations, depression and suicidal thoughts. If any of these reactions occur, call your doctor immediately.
• Long-acting beta-agonists . These drugs are taken in the form of sprays and help to “open” the airways. Salmeterol and formoterol are usually prescribed. These drugs should only be taken in combination with inhaled corticosteroids. Some studies show that taking only long-acting beta-agonists increases the risk of developing severe asthma. Also, these drugs should not be taken to treat acute attacks of the disease.
• Combination inhalers . The combination fluticasone/salmeterol, budesonide/formoterol and formoterol/mometasone contains a long-acting beta-agonist and a corticosteroid.
• Theophylline . It is a bronchodilator that helps keep the bronchi “open” by relaxing the muscles around them.

ASTMA fast Action

These are the so -called “lifeguards” that are used for quick, but short -term relief of symptoms for asthma attacks. They are sometimes used before exercise or workouts. These funds include:

• Short-acting beta-agonists . These drugs act within minutes by rapidly expanding the airways. These include albuterol and levalbuterol.
• Ipratropium . Like other bronchodilators, ipratropium quickly relaxes the bronchi, making breathing easier. Usually this drug is prescribed for emphysema and chronic bronchitis, but sometimes it is used during asthma attacks.
• Oral and intravenous corticosteroids . These drugs—including prednisone and methylprednisolone—relieve inflammation in the airways caused by a severe form of the disorder. They can not be taken for a long time – otherwise the patient risks suffering from serious side effects.

If a patient has an asthma flare-up, a quick-acting inhaler will help to “take it off” within a few minutes. However, if you are constantly taking drugs that do their job, you do not need to use fast-acting inhalers often. Ideally, it is recommended to keep a diary in which the number of injections per week is recorded. If you have to use your rapid-acting inhaler more often than recommended by your doctor, make an appointment. In this case, it is necessary to correct the treatment regimen.

Follow your doctor’s instructions and take your medicines even when your asthma symptoms improve.

What else needs to be done?

Another key factor in symptom control and seizure prevention is avoidance of stimuli.

• If possible, use air conditioning. Air conditioning reduces the amount of pollen that enters an enclosed space. Air conditioning also reduces humidity and reduces exposure to dust mites. If you don’t have air conditioning, try not to open your windows during pollen season.
• Dust furniture. Try to remove excess furniture and items that collect a lot of dust from the bedroom. Dust covers are also recommended for pillows and mattresses. If the floor is parquet or linoleum, remove carpets. Use washable curtains and blinds.
• Maintain optimum humidity. If your home is damp, use a dehumidifier.
• Keep your home free of mold. Wipe wet areas in the bathroom, kitchen, and other rooms. If you live in your own home, there should be no moldy leaves or damp firewood in the yard.
• If you are allergic to dandruff, avoid pets with fur or feathers. Be sure to take care of your pets and bathe them regularly.
• Clean the house at least once a week. If there is no one else to vacuum, wear a mask before cleaning.
• Cover your nose and mouth when it’s cold outside. If asthma symptoms get worse when exposed to cold or dry air, a face mask may help.

As they say, informed means armed. Now you know how to control the symptoms of this disease. The main thing is to apply these recommendations after consulting with your doctor.

Sources:

1. Asthma Information, American College of Allergy, Asthma & Immunology,
2. What is asthma, National Asthma Council,
3. Asthma, Mayo Clinic.

asthma

cold

general practitioner

shortness of breath

cough

At what age can children be inhaled?

At what age can children be inhaled?

With the birth of a baby, every parent strives to create favorable conditions for a healthy and happy development. A well-thought-out and completed home first aid kit will help to provide first aid in a timely manner and prevent unwanted diseases. A modern medical device nebulizer will cope with seasonal and long-term respiratory diseases at home. The first and most common question of parents is, at what age can inhalations be done? Manufacturers of high-quality children’s nebulizers indicate that the device can be used by children from 1 month old. But first of all, before using the nebulizer, you need to consult with your doctor to determine the disease and the method of treatment.

Purpose of the nebulizer

A nebulizer is a compact medical device for inhalation. It breaks up the medicine into small particles (aerosol) and effectively delivers it to damaged parts of the respiratory tract. A nebulizer is designed to speed up recovery and improve the well-being of a child with diseases of the lower respiratory tract. At what age can you breathe with a nebulizer? It is possible to carry out therapeutic inhalation procedures from infancy.

Before using the nebulizer, it is recommended to carefully study the instructions and consult with your doctor.

The most effective nebulizer helps with such diseases:

• Obstructive bronchitis.

• Bronchial asthma.

• Pneumonia.

• Bronchitis.

• Tracheitis.

• Cough, etc.

At what age can a nebulizer be used? The use of a nebulizer is necessary on the recommendation of a doctor. If the child has no contraindications to inhalation, then the device can be used in infancy.

Benefits of inhalation

The healing properties of inhalation have been known since ancient times. Thanks to therapeutic vapors, severe diseases of the respiratory organs were cured. The first inhaler was created by a French inventor. It was powered by a hand pump. With the development of civilization, inhalation devices have become convenient and even more effective. Modern inhalers (nebulizers) contribute to a quick and easy medical procedure. Inhalation allows you to effectively thin the mucus and remove it, irrigate diseased organs with medicinal substances and improve the breathing process. At what age can you do inhalation with a nebulizer? Inhalations with a nebulizer can be done at an early age. It helps to quickly eliminate the unpleasant symptoms of the disease and improve the child’s breathing.

Some rules for inhalation

How to make inhalations for children under one year old?

Children under one year old can be inhaled only as directed by a doctor who will determine possible drugs and the duration of the procedure.

There are no specific rules for the procedure. It is necessary to turn on the device and bring the mask to the face of the child. If the mouth is closed, then the vapors penetrate into the upper respiratory tract, if the mouth is open, then the medicinal aerosol penetrates directly into the bronchi and lungs. For older children, you can purchase a special toy-shaped inhaler that will help turn an unpleasant procedure into an exciting game.

How to do inhalation with saline solution for children?

• Inhalations do 1-2 minutes no more than twice a day
• 2 ml of physiological saline is placed in a container and tightly twisted with a lid, connect tubes and a mask.
• The benefits of saline are due to its ability to moisturize the mucous membranes, which makes it easier to cough up sputum. The salt included in its composition is a natural antiseptic. Saline does not cause allergies, so it is often used for inhalation for children.

How to do inhalation for children?

• The procedure is done no earlier than 1.5 hours after eating. It is best to do inhalation while sitting. If it is impossible to seat the child, then he can lie down. Clothing should be as comfortable and loose as possible.
• Breathing should be even, deep and calm.
• For babies up to 3-4 years old, inhalation is carried out using a mask; for older children, it is recommended to use a mouthpiece.
• Inhalation with a mask can be done when the child is sleeping.
• For preschool children, the procedure should not exceed 3 minutes. After inhalation, 30 minutes of rest is recommended – the child should lie down and relax.

Breathing in different diseases is different:

– When treating deep parts of the respiratory tract, breathing should be deep, slow, through the mouth. It is necessary to hold your breath for 1-2 seconds pe

before each exhalation;

– In case of diseases of the pharynx, larynx, trachea, inhale the aerosol through the mouth, after a deep breath, hold your breath for 2 seconds, then exhale completely through the nose.

– In case of diseases of the nose, paranasal sinuses and nasopharynx, a mask or special nasal cannulas are used, inhalation and exhalation are done through the nose, breathing should be calm, without tension.

When are inhalations contraindicated for children?

Contraindications for inhalation in children are as follows:

– Tendency to nosebleeds and hypertension;

– Respiratory insufficiency of severe degree;

– Cardiovascular insufficiency;

– When the child’s body temperature is more than 37. 5 ° C. Alternatively, inhaler patches can be used in this case.

Nebulizer benefits

Timely inhalation with a nebulizer helps prevent the development of the disease in the early stages. Also, the nebulizer allows you to qualitatively cure respiratory diseases, as it delivers medicinal substances to the focus of the disease.

The advantages of the nebulizer include the following qualities:

1. High efficiency in the treatment of diseases of the lower respiratory tract.

2. Ease of use.

3. Quiet operation.

4. Small size.

5. Easy to care for.

During the period of acquiring a nebulizer, many people have a question from how many months can inhalations be done? Inhalations are indicated for children from 1 month and only after consulting a doctor.

Comments: Before using a nebulizer, you should definitely consult a doctor, especially if you plan to use antibiotics for treatment.