There are many drugs that are inhaled by atomization, and the most widely used ones are of course glucocorticoids (budesonide), bronchodilators (salbutamol, ipratropium bromide), etc. The efficacy is definite and the adverse reactions are small. In view of the fact that clinically there are people who have inhaled ambroxol injection, gentamycin, alpha chymotrypsin, amphotericin B, and dexamethasone, how effective and safe is it?
Inhaled corticosteroids (ICS) is the most effective anti-inflammatory drug for the treatment of bronchial asthma. When acute exacerbation of asthma or AECOPD, often inhaled corticosteroids as part of the treatment, the most commonly used aerosol inhalation drug is budesonide (inhaled budesonide suspension), our common specification is 1mg/ 2ml, 1x 1-2mg, bid or tid, often used in combination with a bronchodilator (eg, bourage). The adverse reactions are mild, and the more common are hoarseness, throat discomfort, oral candidiasis, etc. To prevent these adverse reactions, remember to gargle after each inhalation.
Clinically, although inhaled glucocorticoids are numerous, only budesonide has nebulized inhalation preparations (inhaled budesonide suspension). Others such as beclomethasone, fluticasone, etc., are just aerosol inhalation or dry powder inhalation, not aerosol inhalation. Many hospitals and Chinese literature have reported the efficacy of aerosolized inhaled dexamethasone, and in view of the current proliferation of Chinese literature, the author can not study the quality of these documents, and the surrounding hospitals are not nebulized dexamethasone. One practice. The author consulted many pharmacological monographs and did not mention that dexamethasone can be inhaled. “Expert consensus” is also not recommended for dexamethasone for inhalation, because dexamethasone is more water-soluble and difficult to bind to receptors via cell membranes. The rate of deposition in the lungs is low and the residence time in the airways is short. Effective, and its long half-life, easy to accumulate in the body, the inhibition of the hypothalamic – pituitary – adrenal axis is also strong.
This is the most commonly used drug in the respiratory department and is commonly used for aerosol inhalation including salbutamol (salbutamol sulfate solution for inhalation), terbutaline (teptatin sulfate atomization solution), ipratropium bromide (ipratropium bromide) Ammonium atomized inhalation solution) The adverse reactions of these nebulized inhaled anti-asthmatic agents are generally mild. Many hospitals currently have their own compound preparations, such as Citrate (inhaled compound ipratropium bromide solution). The main components include: Ipratropium bromide and salbutamol, while using β2 receptor agonists and anticholinergic drugs, the antiasthmatic effect can be superimposed, usually 3-4 times daily. Although theophylline drugs also have antiasthmatic effects, they have stimulatory effects on airway epithelium and are not recommended for aerosol inhalation administration.
Already mentioned above, aerosolized inhalation of these bronchodilators is often used together with the use of aerosolized inhaled hormones. It is worth noting that the Expert Consensus indicates that budesonide can be combined with salbutamol or ipratropium Combined nebulizer inhalation (inhalation in the same nebulizer), but budesonide should not be combined with salbutamol + ipratropium bromide (coptiparte) combination because there is evidence to confirm or suggest that this combination is not Compatible or inappropriate. Even so, clinically there are still many places where budesonide and candidate fluids are placed on the same nebulizer and nebulized inhalation. Clinicians should pay attention to it. After all, there is still a gap between the “expert consensus” and reality.
3, mucolytic agent
Clinically, ambroxol injection and chymotrypsin for injection are often used as mucolytic agents for aerosol inhalation. Although many people reported that nebulized inhalable ambroxol has good efficacy, the domestic instructions did not mention that it can be used as a fog. Inhalation, and foreign countries have already inhaled ambroxol formulations, so the “Expert consensus” does not clearly specify whether the use of ambroxol for aerosol inhalation, hoping to have more high-quality Chinese studies to determine.
As for alpha chymotrypsin, the instructions (injection chymotrypsin) explicitly mentions that it can be used for aerosol inhalation administration. This is often done in clinical practice. However, there is no evidence that it can inhale small and medium airways to produce therapeutic effects, nor does it have compatibility with related pharmacology. Study data, in accordance with the consensus tone, seems to be a non-active, non-rejective attitude. It is worth noting that ultrasonic therapy is disabled for atomization therapy.
4, antibacterial drugs
The use of antibacterial drugs to aerosolize drugs is mainly to increase the local drug concentration and reduce the systemic adverse reactions. The search literature can find that the antibiotics used for aerosol inhalation include gentamicin, amikacin, Vancomycin, etc., but the “Expert consensus” pointed out: Should try to avoid the local application of antimicrobial drugs. So far, there are no antibacterial pharmaceutical preparations specifically for aerosol inhalation in China. Clinical and most studies have been replaced by intravenous preparations, and intravenous preparations are not completely suitable for aerosol administration because intravenous preparations contain preservatives.
Many people like to use gentamycin for nebulization (because the adverse effects of systemic medication are large), but neither the instructions nor pharmacopoeia of gentamicin can be used for atomization, and its efficacy and safety are still insufficient. Medical evidence.
Amphotericin B, polyene antifungal drugs, and traditional intravenous drugs limit its use due to its severe adverse reactions, but also take into account that respiratory infections in patients with fungal infections are mostly caused by airway inhalation of fungal spores, in order to maintain the lung tissue High drug concentration, to avoid systemic adverse reactions, so some studies believe that can be administered by aerosol inhalation, and its instructions and related drugs work clearly indicates that the drug can be used for inhalation. The study on aerosol inhalation of amphotericin B is relatively in-depth. Recent studies on the inhalation of itraconazole (triazole antifungal agents) have also been reported successively. Others include voriconazole and caspofungin (echinocandin). Anti-fungi drugs such as anti-inhalation drug research are also underway, but none of the drug’s instructions and related pharmacological monographs mention that they can be administered by inhalation.
Therefore, the “Expert consensus” states that the safety of other anti-infective drugs has not been confirmed except that tobramycin has been approved by the FDA for aerosolized inhalation to treat cystic fibrosis.
In clinical work, it is important to use appropriate drugs for aerosol inhalation.