How to and how not to be treated with a nebulizer

• How does the inhaler work?
• How to assemble a nebulizer chamber
• How to perform inhalations
• What to put in the inhaler
• Common errors when using
• How to use an inhaler for a child
• How to use an inhaler if you have a chronic illness

In clinics, inhalations are carried out under the supervision of doctors; at home they need to be done independently, but not everyone knows how to do it correctly.

In this article we will look at how to use an inhaler: how to assemble the nebulizer chamber, how to carry out inhalation, what common mistakes are made when using it.

How does the inhaler work?

Inhalation treatment is based on inhalation of a therapeutic or prophylactic drug in the state of an aerosol or vapor.

Depending on the technology, there are 4 types of inhalers: steam inhaler, compressor, ultrasonic inhaler, devices with mesh technology.

1. Steam inhaler - heats the drug to a gaseous state, destroys some types of drugs. Steam particles penetrate only into the upper respiratory tract.
2. Compressor inhaler - the main element in it is a compressor that pumps air under high pressure. This is the most widespread and safe technology.
3. In an ultrasonic inhaler, the liquid is split into an aerosol under the influence of ultrasound.
4. A mesh inhaler passes the medicine through a mesh with tiny holes to create an aerosol. In this case, the drug is not destroyed, since the vibrations are directed at the mesh and not at the medicine.

GBOU "NIKIO im. L.I. Sverzhevsky" of the Moscow Department of Health

Developer institution: State Healthcare Institution “Moscow Scientific and Practical Center of Otorhinolaryngology” of the Moscow Department of Health.

Compiled by: Director of the State Institution "MNPTSO" of the Moscow Department of Health, Professor A.I. Kryukov, Head of the Department of Laryngeal Microsurgery and Phoniatrics, Moscow Scientific and Practical Center of Otorhinolaryngology, Moscow Healthcare Department, Ph.D. S.G. Romanenko, senior researcher at the department of microsurgery of the larynx and phoniatrics of the State Healthcare Institution "MNPTSO" of the Moscow Healthcare Department, candidate of medical sciences. O.G. Pavlikhin, Department of Laryngeal Microsurgery and Phoniatrics of the State Healthcare Institution "MNPTSO" of the Moscow Healthcare Department Eliseev O.V.

Reviewer: Doctor of Medical Sciences, Professor V.P. Gamow

Doctor of Medical Sciences, Professor V.F. Antoniv

Purpose: The guidelines present schemes for inhalation therapy for patients with inflammatory diseases of the larynx. The methodological recommendations are intended for outpatient and inpatient otorhinolaryngologists and phoniatricians.

This document is the property of the Moscow Government Department of Health and may not be reproduced or distributed without appropriate permission.

INTRODUCTION

Inhalation therapy has been used since ancient times. Hippocrates is considered the founder of inhalation therapy. At the same time, the simplest inhalation drugs appeared. The ancestors of modern inhalation devices appeared in the 19th century and gradually improved along with the development of technological progress. In 1932, the Norwegian chemist E. Rotheim received a patent for the first aerosol apparatus. Subsequently, until now, inhalation equipment has been improved, and the range of drugs used for inhalation therapy continues to expand.

The main advantage of aerosol therapy is the ability to achieve a quick and effective therapeutic effect using a relatively small dose of the drug and a significant reduction in the negative systemic effect. During inhalation, rapid and intense absorption of drugs occurs, with an increase in the active surface and its deposition in the submucosal layer. A high concentration of the drug is created directly at the site of inflammation.

Endolaryngeal infusions are significantly less effective than aerosol therapy, because administered drugs penetrate shallowly into the tissues of the larynx due to short contact of the drug with the mucous membrane of the larynx. The use of endolaryngeal infusions is often limited by the anatomical and individual characteristics of the patient. In addition, infusions into the larynx cannot be performed several times a day. All of the above does not mean that endolaryngeal infusions should be abandoned altogether. This type of local therapy is indispensable in phoniatric and ENT practice in cases where a rapid therapeutic effect is required without deep penetration of the medicinal substance. For example, in the case of hemorrhage into the vocal fold caused by forced phonation, or acute catarrhal laryngitis, accompanied by impaired microcirculation of the vocal fold against the background of a hard attack, infusions of vasoconstrictors into the larynx (adrenaline 0.1% - 0.3 in 2 ml of physiological solution). Medicines are poured into the larynx, warmed to body temperature, drop by drop until a clinical effect is achieved: blanching of the mucous membrane, constriction of the vessels of the vocal fold. In this case, a rapid therapeutic effect is achieved and there are no side effects such as dryness of the laryngeal mucosa.

Inhalers, based on the methods of obtaining an aerosol medium, are ultrasonic, compressor, pneumatic, steam and heat-moist. When choosing a particular type of inhalation therapy, one should take into account not only the form of a particular drug, but also all parameters of the procedure (form of the drug, aerosol concentration, aerosol temperature, etc.).

Research has proven that the temperature of inhaled aerosols seriously affects the ciliated epithelium and the condition of the medicinal substance itself. High and low temperatures of inhaled solutions negatively affect the course of the inflammatory process. When the temperature of the inhaled drug is above 39-40 degrees Celsius, the function of the ciliated epithelium is suppressed (above 41 degrees it dies). Solutions with temperatures below 25 - 28 degrees are a cold irritant. The optimal aerosol temperature is considered to be 36-38 degrees. Heat-moist and steam inhalations against the background of acute laryngitis can cause the development of edema of the laryngeal mucosa with stenosis of its lumen. It should also be noted that many drugs sharply reduce or even lose their biological activity when heated to high temperatures. In this regard, we consider the use of heat-moist and steam inhalations for the treatment of inflammatory pathology of the larynx to be inappropriate. This type of therapy can be used with caution in subatrophic and atrophic processes in the larynx.

In recent years, the arsenal of pocket inhalers has expanded. There are pocket liquid inhalers and powder inhalers. Pocket inhalers are used to administer a dosed amount of the drug into the respiratory tract. Despite the convenience of their use, the scope of use of this type of inhaler for laryngeal pathology is limited. The bulk of the aerosol settles in the oral cavity. The disadvantages of aerosol packaging include the low temperature of the resulting aerosol. Also, one of the disadvantages of aerosol cans is that as it is used, the pressure inside it decreases and the drug is not completely ejected.

Inhalation equipment.

Inhalation equipment is divided into stationary units and portable portable devices. Due to the fact that the treatment of inflammatory diseases of the larynx requires multiple inhalations throughout the day, more and more attention is being paid to portable inhalation devices.

In medical practice, nebulizers are more often used (from the Latin nebula - fog, cloud). There are two main types of nebulizers: compressor and ultrasonic. Compressor inhalers are either jet or pneumatic. A compressor inhaler is a device for converting a medicinal substance into a fine aerosol under the action of compressed air from a compressor or under the influence of compressed oxygen. In ultrasonic inhalers, atomization is carried out as a result of high-frequency vibration of piezoelectric crystals.

The results of our clinical experimental study prove that inhalation procedures performed on individual ultrasonic inhalation devices are more effective compared to inhalations performed on compressor devices. This is explained by the fact that the aerosol of ultrasonic inhalation devices is an electric aerosol. Such an aerosol, in addition to the medicinal properties of the medicinal substance itself, consists almost entirely of negatively charged particles that have an additional anti-inflammatory effect. During inhalation procedures carried out on compressor inhalation devices, in addition to negatively charged particles, positively charged particles and particles without a charge are also formed. The disadvantage of using an ultrasonic inhaler is the high consumption of the drug, since the loss of the drug also occurs in the exhalation phase.

According to the degree of dispersion, aerosols are distinguished as highly dispersed (particle size 0.05-0.1 µm), medium dispersed (particle size 0.1-1 µm) and coarsely dispersed (particle size more than 1 µm). Particles with a diameter of 8 - 10 microns usually settle in the oral cavity, 5 - 8 microns in the pharynx and larynx, 3 - 5 microns - in the trachea and bronchi, 1 - 3 microns in the bronchioles, 0.5 - 2 microns - in the alveoli. For the treatment of diseases of the upper respiratory tract, aerosols of medium and low dispersion are mainly used.

Inhalation therapy for the treatment of laryngeal diseases can be used either as monotherapy or in combination with other treatment methods. The use of inhalation therapy is indicated for patients with inflammatory pathology of the larynx, edematous laryngitis of various etiologies, vocal fold nodules, as symptomatic therapy to achieve a mucolytic effect, moisturizing the laryngeal mucosa.

Contraindications to inhalation therapy

1. Tendency to spasms of the coronary arteries
2. Condition after myocardial infarction and cerebral hemorrhage
3. Bleeding of various etiologies and susceptibility to them
4. Severe atherosclerosis of the vessels of the brain and heart
5. Spontaneous pneumothorax
6. Common bullous form of emphysema
7. Malignant neoplasms.

Rules for inhalation

1. Inhalations are carried out no earlier than 1-1.5 hours after eating or physical activity.
2. Before the procedure, the patient should not take expectorants or gargle with antiseptic solutions. It is recommended to rinse your mouth with boiled water at room temperature.
3. Smoking is prohibited before and after inhalations.
4. Inhalations should be taken sitting in a comfortable position, straight, in such a way as to ensure calm breathing. It should be taken into account that a strong forward tilt of the body during the procedure makes breathing difficult.
5. For diseases of the nose, paranasal sinuses and nasopharynx, inhalation and exhalation must be done through the nose. In case of pathology of the larynx, inhalation should be done through the mouth. After taking a deep breath through your mouth, it is recommended to hold your breath for 2 seconds and then exhale completely through your nose.
6. Breathing during inhalation should be normal, not forced. Frequent deep breathing causes hyperventilation and may cause dizziness. If dizziness occurs, it is necessary to interrupt inhalation for 1-2 minutes.

Aerosol therapy - basic principles.

Aerosols of drugs have mucolytic, anti-inflammatory, anti-edematous, antibacterial effects, and are able to maintain mucociliary clearance and regulate the degree of hydration.

Antibacterial and antifungal agents, enzymes, hormonal drugs, mucolytics, mineral waters, herbal medicines, biostimulants, and biologically active substances are administered in aerosol form.

The use of inhalation therapy makes it possible to reduce the intake of antibacterial and other drugs, significantly increase the effectiveness of treatment, and reduce the manifestation of systemic and side effects of other drugs.

One of the necessary conditions for normal phonatory activity of the vocal folds is sufficient moisture in the mucous membrane of the vocal folds. Dryness of the laryngeal mucosa can be caused not only by an inflammatory process, but also by side effects of the use of medications such as topical corticosteroids for bronchial asthma, desensitizing drugs, etc. This is especially important for patients with vocal professions. The use of inhalation therapy with mineral water or saline in these cases will help neutralize the side effects of these drugs, improve voice quality and accelerate epithelization processes after endolaryngeal interventions.

Recently, the attitude towards the use of oil inhalations has changed. The purpose of oil inhalation is to cover the mucous membrane with a thin protective and softening layer. The duration of oil inhalations is on average 5-8 minutes. In 5 minutes, 0.25 g of oil is converted into an aerosol. According to numerous studies conducted in recent years, it has been established that inhaled oil entering the alveoli contributes to the development of alveolitis and the destruction of surfactant. Therefore, this method of treatment, which was widely used in the past, is currently recommended not to be used.

When carrying out inhalation therapy, it is necessary to adhere to a certain sequence of use of medicinal substances. The presence of a large amount of sputum and crusts on the surface of the mucous membrane prevents the absorption of inhaled substances. In these cases, treatment should begin with inhalation of mucolytic drugs and only after that, after 20-30 minutes, aerosols of other drugs should be prescribed. If severe dryness of the mucous membrane of the oropharynx and larynx appears after the use of inhaled corticosteroids, inhalation with saline or mineral water is indicated to moisturize the mucous membrane.

When planning inhalation therapy, one should adhere to the principle of sequential use throughout the day of medications with different pharmacological activities and directions and selection of individual treatment regimens depending on the nature, severity and stage of inflammation.

Medicines for nebulizer aerosol therapy.

Antibacterial drugs.

The high effectiveness of antibacterial and antifungal drugs when applied topically in the treatment of inflammatory pathology of the larynx has long been known. However, before starting inhalation, you should especially carefully collect an allergy history. There are known cases of anaphylactic shock during an inhalation procedure with antibacterial agents. Previously, inhalations with streptomycin, penicillin, tetracycline, chloramphenicol and oleandomycin were often prescribed. Currently, inhalations of 2 ml of a 0.01% solution of miramistin or 2 ml of a 1% solution of dioxidine mixed with 3 ml of saline are most often used in practice. The antibiotic Fluimicil, which also has a mucolytic effect, has shown high therapeutic effectiveness. For inhalation, use ½ bottle of the drug for inhalation, 2 times a day. It is possible to use other antibacterial agents, which are prescribed in accordance with the result of a microbiological study. The average duration of therapy is 5 days.

Antifungal drugs

For the treatment of laryngeal mycoses, in addition to general antifungal and anti-inflammatory therapy, inhalations of 3000 units/ml of nystatin are used. The solution is prepared before use: 75 mg of nystatin sodium salt powder in 5 ml of distilled water once a day. The sodium salt of levorin is also used, 200,000 units per inhalation. The course of treatment usually lasts 12-15 days. Just as with any other pathology of the larynx, inhalations with antifungal drugs, if necessary, alternate with inhalations with proteolytic enzymes, saline or mineral water.

Corticosteroids.

Inhaled corticosteroids have anti-edematous and anti-inflammatory effects. Inhalation of corticosteroids is used for all inflammatory diseases of the larynx, especially those accompanied by swelling of the mucous membrane. Mixtures of hydrocortisone hemisuccinate 25 mg or prednisolone 15 mg or dexamethasone 2 mg in 3 ml of saline are used. Inhalations are prescribed 2 times a day. In case of severe swelling of the laryngeal mucosa - up to 4 times a day. The duration of treatment depends on the dynamics of inflammatory changes. For chronic inflammatory processes, the course of treatment averages 10 days. A side effect of these drugs is dryness of the laryngeal mucosa. In patients with inflammatory diseases of the larynx, especially after surgery, this may slow down the epithelization process. In this regard, after inhalation of a corticosteroid, it is possible to inhale saline solution or mineral water after 10-15 minutes.

Proteolytic enzymes.

Aerosols of proteolytic enzymes have a mucolytic effect and improve mucociliary clearance. Enzyme preparations have a local anti-inflammatory and anti-edematous effect. The use of proteolytic enzymes in the form of inhalations is especially indicated for the treatment of laryngitis, accompanied by the formation of dense fibrin films or crusts, with subglottic laryngitis against the background of systemic diseases, with atrophic laryngitis.

The drugs are diluted in physiological solution or distilled water: Chymotrypsin – 3 mg in 1 ml, Trypsin 3 mg in 1 ml, Chymopsin 5 mg in 1 ml. Lysozyme is used in the form of a 0.5% solution; 3-5 ml of solution are consumed per 1 inhalation. Inhalations are prescribed 1-3 times a day for 7 days. Enzyme preparations can cause allergic reactions, and therefore they should be used with great caution.

Mucolytics and mucoregulators.

Mucolytics and mucoregulators are used for inflammatory diseases of the larynx to liquefy secretions and facilitate mucociliary clearance. Acetylcysteine ​​is used in the form of a 20% solution, 2-4 ml 3-4 times a day. In therapeutic dosage it has a good mucolytic effect. In high dosages, it suppresses the activity of ciliated cells of the bronchial mucosa and mucociliary clearance. An undesirable effect of acetylcysteine ​​is a reflex cough due to local irritation of the respiratory tract. Increases the tendency to bronchospasm, so it is recommended not to use it in patients with concomitant pulmonary pathology. Fluimicil antibiotic is a drug with antibacterial and mucolytic effect. Dosage used: ½ bottle for 1 inhalation 2 times a day. Lazolvan is a metabolite of bromhexine, which has a bronchosecretolytic and expectorant effect. Improves the rheological properties of sputum, reduces its viscosity and adhesive properties, and normalizes mucociliary clearance. Lazolvan is used in a dosage of 4 ml 2-3 times a day, then 2 ml 3-4 times a day in pure form or diluted with saline 1:1. The course of treatment is 7 days.

To enhance the mucolytic effect and moisturize the laryngeal mucosa, the clinic successfully uses sodium chloride 0.9% isotonic solution 2-3 ml per inhalation, sodium bicarbonate 2% solution 2-3 ml per inhalation. Inhalation of saline solution can be used for a long time as a symptomatic remedy for dry laryngeal mucosa.

The main components of mineral water are sodium, calcium, magnesium, chlorine, iron, and radon. Potassium iodide increases the amount of mucus and thins it. Magnesium carbonate increases mucus secretion, sodium carbonate reduces mucus secretion and thins it. Salt-alkaline waters reduce the feeling of dryness and cough irritation. Mineral waters containing hydrogen sulfide cause vasodilation and a short-term increase in temperature, while the function of the ciliated epithelium is activated. Mineral waters with a salt concentration of up to 150 mg/l are used. According to our data, medium-mineralized waters have the best therapeutic effect: Essentuki No. 17, Slavyanskaya.

For many years, herbal preparations that have anti-inflammatory, bactericidal, and mucolytic effects have been successfully used in the treatment of inflammatory diseases of the larynx. Only mixtures of drugs approved in the Russian Federation are allowed for inhalation

1. Pharmaceutical mixture: Eucalyptus (leaf) 15.0, Salvia officinalis (leaves) 20.0, Chamomile (flowers) 10.0, Peppermint (herb) 10.0, Scots pine (buds) 15.0, Elecampane tall (roots) 20.0, Common thyme (herb) 10.0,
2. Pharmaceutical mixture: Menthol 0.71g, Eucalyptus tincture 35.7, glycerin 35.7, Ethyl alcohol 100 ml.

It is possible to use chamomile infusion, a mixture of aloe extract 5 ml, Kalanchoe juice, plantain, rose hip extract, 10% solution of white natural honey. To reduce swelling of the mucous membrane and secretion of mucus, inhalations with astringents are prescribed, a decoction of oak bark, sage, infusion of St. John's wort or immortelle flowers. A good therapeutic effect was noted when using humisol 2.0 and pelloidin. Clinical data indicate the moisturizing and reparative effect of these drugs by improving microcirculation. When using multicomponent herbal preparations and honey, an allergy history should be collected with special care.

We have developed treatment regimens for inflammatory diseases of the larynx using inhalation therapy. Inhalation therapy is used in complex treatment, including antibacterial, anti-inflammatory, desensitizing agents, physiotherapy, enzyme therapy, and microsurgical interventions. As monotherapy, inhalation treatment is indicated for mild forms of inflammatory diseases of the larynx.

Scheme of inhalation therapy for acute catarrhal laryngitis, exacerbation of chronic catarrhal laryngitis:

1. Mixture: Miramistin 0.01% - 2.0 + Saline solution 2.0 ml + Dexamethasone solution 2 mg. Inhale 2 times a day for 10 minutes.
2. Saline solution 5.0 or Mineral water 5.0 20 minutes after inhalation of Miramistin and Dexamethasone. In case of increased dryness of the mucous membrane of the larynx, as well as for people in vocal professions, it is possible to use inhalations of mineral water or saline solution as a moisturizer up to 6 times a day. Inhalation duration is 5-10 minutes.

The course of treatment is 7-10 days.

Scheme of inhalation therapy for acute edematous laryngitis, exacerbation of chronic edematous-polyposis laryngitis:

1. Dexamethasone 2 mg in 3 ml of saline 2 times a day for 10 minutes. With severe swelling of the laryngeal mucosa, inhalations can be used up to 4 times a day.
2. Saline solution 5.0 ml or mineral water 5.0 ml after inhalation of a corticosteroid after 10 - 15 minutes, as well as during the day if the laryngeal mucosa is dry. Inhalation duration is 5-10 minutes.

The course of treatment for acute inflammation is 3-7 days, for chronic inflammation – 7-10 days.

Scheme of inhalation therapy for infiltrative phlegmonous, abscessing laryngitis, exacerbation of chronic hyperplastic laryngitis:

1. When crusts and dense fibrinous plaque form, therapy begins with inhalation of a mucolytic or proteolytic enzyme. Use 2-4 ml of 20% Acetylcysteine ​​solution 3-4 times a day or 4 ml of Lazolvan diluted 1:1 with saline solution. Use 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of saline, or 0.5% lysozyme solution, 5 ml 2 times a day, then 2 ml 3-4 times a day in pure form or diluted with saline 1: 1.
2. After 10 minutes - Fluimicil antibiotic ½ bottle 2 times a day. If the fungal nature of the disease is identified, inhalation therapy with antifungal drugs is carried out. Inhalation duration is 10 minutes.
3. After 15-20 minutes - Dexamethasone 2 mg in 3 ml of saline 2 times a day. Inhalation duration is 10 minutes.
4. 5.0 ml of saline or 5.0 ml of mineral water 4 - 6 times a day: 10 - 15 minutes after inhalation of the corticosteroid and an additional 2-4 times during the day, depending on the amount of viscous sputum or crusts on the mucous membrane of the vocal folds . Inhalation duration is 10 minutes.

The course of treatment is 7-10 days. In case of chronic hyperplastic laryngitis, inhalations with mineral water or saline 2-4 times a day are prescribed for up to 2-3 weeks in order to moisturize the laryngeal mucosa and reduce the viscosity of the secretion.

Scheme of inhalation therapy for chronic subatrophic and atrophic laryngitis:

1. 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of saline, or 0.5% lysozyme solution 5 ml 2 times a day then 2 ml 3-4 times a day in pure form or diluted with saline 1:1 . Inhalation duration is 10 minutes.
2. 5.0 ml of saline solution or 5.0 ml of mineral water 4 - 6 times a day for 10 days or for a long time 2 times a day. Inhalation duration is 10 minutes.
3. Inhalation with 2.0 ml of pelloidin or humisol 2 times a day. It is possible to use honey inhalations. Inhalation duration is 10 minutes. 10 procedures are prescribed for a course of treatment.
4. Inhalation with a ready-made pharmaceutical mixture of medicinal herbs 2 times a day after the end of the previous course of therapy for 10 days (with very significant crust formation). Inhalation duration is 10 minutes.

Long-term, regular use of inhalations with mineral water or saline 2-4 times a day is recommended in order to moisturize the laryngeal mucosa and reduce the viscosity of the secretion until remission of the disease.

Scheme of inhalation therapy for acute laryngitis after endolaryngeal intervention:

1. In the first days after surgery, inhalations of antibacterial drugs are used: 2 ml of 0.01% miramistin solution or 2 ml of 1% dioxidine solution mixed with 3 ml of saline. Fluimicil antibiotic ½ bottle of the drug for inhalation, 2 times a day.
2. Inhalation of dexamethasone 2 mg in 3 ml of saline 2 times a day for 5-7 days.
3. With increased formation of fibrin films, inhalation of 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of physiological solution, or 0.5% lysozyme solution, 5 ml 2 times a day, then 2 ml 3-4 times a day in pure water, is added to the treatment. form or diluted with saline solution 1:1. Inhalation duration is 10 minutes.
4. 5.0 ml of saline solution or 5.0 ml of mineral water 4 - 6 times a day for 10 days or for a long time 2 times a day. Inhalation duration is 10 minutes.
5. If the mucous membrane of the larynx remains dry and epithelialization processes slow down, inhalations with pelloidin or humisol 2.0 are prescribed 2 times a day. 10 procedures are prescribed for a course of treatment.

The course of treatment is 7-10 days. If the inflammatory process is prolonged, inhalations with saline or mineral water are prescribed 2-4 times a day for a long period.

Treatment of inflammatory diseases of the larynx should be comprehensive. When planning therapy, the individual characteristics of the patient should be taken into account: age, duration of the disease, nature of the voice load, characteristics of professional activity, the presence of concomitant pathology. Only treatment tactics based on the principles of an individual approach, stages, and combined treatment methods can rehabilitate a patient with laryngeal pathology.

How to assemble a nebulizer chamber

Often, users of nebulizers have difficulties with the device - it can be difficult to assemble the chamber into which the medicine is poured. Let's look step by step at how to do this correctly, using the OMRON Comp Air NE-C24 inhaler as an example.

When you first open the nebulizer box, the chamber may be either assembled or disassembled. Let's consider the option when it is disassembled and show how to assemble it.

The nebulizer chamber consists of 4 elements.

1. Reservoir for medicines.
2. Bumper.
3. Nebulizer chamber cover.
4. Stub.

For the nebulizer to work correctly, it is necessary to place the bumper inside the tank - without it, the medicine will not turn into an aerosol, and inhalation will not make sense.

Once you have installed the baffle, pour the medicine into the reservoir, close the cap, and connect the air tube.

The reservoir is assembled. All that remains is to choose a suitable nozzle for inhalation: a mouthpiece, a mask for an adult or a child.

In OMRON inhalers, the bumper is placed on the cone-shaped element of the reservoir (nozzle).

How to choose a nebulizer

When choosing an inhaler for home use, a number of parameters are taken into account.

• Mechanism of action.

The modern type of inhalation devices is electronic mesh (mesh). The splitting of the drug into small particles is carried out using a vibrating membrane and a mesh with miniature divisions. A highly concentrated droplet aerosol reaches the inflammatory focus located in the deepest parts of the bronchi.

Ultrasonic and compressor inhalers are also suitable for children. Steam models may cause burns.

• Features of the work.

Silent devices, such as mesh nebulizers, eliminate discomfort and fear before the procedure, and are suitable even for infants.

• Size.

The compact size of the nebulizer allows you to take the device on the road and travel.

• Equipment.

It is advisable that the kit include several attachments and a bag for storing and carrying the device.

• Design.

Attractive design, such as in the AGU N7 Minimill and AGU Tomchi nebulizers, turns the procedure into a fun game.

How to perform inhalations

Before use, prepare the nebulizer: pour the inhalation solution into the nebulizer chamber. Do not place it on its side as this may cause the medicine to spill out.

It is recommended to carry out inhalation while sitting, in a relaxed position.

1. Press the power button.
2. Cover the mouthpiece tightly with your lips.
3. During inhalation, breathe slowly and deeply.

The duration of inhalation and the volume of medication are prescribed by the doctor.

How to carry out inhalations.

Who needs inhalation and when is it dangerous?

How much to breathe with the inhaler and when it is needed is determined by the attending physician. Prescription of procedures is practiced when identifying disorders such as:

• Allergic and asthmatic lung diseases with attacks.
• Bronchitis of various forms.
• Pathologies of the endocrine system.
• Cystic fibrosis.
• Respiratory tract fungus.
• ARVI, flu, rhinitis. You can breathe with an inhaler if you have coronavirus.
• Cardiovascular disorders.
• Tuberculosis.
• Occupational diseases of miners, chemists, actors.
• Pneumonia.
• Diseases of the nervous system.

How much inhalation to do and what substances to use depends on the type of cough the patient has. Therapy is indicated for dry tracheitis cough. It will help eliminate soreness and neutralize swelling of the larynx and vocal cords. For wet coughs, treatment with an inhaler thins the mucus and helps clear the bronchi.

You should not use equipment and medications yourself. Only the doctor determines whether inhalations can be done. There are a number of contraindications for therapy. Among them:

• Myocardial infarction, arrhythmia and other acute heart diseases.
• Hypersensitivity to active substances.
• Purulent sore throat.
• Fever. Answering the question whether it is possible to breathe with an inhaler at a temperature, doctors say that this is prohibited. It is not recommended to carry out therapy if the thermometer shows more than 37.5°C.
• Pulmonary failure.
• Tendency to nose and lung bleeding.
• Ischemic stroke.
• Severe hypertension.

What to put in the inhaler

Medicines, saline solutions, and essential oils are used in inhalations. What to choose depends on the source of inflammation and the characteristics of the inhaler. For example, it is not recommended to use antibiotics and hormonal drugs in steam inhalers - they are destroyed at high temperatures.

What medications are used for inhalation:

1. Bronchodilators for the treatment of bronchial asthma and chronic obstructive pulmonary disease.
2. Non-steroidal anti-inflammatory drugs - reduce pain, fever and inflammation.
3. Antibiotics if the patient has bacterial infections.
4. Corticosteroids are steroidal anti-inflammatory drugs.
5. Mucolytics - they help remove phlegm from the lungs.

Saline solution is suitable for prevention, as well as for ARVI and influenza. It relieves swelling and irritation of the mucous membrane, promotes the removal of sputum. Since this is a saline solution, it can be used for inhalation for children.

It is believed that Borjomi or Essentuki mineral water can replace saline solution, but inhaler manufacturers do not recommend their use. This is because the composition contains non-physiological suspensions.

Essential oils are used only with steam inhalers in the treatment of the upper respiratory tract - they are useful for the prevention of acute respiratory viral infections and influenza.

They are prohibited from being used in nebulizers, since if the oil enters the lower respiratory tract, it can clog the bronchi.

What should not be used for inhalation:

• Suspensions and solutions that leave a sediment.
• Decoctions and infusions of herbs.
• Solutions of aminophylline, papaverine, diphenhydramine.

Tips for use

1. Before use, it is necessary to wash the inhaler parts.
2. Parts in contact with a sick person should be thoroughly disinfected (with an aqueous solution of chlorhexidine or miramistin).
3. Assemble the inhaler.
4. It will be filled out by special solution.
5. Solutions intended for steam inhalation are not heated.
6. Before using the inhaler, it is better to avoid eating and smoking.
7. During one operation, the use should not exceed 7-10 minutes, and the inhaler should not be used more than 5-6 times a day.
8. During the procedure, inhalations should be slow.

Common errors when using

If you have not previously had the need to perform inhalations, during the first use you may encounter errors with the choice of inhalation product, with assembly, or during the procedure.

Let's look at the most popular of them.

1. Do not handle the device if it is used by one person. It is necessary to wash the inhaler - residual medication harms the device, and remaining bacteria can lead to recurrent illness.
2. Pull out the bumper or insert it incorrectly into the nebulizer chamber. The bumper turns the liquid into an aerosol, and thanks to it the device performs its main function - it allows the medicine to penetrate to the source of inflammation.

Due to an incorrectly inserted bump stop, the procedure becomes meaningless. How to install the bump stop correctly, see the instructions for the device - different manufacturers have different designs.

3. Pour anything - including suspensions and herbal infusions. And also replace saline solution with mineral water. It is recommended to use only those medications prescribed by your doctor and those recommended for use by the manufacturer.

Preparation of equipment

Before using the inhaler, you should perform a number of preparatory steps:

1. Rinse the face mask, connecting hose and nebulizer chamber with clean water and dry.
2. Treat elements in direct contact with the patient with an aqueous solution of chlorhexidine or miramistin.
3. Assemble the device in accordance with the instructions.
4. Fill the reservoir with a pre-prepared medicinal solution and place it in a vertical position.

The tank capacity for steam varieties is 70-100 ml, for compressor and ultrasonic varieties - 2-8 ml. If the maximum permissible volume is exceeded, liquid enters parts of the device that are not intended for this purpose and can damage the inhaler.

How to use an inhaler for a child

Children should only use the inhaler under adult supervision. It happens that not every child can sit quietly for 15–20 minutes during the procedure. And parents of such children know how difficult it is to sit their child down and convince him to calmly breathe into a mask.

We have collected tips that will help you carry out the treatment calmly.

1. Take inhalations at the same time every day so that they become part of your routine. This way the child will get used to it and be less capricious.
2. Come up with a special name for the treatment time. And think about how to distract your child - you can read a book, turn on your favorite song, get toys.
3. Together, stick stickers on the nebulizer so that the child has a pleasant association with the device.
4. Let your child turn the device on and off and put on the mask themselves.
5. Praise or give small gifts after the procedure because the child sat calmly and helped you.

An adult should assemble the inhaler, fill in the medicine, and wash the components so as not to damage the device and for the procedure to be effective.

Inhalations with bromhexine

What does bromhexine help with?

Bromhexine is a mucolytic and expectorant drug. The drug is used for bronchitis, pneumonia, laryngitis, pharyngitis, tuberculosis, bronchial asthma. It can be used for both dry and wet coughs. It is advisable to start taking bromhexine in the early stages of the disease to get the best effect.

Cough preparations by group

Is it possible to do inhalations with bromhexine?

According to the instructions, bromhexine is taken orally, and there is no official information that it should be used for inhalation, but sometimes it is used by inhalation at home.

The closest analogue of bromhexine, ambroxol (Ambrobene, Lazolvan, etc.), is sold specifically in the form of a solution for inhalation. In any case, before using this or that drug, be sure to consult a specialist.

Which bromhexine is suitable for inhalation?

As an example, let’s take the form: bromhexine drops 8 mg/ml. Before inhalation, it must be diluted with distilled water in a 1:1 ratio.

If you take another solution of bromhexine, where the dose of the drug is 4 mg per 5 ml, then the total volume for an adult will be 20 ml. Whereas the inhaler chamber usually has a maximum capacity of 5 ml.

Bromhexine solution for inhalation

Dosage for preparing the solution:

• adults: 8 mg, which corresponds to 1 ml of bromhexine drops;
• children over 10 years old: 4 mg;
• children from 6 to 10 years old, 2 mg;
• children under 6 years of age in a dose of up to 2 mg;
• Toddlers should not use this form due to the high concentrations of substances it contains.

Inhalation is carried out twice a day. Course of treatment: 5 days.

How to prepare the solution

Dilute the drug with distilled water (water for injection) in a 1:1 ratio. Then the prepared solution is heated to a temperature of 36-38 degrees, but no more and no less, because high and low temperatures of the solution negatively affect the inflammatory process. At a temperature of 25-28 degrees it is an irritant for the bronchi due to the cold factor. And if the solution is 39-40 degrees, then it has a detrimental effect on the components of the medicine: such a temperature destroys the medicine.

How to use an inhaler if you have a chronic illness

Inhalations for chronic respiratory diseases are the most effective treatment. This is necessary to relieve inflammation, which provokes attacks.

The most common attack triggers in chronic lung diseases.

For chronic diseases, inhalation is used:

• to relieve attacks and exacerbations (for emergency medical care);
• for basic treatment of patients at risk of frequent exacerbations;
• for taking medications that can only be delivered by nebulizer;
• at large doses of the drug.

There is no fundamental difference in the technique of using an inhaler compared to the treatment of ARVI and influenza.

Contraindications are:

• Spontaneous pneumothorax
• Common and bullous forms of emphysema
• Bronchial asthma with frequent attacks
• Pulmonary heart failure stage III
• Pulmonary hemorrhage
• Arterial hypertension III degree
• Severe atherosclerosis of coronary and cerebral vessels
• Inner ear diseases, tubotitis, vestibular disorders
• Atrophic rhinitis
• Epilepsy
• Individual intolerance to the drug