The previous article mentioned the question of how much normal saline to add to nebulization inhalation: should I add normal saline to nebulized inhalation? How much is appropriate? Some peers commented that, however, not all nebulized drugs can be diluted with normal saline.
The commonly used aerosol inhalation drugs in clinic mainly include inhaled corticosteroids (ICS), short-acting β2-receptor agonists (SABA), short-acting choline M receptor antagonists (SAMA) and mucolysis. several categories of agents.
In actual medication, two or more drugs are often mixed and used in aerosol. The requirements for the maximum capacity of the atomizing device and the atomization time. Below, we sort out the compatibility instructions of commonly used nebulized drugs and normal saline for your reference.
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Combination instructions of commonly used nebulized drugs and normal saline< /strong>
1. budesonide suspension for inhalation
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Saline can be added, not strongly recommended.
✦Can be mixed with 0.9% sodium chloride solution and/or containing terbutaline, salbutamol, fenoterol , acetylcysteine, cromolyn sodium or ipratropium bromide nebulized liquid mixture. Should be used within 30 minutes of mixing. ✦For most nebulizers, the appropriate liquid volume is 2 to 4 mL. Usage: 2. Beclomethasone propionate suspension for inhalationnot specified. ✦Single-dose vials are administered via a nebulizer. Shake well before use and squeeze the desired amount into the nebulizer. Dosage:
3. Fluticasone propionate nebulization suspension recommended to be diluted with saline. ✦Dilute with Sodium Chloride Injection as needed. ✦To ensure better inhalation of the suspension or to prolong the inhalation time of the drug, it can be diluted with Sodium Chloride Injection immediately before administration. Dosage:
4. Tebutaline Sulfate Nebulized Inhalation SolutionNot specified. ✦Squeeze the solution from the vial into the nebulizer reservoir. ✦The atomizing liquid of this product cannot be mixed with alkaline solution, that is, the solution with pH greater than 7. Dosage:
5. Salbutamol Sulfate Nebulized Inhalation SolutionSelect whether to dilute according to the dose. Usage:
6. Ipratropium bromide solution for inhalationcan be diluted with saline, not strongly recommended. ✦Each 1 ml nebulized inhalation solution in a single-dose vial can be diluted with normal saline to a final volume of 2 to 4 mL.✦Can be combined with the expectorant ammonia hydrochloride Bromsol (Mucosolvan) inhalation solution, bromhexine hydrochloride (Bisolvon) inhalation solution and fenoterol (Berotec) inhalation solution are used together.✦Because precipitation may occur , Do not use it in the same nebulizer for inhalation with the sodium cromodate inhalation solution containing the preservative benzalkonium chloride. Dosage:
. Compound Ipratropium Bromide Solution for InhalationNot recommended.✦Does not need to be mixed with any other nebulized inhalation solution formulation.< span>✦It is recommended not to mix this product with other drugs in the same nebulizer. Dosage:
8. Acetylcysteine for inhalationNot specified. Usage:
9. Ambroxol hydrochloride solution for inhalationmust be diluted with saline. ✦This product should be mixed 1:1 with 0.9% Sodium Chloride Injection for optimal humidified air. ✦Can be mixed with β-sympathomimetic drugs and ipratropium bromide solution for inhalation, but not with sodium cromoglycate. ✦Avoid mixing with drugs that cause the pH of the mixed solution to be higher than 6.3 to prevent free ambroxol from becoming ineffective or turbid due to increased pH. Dosage:
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about fog Several precautions for chemical drugs
In addition to paying attention to the incompatibility of drugs during the inhalation treatment, we should also pay attention to various adverse drug reactions. The degree and type of adverse reactions vary, and are related to factors such as the patient’s own factors, the irregularity of aerosol inhalation, the side effects of aerosol therapy drugs, and the unreasonable use of non-aerosol dosage forms. ✦ Common local adverse reactions of ICS are shown in the table below: ✦ Common adverse reactions of several inhaled bronchodilators are listed below. Table:
✦ The following 3 adverse reactions need to be specially explained to attract everyone’s attention:
< span>NO1. Hypokalemia
Adverse drug reactions such as salbutamol and terbutaline include hypokalemia, cardiac disorder, etc. Patients with acute severe asthma should be particularly careful when using salbutamol and terbutaline. The above effects may occur. Monitoring of serum potassium concentration is recommended in this situation. Hypokalemia can increase the propensity for arrhythmias. Because hypokalemia also increases the risk of digitalis toxicity, special attention is recommended for patients receiving digitonin.
NO2. Abnormal blood sugar
SABA can increase the risk of hyperglycemia. Inhalation of salbutamol sulfate can cause reversible metabolic changes, such as increased blood glucose concentrations. Diabetic patients may not be able to compensate for this increase in blood sugar, and there have been reports of developing ketoacidosis. Concomitant use of adrenal glucocorticoids can exacerbate these effects. It is recommended that patients with diabetes mellitus should monitor blood glucose when starting salbutamol and terbutaline. In patients with gestational diabetes, special attention should be paid to the increased risk of hyperglycemia and ketoacidosis. Insulin doses may therefore need to be adjusted.
NO3. Bronchospasm
As with other inhalation therapy, after aerosol inhalation Patients may experience paradoxical bronchospasm immediately. In the event of a severe reaction, treatment must be reassessed and, if necessary, alternative treatment options established. Bronchospasm may occur with immediate exacerbation of wheezing when budesonide is used concomitantly with other inhaled asthma medications. If acute bronchospasm develops after administration of budesonide suspension for inhalation, immediate treatment with a fast-acting inhaled bronchodilator, interruption of budesonide suspension for inhalation treatment, and other alternative therapy . Likewise, if a patient experiences an exacerbation of asthma while using the albuterol nebulizer, another method of administration or inhalation of another fast-acting bronchodilator should be used immediately. In addition, budesonide is not a bronchodilator and therefore should not be used for rapid relief of acute bronchospasm or other acute asthma attacks. Rapid-acting beta2-receptor agonists (SABAs) and ICSs can be inhaled during acute asthma exacerbations, and other expectorants should be used with caution. Planning: MeichaoTitle image:Zhanku Hailuo
References1. Respiratory Branch of Chinese Medical Association. Chinese expert consensus on the clinical application of aerosol expectoration. Chinese Journal of Tuberculosis and Respiratory Medicine, 2021, 44(4).2. Asthma Group of Respiratory Branch of Chinese Medical Association. Guidelines for Prevention and Treatment of Bronchial Asthma (2020 Edition). Chinese Journal of Tuberculosis and Respiratory Medicine, 2020, 43(12).