Nebulization treatment for respiratory diseases

Nebulization is currently one of the preferred local drug delivery methods for clinical respiratory diseases. Its safety and effectiveness have been verified by evidence-based medicine for decades. It is neither a scourge that is "10 times more harmful than infusion" as reported online, nor is it a "panacea" that can cure coughs and asthma. The final therapeutic effect and potential risks completely depend on the adapted disease, dosage regimen, and whether the operation is standardized.

An interesting thing happened yesterday when I was in the pediatric emergency room. My mother was holding her 5-year-old baby who was coughing and couldn't straighten up. She had just finished ordering the nebulizer. The aunt in line next to her immediately came over and lowered her voice to persuade: "Girls, please don't do this to your baby. It's all hormones, and the baby won't grow taller!" My grandson had it done once before and had a fever for three days! ”The mother was so frightened that she wanted to cancel the order on the spot. I have been in the respiratory department for almost 7 years, and I have seen this kind of misunderstanding too many times. Last month, I had a 4-year-old baby with an acute attack of asthma. When he arrived, his blood oxygen level had dropped to 89. His little face was red from suppressing it, and he didn’t even have the strength to cry. He was given budesonide combined with albuterol for nebulization and inhalation in less than 10 minutes. Most of the wheezing sounds disappeared, and he could play with the small sticker I gave him. If he waited for the oral medicine or infusion to take effect, he might have to go to the ICU for intubation.

Why are people’s opinions on atomization so polarized? In the end, it’s all about poor information.

Let’s talk about the hormone issue that everyone is most afraid of. The currently commonly used atomized inhaled hormone in clinical practice is budesonide, which is the only inhaled hormone approved by the FDA for use in children under 4 years old. Its administration method is to act directly on the respiratory mucosa, and the amount that can actually enter the systemic blood circulation is less than 1%. The probability of systemic side effects is much lower than that of oral antipyretics and cough suppressants. Those who say that atomization affects height and precocious puberty have either increased the dosage randomly and used it for several years, or they blame other problems on atomization. Of course, it is not completely free of side effects. I met a parent before who felt that the treatment prescribed in the hospital twice a day was too slow, so he changed it to 5 times a day at home. After using it for two months, the baby occasionally had a hoarse voice, and it just stopped for a week. There was no irreversible damage at all.

But don’t think of atomization as a magic medicine. For dry coughs and sore throats caused by common colds, if you use saline atomization to moisturize your throat at most, it will have no therapeutic effect. There is absolutely no need to spend that wasted money. There are also some grassroots clinics that like to use dexamethasone to atomize people. This is purely random. Dexamethasone is water-soluble. The atomized particles cannot penetrate the respiratory mucosa at all and get stuck in the throat. In the end, they are swallowed into the stomach. It is useless to spend money on it.

Another controversial point currently is the use of α-interferon nebulization. Many primary hospitals will routinely prescribe this to treat viral pneumonia. However, the 2023 version of the "Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia in Children" actually does not recommend routine use because there is currently insufficient evidence-based evidence to prove that it is effective for ordinary people. It is effective for viral pneumonia, but of course it does not mean that it cannot be used at all. If you encounter high-risk children with severe syncytial virus infection or influenza, taking it within 48 hours of the onset of illness can indeed reduce the probability of severe illness. This all depends on the clinical judgment of the doctor in charge. There is no need to think that the doctor is prescribing drugs randomly when you see interferon prescribed.

Let me tell you a few small details that I usually explain to patients repeatedly, which can really save a lot of pitfalls. Don’t do nebulization on an empty stomach. Many people will irritate the respiratory tract and cough violently when inhaling. They are prone to vomiting on an empty stomach, especially children. After finishing, be sure to wash your face and rinse your mouth. If your baby doesn't know how to rinse his mouth, drink two sips of water or wipe off the oral mucosa with wet gauze. Otherwise, the remaining medicine will stick to the mouth and face, which may cause thrush. If you want to buy an atomizer at home, don’t buy one that looks like a toy that costs tens of dollars. It depends on the parameters. Only those with a diameter of 2-5 μm are useful. If they are too big, they will get stuck in the throat and cannot reach the lower respiratory tract, which means it is in vain.

In fact, to put it bluntly, atomization is essentially a route of drug administration, and there is no distinction between taking medicine, injections, and infusions. Use the right medicine for the right disease, follow the doctor's instructions and follow the dosage. Don't increase the dosage blindly and don't listen to others' random advice and insist on not using it. Then there will be no problems. If you are really unsure, asking the doctor in charge is much more useful than reading dozens of unexplained popular science.