Correct usage of aerosolization for respiratory diseases

Choose a special atomizing preparation approved by the drug regulatory department, clean your face and mouth before use, maintain natural breathing and occasionally take deep inhalations during atomization, rinse your mouth thoroughly after cleaning the face, and dispose of the atomizing device according to the instructions. Special groups such as children and the elderly can adjust the operating rhythm according to their tolerance. It is strictly prohibited for ordinary people to use non-atomizing preparations to prepare and atomize on their own without authorization.

Don’t tell me, there are really more cases of atomization traps encountered in the clinic than you think. Last week, the pediatric department picked up a 3-year-old baby who had been coughing for almost a week. The mother heard from neighbors in the community that ambroxol injection was effective in nebulizing it, so she gave the baby some ambroxol injection at home for three days. However, the cough did not go away, and instead she started to wheeze. When she arrived, her face was red from holding back, and she heard wheezing on auscultation - it was because the preservatives and large particles in the injection irritated the airway.

Oh, yes, here is a point that is still controversial in the industry: can non-atomized preparations be used for atomization? If it were placed 10 years ago, many grassroots hospitals would indeed use it this way. After all, there were few special aerosol preparations at that time and the price was high. Some doctors would use it occasionally when they assessed that the benefits far outweighed the risks. But now the evidence-based evidence is very clear. Most of the particle sizes of injections do not reach the 1-5 μm required for atomization. They either get stuck in the mouth and throat, or go directly into the stomach, and cannot reach the lower respiratory tract at all. The preservatives in them can easily induce airway hyperreaction, so the current mainstream diagnosis and treatment guidelines have clearly not recommended routine use. Of course, there are special circumstances. For example, in some remote areas, special atomized medicines are unavailable. Clinicians will also make trade-offs based on the patient's situation. However, we ordinary people must not make random preparations at home. Antibiotics, cold medicines, and Chinese patent medicine injections are not allowed to be touched. Currently, the only antibiotics approved for atomization in China are tobramycin atomized solutions. Ordinary cephalosporins and penicillins do not have atomized dosage forms at all, and using them blindly will cause problems.

Many people don’t pay attention to anything before vaping. They just sit there and inhale after eating fried chicken and applying thick facial cream. I have met several patients who have a red rash around their mouths after inhaling hormones. This is caused by the mixture of oil on the face, facial cream and residual drugs from atomization. There are also food residues in the mouth. When atomized, the liquid mixed with the residue remains on the oral mucosa, which can easily breed bacteria and aggravate infection. Therefore, it is best to wash your face before doing it, wipe off the skin care products on your face as much as possible, and rinse your mouth. If you have children, just give them two mouthfuls of warm water in advance to wash away the food residues in their mouths. It doesn’t have to be too troublesome.

A patient asked me before, does nebulization have to sit upright and inhale? In fact, there are really no strict rules. As long as you don't turn the atomizer cup upside down to spray the medicine, it will be fine if you are sitting, half-lying, or even if the child is making a fuss and falls asleep while holding it. As for the breathing rhythm, there is no need to deliberately inhale hard. Many people hold the atomizer cup and wish they could finish inhaling the medicine in one minute. In fact, it is useless. Just breathe normally, take a deep breath occasionally, hold it for two or three seconds and then exhale slowly. Only then can the medicine sink into the bronchioles and alveoli, and the effect will be good. Generally, the time for a single atomization is controlled to 10-15 minutes. If the dose is large, it can take up to 20 minutes. Inhaling for too long can easily lead to excessive airway humidification. Elderly people with a lot of phlegm may even choke on the phlegm.

Oh, yes, there are still many people who are confused about whether to add saline to dilute the nebulizer. There is really no unified requirement for this. If you use medicines such as budesonide and terbutaline, each of them has 2ml. It can be used without adding it, and the amount of mist is sufficient. If you only use half a pill and the amount of medicine is too small and mist occurs intermittently, it is no problem to add 1-2ml of normal saline. There is no need to search online for a long time or even quarrel with family members for this matter. It is really unnecessary.

The first thing you should do after inhaling is to rinse your mouth, especially if you use hormones. You must tilt your head up and gargle all the way to the throat. Don't just take a mouthful of water and spit it out. Otherwise, the hormones will remain on the throat mucosa, which may lead to thrush and hoarseness over time. If your child doesn't know how to rinse his mouth, just use gauze dipped in warm water to wipe down the inner wall of the mouth. Two more mouthfuls of warm water can also wash away the residue. The face should also be wiped clean with warm water, especially if children have tender skin. Do not leave any medicine on the face to irritate the skin.

Don’t just throw the household atomizer device there after use. Every time you use it, take apart the atomizer cup, mouthpiece or mask, rinse it with warm water, and put it in a ventilated place to dry. Do not scald it in boiling water, let alone cook it. The atomizer cup is mostly made of polypropylene. After it is deformed by scalding it at high temperature, the particle size of the mist will be wrong, and the inhalation will be in vain. Don’t use disposable atomizing masks over and over again. If it’s for home use, you can usually replace an atomizing cup after 15-20 uses. Don’t use it for the first half of a year and keep using it until mold grows inside.

After I tested positive for COVID-19 last year, I coughed for almost three weeks. I couldn’t sleep at night because of the cough. I prescribed budesonide and terbutaline nebulizers at home. I was in a hurry to catch up with work at first, so I inhaled them very quickly. I finished them in five minutes. Inhaling them for two days was of no use at all. Later, I simply put my work aside and started breathing slowly while listening to a book. Each time I breathed, I breathed for about 12 minutes. Occasionally I held it in deeply, and I basically stopped coughing in three days. In fact, atomization really doesn’t have so many mysterious details. The core is not to mix medicines blindly, and don’t operate too outrageously. If you are not sure what medicine to use and how to operate it, go to a community hospital or a nearby clinic to ask a doctor. Don’t blindly read online folk remedies, which will delay your condition.