Inhalation for chronic and obstructive bronchitis in adults and children: drugs, solutions, antibiotics

To the question – is it possible to do inhalations for bronchitis? – pulmonologists answer affirmatively, since the introduction of medicinal substances through the respiratory tract, bypassing the gastrointestinal tract, is one of the most important methods of treating cough in respiratory diseases.

Inhalations for bronchitis make it possible not only to quickly and purposefully affect the ciliary epithelium of the mucous membrane of the inflamed bronchi, improve the clearance of tracheobronchial secretions and relieve spasms, but also to minimize possible side effects of drugs.

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Indications for the procedure

The main indications for inhalation therapy using any nebulizing device or apparatus (inhaler) include all forms of diseases of the tracheobronchial and respiratory areas of the respiratory tract: acute and chronic bronchitis and tracheobronchitis, purulent bronchitis, bronchopneumonia, obstructive bronchitis and COPD (chronic obstructive pulmonary disease), asthmatic bronchitis and bronchial asthma.

It should be borne in mind that hot steam inhalations for bronchitis at a body temperature above subfebrile (more than +37.5°C) are contraindicated, and in case of severe arterial hypertension, they are not recommended.

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Preparation

The main preparation for inhalation concerns the preparation of the solution - in strict accordance with the specified proportions and dosage. The solution introduced by a mechanical or electric nebulizer should be approximately body temperature.

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Technique bronchitis inhalations

The technique depends on the device used. The solution should be sprayed simultaneously with inhalation (with your head slightly tilted back), the inhalation should be calm, without forcing. After a 3-4 second delay, exhale through the nose. Inhalers with a mouthpiece are the most convenient: the main thing is not to open your lips when inhaling.

The rule is simple: one dose (inhalation) – one spray of solution.

Inhalation preparations for bronchitis

With all the variety of spray devices used today (pneumatic, membrane or ultrasonic inhalers), they are considered the most effective due to the finely dispersed aerosol into which the liquid drug is converted and penetrates the ciliated epithelium of the bronchial mucosa by passive diffusion.

To carry out effective inhalations for bronchitis, medicinal substances are needed that provide the maximum therapeutic result in the fight against the main symptoms of this disease - cough and narrowing of the bronchial lumen.

In practice, the following drugs are used for inhalation in case of bronchitis:

• bronchodilators (bronchodilators) – Salbutamol (Salbutan, Salbuvent, Ventolin, Aerolin and other trade names), Berodual, Formoterol (Foradil), Terbutaline, Fenoterol (Berotek, Aerum, Aruterol);
• liquefying bronchial mucus (mucolytics) based on ambroxol hydrochloride (Ambrobene, Lazolvan, etc.) and acetylcysteine (Acetylcysteine solution for inhalation, Tussicom, Fluimucil);
• cromoglycic acid compounds (Cromolyn powder for solution preparation, Tayled or Taleum aerosols);
• Fluorinated glucocorticosteroids for inhalation use using a nebulizer: Pulmicort (Budesonide), Fluticasone (Flixotide), Dexamethasone, Beclomethasone dipropionate (Beclomet, Becotide). Experts emphasize that despite the availability of the above drugs, no one currently performs inhalations with Prednisolone: Prednisolone is a non-fluorinated GCS (i.e., its mineralocorticoid activity is higher and systemic side effects are more frequent) and is intended for parenteral and oral use.

We will discuss below when antibiotics for inhalation are necessary for bronchitis.

Inhalation solutions for bronchitis

In addition, some antiseptic solutions are used for inhalation in bronchitis, carried out with a nebulizer. However, some of them are used in otolaryngology - for patients with tonsillitis, laryngitis or pharyngitis.

Despite the fact that the use in pulmonology is not indicated in the official instructions, Miramistin inhalations are popular due to the bactericidal properties of this quaternary ammonium compound of benzalkonium: practically not absorbed by the mucous membrane, the drug (in the form of a 0.01% solution) has a detrimental effect on microbial, viral and fungal infections. It is recommended for adults to carry out one inhalation per day (single dose - 4 ml), and for children 5-12 years old - 3 ml (1 ml of Miramistin + 2 ml of saline). Although this antiseptic is effective only at the initial concentration.

The bacteriostatic drug Decamethoxin or Dekasan for inhalation is used in cases of complicated bronchitis, when the expectorated sputum contains pus. Then inhalations with a nebulizer are carried out twice a day - 5-10 ml of solution: it is prepared from a mixture of the drug with saline in a ratio of 1:1 for adults and 1:3 for children (over two years old).

An antiseptic and anti-inflammatory agent, which is a 1% alcohol solution of eucalyptus leaf extract - Chlorophyllipt for inhalation is also more used in ENT practice. It is also diluted with saline (1:10) and applied 3-5 ml twice a day.

By the way, to moisturize the mucous membrane, you can do inhalations with saline solution: one or two times a day, 5-10 ml of slightly warm 0.9% aqueous sodium chloride solution.

Inhalations with Dioxidine are also assessed ambiguously. Firstly, this bactericidal drug, according to the instructions, is used in the treatment of severe purulent inflammations, necrotic wounds (including burns) and sepsis. Secondly, inhalations with Dioxidine are done only for purulent diseases of the nasopharynx and only for adults. In addition, this drug is toxic, and its tolerance by patients is monitored in a medical institution (with monitoring of the main indicators of body functioning).

Regarding inhalation with Euphyllin, it should be noted that this drug is intended to relieve spasms of the bronchi, blood vessels of the lungs and brain - by oral administration, intramuscular and intravenous injections, as well as rectally (microclysters are done). Euphyllin has an irritating effect on mucous membranes, so the doctor will not prescribe it for inhalation.

Inhalations for acute and chronic bronchitis

Inhalations for acute bronchitis are performed to relieve coughing by thinning thick mucus that is difficult to cough up. For this purpose, mucolytic drugs are used.

Inhalations are done with a nebulizer with Acetylcysteine (in the form of a 20% solution for inhalation in ampoules, another trade name is Tuussik) - 2-5 ml up to three times a day (the duration of the procedure is 15 minutes). Inhalations for bronchitis in children with this drug are allowed to be carried out only after two years. More useful information in the material - Treatment of bronchitis in children

Ready-made solution (15 mg/2 ml) Lazolvan for bronchitis - inhalations are carried out for adults and children from five years of age - 2.5 ml; children from two to five years old - 2 ml; children under two years - 1 ml of the drug, no more than twice a day. Lazolvan cannot be dissolved in saline: the pH of the saline solution is higher than 5 (7-7.5), and the drug will precipitate. Dilution in equal proportions with distilled water is allowed. The same applies to inhalation with Ambrobene, since both products contain ambroxol hydrochloride and are synonyms. The concentration of Ambrobene solution is 7.5 mg/ml, but this does not affect the dosage.

Pulmonologists recommend preventing coughing fits after the procedure by using bronchial remedies beforehand. And about an hour after inhalation, do a drainage massage, read in detail - How to do a massage for bronchitis

Inhalations for chronic bronchitis are carried out with both mucolytic and bronchodilators: Salbutamol, Berodual, Formoterol, Terbutaline, Fenoterol. And in case of exacerbation, Dekasan is used.

In acute and chronic inflammation of the bronchi, there is often a narrowing of their lumen, which is manifested by difficulty breathing with shortness of breath and wheezing. And in such cases, inhalations are carried out for obstructive bronchitis.

Inhalations of Salbutamol (in the form of an inhalation solution of 1.25 mg/ml in ampoules) are prescribed - 2.5 ml (without diluting) up to four times a day. Possible side effects include tachycardia, nausea and vomiting, tremors and increased anxiety.

Inhalations with Berodual are allowed to be carried out five times during one day (but not more often than two hours after the next procedure, lasting about five minutes). The dosage for a nebulizer is 4 drops of the drug per 3 ml of saline. When using a hand inhaler, the drug is not diluted. The side effects of Berodual are similar to Salbutamol.

Read also – Treatment of obstructive bronchitis

Inhalations for purulent bronchitis

If the disease has entered the stage of inflammation with necrosis (as evidenced not only by yellow-green sputum when coughing and wheezing when breathing, but also by subfebrile fever), it should be borne in mind that hot (steam) inhalations for purulent bronchitis should never be done. But you can inhale Dekasan, Chlorophyllipt or Miramistin.

And here it would be necessary to use antibiotics for inhalation in bronchitis, best of all - fluoroquinolones, macrolides and cephalosporins of the latest generations. But all of them are systemic drugs and have other methods of application - oral or parenteral.

As studies show, even in a modern clinical hospital, only half of patients with acute bronchitis can have their pathogen reliably identified. And viruses play a key role in the etiology of this disease (in more than 90% of cases). Therefore, treatment, even without verification of the bacterial pathogen, requires the use of antibiotics in the presence of purulent sputum and an increase in its quantity.

Previously, doctors prescribed inhalations with Bioparox (with the polypeptide antibiotic fusafungine), but the European Medicines Agency, having conducted an examination of the drug’s side effects, banned its release in the spring of 2016.

Now antimicrobial drugs for inhalation in bronchitis are limited to a 4% solution of Gentamicin sulfate (an antibiotic of the aminoglycoside group), which is diluted for inhalation with saline solution - 1:6 for adults and adolescents over 12 years old, and for children 2-12 years old - 1:12. No more than 3 ml is spent per procedure per day. The list of side effects of Gentamicin (true, with parenteral administration) includes not only a decrease in kidney function, but also hearing impairment up to its complete loss.

See also - Antibiotics for bronchitis

Inhalations for asthmatic bronchitis

Asthmatic or allergic bronchitis requires – in addition to the previously mentioned bronchodilators and mucolytics – the administration of glucocorticoids, which relieve inflammation.

For inhalation with Dexamethasone, a solution for parenteral administration (2 ml ampoule) is used, which is mixed with saline (12 ml). The dose of one procedure does not exceed 4 ml, and their quantity and duration of treatment are determined by the doctor.

Pulmicort suspension for inhalation is also used (2 ml of suspension contains 0.5 mg of the active substance budesonide). Dosage: 1-2 mg per day for an adult, for children over six months - 0.25-0.5 mg.

Effective inhalations for bronchitis (for adults and children over five years of age) are procedures with a nebulizer with cromoglycic acid compounds in the form of nedocromil sodium (Cromolin powder for solution preparation, ready-made aerosols Tayled, Taleum): three to four times a day, 5-10 mg 4 times a day. It is recommended to do an inhalation with one of the bronchodilators before the procedure, since nedocromil sodium may cause bronchospasm.

Inhalation for bronchitis at home

The suggested recipes for inhalations for bronchitis, which can be done to relieve cough, are numerous and varied.

The most well-known inhalations for bronchitis at home are steam: breathe through your mouth over a container of water at t<+60-65°C (for a child t<+42-45°C), covering your head with a terry towel, and exhale through your nose. The effect of steam promotes blood flow and improves the trophism of the tissues of the lower respiratory tract; the secreted mucus becomes less viscous and easier to cough up.

If you add a teaspoon of table or sea salt to every half liter of water, you will get a salt inhalation. When sodium chloride is replaced with sodium bicarbonate, you will get inhalations with soda. And if you boil potatoes in their skins, drain the water and, covering your head, breathe in the hot broth, you will get a potato inhalation.

The last two procedures are alkaline, which is useful for thick, hard-to-remove phlegm. Therefore, inhalations with mineral water are done: with natural hydrocarbonate mineral water - Borjomi inhalations for bronchitis; Transcarpathian waters Svalyava, Polyana Kvasova and Luzhanska, as well as inhalations with Essentuki (Essentuki No. 4 and No. 17).

Despite the entire arsenal of phytoncides with their bactericidal properties, garlic inhalations (a teaspoon of juice squeezed from grated garlic per 200 ml of water) are unlikely to relieve a cough: they help better with inflammation localized in the throat and larynx.

If you use an inhaler (and not a funnel or cone that covers the container with the solution), then inhalation with propolis will bring unconditional benefit to the inflamed mucous membrane (adults can use propolis tincture in alcohol, adding a teaspoon to 100 ml of boiled water).

How many times should inhalations be done for bronchitis? No more than twice a day with a 10-12-minute duration of one procedure for an adult, five minutes for children aged 6-10 years and three minutes for a younger child.

It is recommended to use medicinal plants and herbs for inhalation for bronchitis (in the form of decoctions).

Warm-moist inhalations with chamomile: a decoction is prepared from the flowers of the plant (a couple of tablespoons per glass of water), used warm (after straining the decoction) - using a hand-held inhaler.

Eucalyptus inhalation: a decoction of dry leaves is prepared in a similar way.

Inhalation with a decoction of pine buds or young needles (boil two to three tablespoons for 10-15 minutes in 700 ml of water).

The most effective herbal infusion for inhalation consists of chamomile and calendula flowers; thyme, peppermint and sage herbs, as well as fireweed and eucalyptus leaves.

What oil is best to use for inhalation for bronchitis? Herbalists advise: for coughs caused by infectious inflammation, inhalation with fir oil (4-5 drops in 150-180 ml of water), clove oil, essential oils of thyme, rosemary, fir, eucalyptus, tea tree, lemongrass, marjoram, and sage is useful.

But inhalation with sea buckthorn oil is technically difficult to implement: solutions with oil are not poured into an inhaler-nebulizer, and all other devices simply will not carry the heavy oil suspension to the bronchi, and it will settle in the throat and trachea.

Due to the presence of menthol and camphor, as well as essential oils of mint, eucalyptus, cloves and Chinese cinnamon, inhalations are made with a star (meaning, with a grain of the "Golden Star" balm). However, it should be remembered that such inhalations are contraindicated for bronchitis in children, and this recipe is not suitable for asthmatic bronchitis, moreover, it will lead to increased coughing and swelling.

Apparently, as a substitute for mint essential oil, inhalation of Validol has spread among the people, since Validol contains a solution of menthol in methyl ester of isovaleric acid, and it relieves spasms and soothes. But Validol in any form is contraindicated for children under 12 years old and those with low blood pressure or problems with blood supply to the brain.

Contraindications to the procedure

In addition, contraindications to inhalation apply to patients with: severe cardiac and/or pulmonary insufficiency; severe tachycardia or cardiac arrhythmia; pneumonia caused by infections such as Haemophilus influenzae, Pneumocystis, Chlamydia trachomatis or Cytomegalovirus; pulmonary hemorrhage (primarily in pulmonary tuberculosis); purulent inflammation of the pleura or the presence of air in its cavity; bullous form of pulmonary emphysema.

In the presence of bacterial, viral and fungal infections of the respiratory organs, inhalation of corticosteroids is contraindicated.

Any inhalations for bronchitis should not be done in infants with congenital problems of the pharyngeal reflex and soft palate if they have been diagnosed with recurrent aspiration bronchitis.

In case of allergic bronchitis, inhalations with decoctions of medicinal plants and essential oils are not performed. Inhalation solutions containing menthol oil or camphor are unacceptable for use in the treatment of young children (under two years of age).

Inhalations for bronchitis in pregnant women do not allow the use of most drugs (especially antibacterial, steroid and bronchodilators); in the first three months, pregnant women are not recommended to inhale acetylcysteine and Ambroxol hydrochloride (Lazolvan). There remain such means as salt, soda, mineral water and, of course, steam inhalations for bronchitis - over boiled potatoes in their skins or a decoction of eucalyptus leaves. More details - How to treat a cough during pregnancy

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Complications after the procedure

As experience shows, the main negative consequences after the steam inhalation procedure, which is carried out at home, are burns of the mucous membrane of the respiratory tract.

Complications after the Berodual or Salbutamol inhalation procedure include headache, tachycardia, and tremors of the extremities. In patients with diabetes, blood sugar levels may rise, and in elderly patients, nausea, vomiting, and intestinal problems may begin.

In asthmatic bronchitis, inhalations can cause increased spasms, airway obstruction and asthma attacks.

With long-term use of inhalations with glucocorticosteroids in children with chronic asthmatic bronchitis, there may be growth retardation and decreased bone density due to disruption of the production of hormones of the hypothalamus, pituitary gland and adrenal glands.

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Care after the procedure

No special care is required after inhalation, you just need to rest quietly in a warm room, not drink or eat anything for about an hour, and it’s better not to even talk.

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