Nebulizer Background

Therapeutic delivery of aerosolized medication is important for a myriad of respiratory ailments.  Benefits of aerosolized vs. systemic therapy include localized drug delivery, rapid effect onset, and reduced systemic absorption, thus minimizing side effects. Medications available for inhalation include beta-agonists, anticholinergic bronchodilators, glucocorticoids, antibiotics,  and vasodilators. The 3 types of nebulizers are jet (pneumatic), mesh, and ultrasonic.  Nebulizers are indicated for use in patients too ill or young to use handheld devices and for patients who have suboptimal efficacy with handheld devices secondary to poor technique.  An effective nebulizer should be able to administer 50% of the dose within 10 minutes.  Studies show that between 2% to greater than 20% of the initial nebulizer dose is deposited into the lungs., Numerous factors can influence drug efficacy.  There are technical and patient factors that affect aerosol delivery by nebulizers.  Technical factors include flow rate, fill volume, characteristics of driving gas, continuous vs. intermittent delivery, mechanism of action, manufacturer, and properties of the solution to be aerosolized.  Patient factors include breathing pattern, nasal vs. oropharyngeal breathing, airway obstruction, positive pressure ventilation, and presence of an artificial airway. Nebulizer medication can be administered via mouthpiece or face mask.  Patient response to either concern with anticholinergics, as this can lead to blurry vision, pupil dilation, and worsening of glaucoma. modality is equivalent; thus, patient factors should determine which is used.   Eye deposition can occur with face masks and is of particular concern with anticholinergics, as this can lead to blurry vision, pupil dilation, and worsening of glaucoma.

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