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When the baby has respiratory symptoms such as cough, phlegm, and sore throat, many doctors will give the baby atomization treatment. At this time, parents may have some questions.

Why do doctors choose atomization instead of injection?

What medicine is inhaled?

Are there hormones and antibiotics in it?

……

Some people even say that atomization is more terrible than the injection, which makes people panic.

Here, combined with the professional literature "Expert Consensus on the Application of Aerosol Inhalation Therapy in Respiratory Diseases", I sorted out the pharmacological characteristics and safety-related contents of commonly used aerosol inhalation drugs as follows.

Antibiotics are used in atomization? Almost impossible!

Clinical Conditions:

At present, children's antibiotics commonly used in clinics have no atomized dosage forms in the market.

On the one hand, there is no safe, reliable, and effective clinical evidence. On the other hand, there is no authoritative guide to guide medication.

Therefore, at present, there is no available atomized dosage form containing antibiotics in China.

At present, there is no atomized dosage form containing antibiotics that can be used by pediatrics in China. Therefore, atomization has no direct relationship with antibiotics and abuse of antibiotics.

Don't Use These Medicines Either.

Common Antibacterial Drugs and Chinese Patent Medicines for Treating Respiratory Tract Infections in the Market

1) People use antibacterial drugs for atomization administration mainly to increase local drug concentration and reduce systemic adverse reactions. By searching the literature, it can be found that antibacterial drugs used for atomization inhalation include gentamicin, amikacin, vancomycin, and so on.

Many people like to use gentamicin for atomization, but instructions of gentamicin and pharmacopoeia do not mention that gentamicin can be used for atomization. There is still insufficient medical evidence for its efficacy and safety.

Therefore, the above-mentioned “Expert Consensus” pointed out that local application of antibacterial drugs should be avoided as much as possible. Up to now, there is no special preparation of an antibacterial drug for atomization inhalation in China.

Intravenous preparations are used to replace antibacterial drugs in clinics and in most studies. However, intravenous preparations are not completely suitable for atomization, because they contain preservatives.

2) The clinical experience and basic research of atomization inhalation of Chinese patent medicine are insufficient. The reliability and safety of the curative effect need to be verified, so it is not usually recommended.

Three Kinds of Commonly Used Drugs for Atomized Inhalation

Glucocorticoid

It is the most widely used and the most effective way to control airway inflammation. It is the preferred drug for treating bronchial asthma, various respiratory diseases related to wheezing, cough-related diseases, and various respiratory diseases with wheezing symptoms.

At present, there are three kinds of inhaled glucocorticoids commonly used in clinics, which are budesonide, beclomethasone propionate, and fluticasone propionate, with the following characteristics.

Name
budesonideHigh hydrophilicity, stronger anti-inflammatory effect and lung targetingThe first choice for nebulizing hormones for infants and young childrenThe most commonly used, the only inhaled hormone recommended in the World Health Organization's Children's Essential Medicines List, with good safety
beclomethasone propionateLow water solubility, slow onset of effect, needle-like shape causes reduced atomization efficiency
fluticasone propionateHighly fat-soluble, the potential risk of systemic adverse reactions is greaterChildren 4-16 years old

NameCategoryEffective timeMaintenance timeApplication
Salbutamolβ2- receptor agonistWithin 5 minutes4-6 hours It is the first choice of drugs for an acute attack of asthma and wheezing.
Terbutalineβ2- receptor agonist5-15 minutes4-6 hoursThe maximum action time is relatively long. The effect is weak.
Ipratropium bromideAnticholinergic drugs15-30 minutes4-6 hoursGenerally, it is not used alone.
Salbutamol/ipratropium bromide compound solutionβ2- receptor agonists/anticholinergic drugs 5-15 minutes4-6 hoursThey cannot be mixed with any other drugs.
AdrenalineAdrenergic receptor agonistsStudies have shown that the advantages of treating bronchiolitis are not obvious.

Expectorant

1) N-acetylcysteine
It is a commonly used expectorant aerosol inhalation at present, which can reduce the viscosity of sputum and facilitate sputum discharge. However, the use of this drug is controversial in the EU.

Therefore, in the consensus of experts on aerosol inhalation therapy in China, this drug can be used for the treatment of idiopathic pulmonary fibrosis. That is to say, it is usually unnecessary to use it for children's cough and pneumonia.

2) Bromosol Injection
Atomization inhalation is not recommended in the instruction manual, but there are clinical reports in China. There are special atomization dosage forms in foreign countries, but there are few related studies about it applied to children. It is not recommended for routine atomization inhalation.

3) 3% hypertonic saline:
The latest evidence at home and abroad shows that it can effectively shorten hospital stay and improve the clinical symptoms of children with acute bronchiolitis. If the child's clinical symptoms do not relieve or irritating cough occurs after 48 ~ 72 hours of use, it should be stopped in time. It is banned from bronchial asthma.

Disease nameInhaled glucocorticoidBronchial relaxant
Bronchial asthmaAcute attack periodMild: On the basis of inhalation of SABA, 1.0mg BUD suspension should be inhaled by atomization. After 4h or 6h, repeat the administration until the symptoms are relieved.SABA: Aerosol inhalation of salbutamol or terbutaline 2.5 ~ 5.0 mg;
SAMA: Atomization inhalation therapy is not the first choice. Choose it only when SABA monotherapy is ineffective. Add 0.25~0.5mg of ipratropium bromide into SABA solution for atomization inhalation.

Moderate and severe: In the first hour of initial treatment, BUD1.0mg should be inhaled by atomization for 30min / time. It can replace or partially replace systemic glucocorticoid in the acute attack of non-fatal asthma.
Stable period
The initial treatment dose is 0.5 ~ 1.0 mg/d. The evaluation should be conducted after 1~3 months.Children with asthma of any control treatment level can use SABA as needed to relieve symptoms.
Cough variant asthma
BUD suspension should be inhaled by atomization for 0.5 ~ 1.0 mmg/time, 1~2 times/d. The treatment time is generally not less than 6~8 weeks.
The drug dose is the same as that of typical asthma.

Post-infection cough
BUD suspension should be inhaled by atomization for 0.5 ~ 1.0 mg/time. The frequency and time of use depend on the condition of the patient. The course of treatment generally does not exceed 3 weeks.
Asthma in infants (such as bronchiolitis)
Severe: BUD suspension 1.0mg/time and bronchodilator should be inhaled once /20min for 3 consecutive times according to the condition. The interval time of atomization inhalation can be gradually extended to 4, 6, 8 to 12 hours.
It is recommended to inhale bronchodilators by atomization. The dosage of terbutaline is 2.5mg/time if the weight is < 20kg and 5.0 mg/time if the weight is ≥ 20kg.

Moderate: The above combination should be used twice a day for 2 ~ 3 days.
If the patient is younger than five years old, the dose of salbutamol is 2.5mg/ time. The interval of medication depends on the severity of the disease.
Age: Asthma children under three years old and high-risk children need long-term inhalation of BUD suspension, starting with a dose of 1.0mg/d and gradually decreasing. Adjust the dose every 1~3 months until it reaches the minimum effective maintenance dose (the minimum effective maintenance dose of BUD suspension is 0.25mg /d).Ipratropium bromide: If the patient is younger than 12 years old, the dose is 0.25mg/time. It can be administered repeatedly according to the condition.

Mycoplasma pneumonia
Acute phase: If there is obvious cough and wheezing and there is obvious inflammatory reaction and atelectasis in chest X-ray film, BUD suspension should be inhaled by atomization for 0.5~1.0mg/ time combined with bronchodilator twice a day for 1~3 weeks.Acute phase: It should be combined with BUD suspension. Bronchodilator should be inhaled by atomization twice a day for 1~3 weeks.
Recovery period: If there is airway hyperresponsiveness, small airway inflammation on chest X-ray film or atelectasis is not completely recovered, BUD suspension should be inhaled by atomization for 0.5~1.0mg/d. The condition should be reviewed after 1~3 months.
Acute laryngotracheal bronchitis
In most studies, the initial dose of BUD suspension is 1.0~2.0mg, and then it should be inhaled every 1.0 mg/12 hours. There are also studies suggesting 2.0mg/ time, once /12h, up to 4 times/d.
Bronchopulmonary dysplasia
The dose and course of treatment for prevention and treatment of BPD by atomizing inhalation of BUD suspension are unclear. In some studies, BUD suspension 0.5mg/time was inhaled by atomization 2 times /d for 14 days.2.5~5.0mg of terbutaline or salbutamol should be inhaled once/ (6 ~ 8) h. Generally, it is used for children with bronchospasm in the acute clinical stage.

References:

1. Expert consensus on the application of aerosol inhalation therapy in respiratory diseases [J]. Chinese Journal of Medicine, 2016,96(34):2696-2706
2. Expert consensus on inhaling anticholinergic drugs to treat asthmatic diseases in children [J]. Chinese Journal of Applied Pediatrics, 2017,32(4):241-243

3. Expert consensus on aerosol inhalation treatment of adult chronic airway diseases [J]. Chinese Journal of Respiratory and Critical Care Medicine, 2012,11(2):105-109

4. Expert consensus on the application of glucocorticoid aerosol inhalation therapy in pediatrics (revised edition in 2014) [J]. Journal of Clinical Pediatrics, 2014,32(6):504-510

5. Consensus of Chinese experts on the internet of things-assisted atomization inhalation therapy [J]. International Journal of Respiratory Medicine, 2017,37(10):721-728

6. Expert consensus on the application of glucocorticoid aerosol inhalation therapy in pediatrics (revised edition in 2018) [J]. Journal of Clinical Pediatrics, 2018,36(2):95-104

7. Consensus of experts on atomization therapy (draft) [J]. Chinese Journal of Tuberculosis and Respiration, 2014,37(11):807