Foreword——
It is now the midwinter season, and temperatures in most parts of the country have dropped below freezing, and the winter solstice will soon come. Parents are afraid that their children will catch a cold and "stay" at home. Even so, they still can't stop them from catching colds, fevers, coughs, asthma, hey, tears...
A few days ago, A 3-year-old child in the ward had just recovered from severe pneumonia. A few days later, his mother brought the child to the outpatient clinic. When I saw it, wasn't this the little guy who was infected with Klebsiella pneumoniae a few days ago? This illness caused a lot of mental suffering for my parents.
The mother said: "The baby has been doing well in all aspects for a few days after being discharged from the hospital. However, he has been coughing endlessly and there seems to be phlegm in his throat. Is he not fully recovered?"
Dad He said: "The doctor told me that the child is too young to use cough medicine casually. He said that coughing is a kind of protection, but people say that aerosol inhalation has many side effects."
Nowadays, the international and domestic pediatric circles have repeatedly recommended that children under 2 years old and before 6 years old are not recommended to take cough medicines and cold medicines (at least before 2 years old); just like antibiotics should not be abused in children, To prevent bacterial imbalance. Therefore, parents have been murmuring in their hearts, what should they do if their child coughs and cannot cough up phlegm?
Questions from parents:
In fact, over the years, the views on aerosol inhalation treatment have gone back and forth for a long time, and there has been endless debate. Which view is more reliable?
Isn’t it said that a child’s cough can be cured quickly by nebulizing it? When parents take their children to see a doctor, the doctor will most likely ask the child to do atomization inhalation. Is the effect of atomization treatment so "magical"?
Recently, atomization inhalation has been circulated on the Internet, mostly due to the effect of hormones. Who dares to use hormones? What obesity, buffalo hump, beard growth and infections? Who wouldn’t shy away from this side effect?
The adverse reactions of aerosol inhalation are no less than those of infusion. The mucous membrane absorbs drugs quickly. Does that mean that the side effects of the drugs can also affect the body? Can any medicine be used during aerosol inhalation? Can antibiotics also be used? Oh, now that information is so developed, anyone will get the answer as soon as they ask "Du Niang", but it is unknown whether it is accurate or not.
Authoritative guidance:
In fact, atomization treatment is not a "new treatment", nor is it derived from intravenous infusion therapy because people seek convenience. As early as the 1950s, British medical research had used atomization therapy as an auxiliary treatment for respiratory diseases, and my country has also carried out atomization therapy for respiratory diseases in clinical practice for 20 to 30 years.
In order to further standardize and rationally use children's medicines and ensure the safety of children's medicines, the National Children's Medical Center and the "Chinese Journal of Practical Pediatrics" editorial board have organized discussions with experts from the national pediatric community in recent years and have formulated a number of The most authoritative clinical guidelines and knowledge related to aerosol inhalation therapy include "Guidelines for Rational Medication Use in Children with Asthmatic Diseases", "Experts' Knowledge on Rational Medication Use of Atomized Inhalation Therapy (2019 Edition)", "Atomization Inhalation Therapy" "Expert Knowledge on the Application of Therapy in Respiratory Diseases"; This provides us with authoritative guidance on aerosol inhalation, and provides guarantees and medication specifications for children's atomization treatment. As long as we strictly follow the medication guidelines, aerosol inhalation will Inhalation treatment is safe and reliable.
What is atomized inhalation:
Nebulized inhalation is to mix drugs and sterilized water in a professional atomizing device, and dissolve and disperse them into inhalable substances through the atomizing device. The tiny droplets (small droplets or particles with a diameter of several microns) are deposited in the respiratory tract and/or lungs through the child's inhalation, thereby achieving local treatment of the respiratory tract.
The function is:
Atomized inhalation allows the drug to directly act on the respiratory mucosa to achieve direct curative effect. Moreover, atomized inhalation is safe, easy to operate, and the dosage can be flexibly adjusted. , convenient application and other characteristics, and has no special requirements for children's treatment compliance, which is especially suitable for pediatric patients, so it has been widely used clinically in pediatrics. It has been widely used in the auxiliary treatment of children with bronchial asthma, acute laryngitis, bronchiolitis, bronchopneumonia and other diseases.
Therefore, we can understand that our respiratory tract is connected with the outside world. Atomized inhalation makes full use of the openness of the respiratory tract and adds some processed and inhalable medicine-containing substances into the air that children breathe. The mist droplets can relieve airway spasm, anti-inflammation, humidification, and thin sputum.
First of all, we still have to emphasize that the medication routes and treatment purposes are different between the two. Atomized inhalation is more used as an auxiliary treatment for respiratory diseases. Therefore, its scope of medication may be smaller than intravenous infusion. No intravenous infusion. Intravenous infusion is a method of injecting large amounts of fluids, electrolytes, drugs, etc. into various organs of the body through intravenous channels for treatment.
In recent years, scientific research departments have continuously improved the driving devices of atomized inhalation, which has increased the types of drugs used in atomization and gradually enhanced safety. At present, it is mainly used for laryngitis, bronchitis, bronchiolitis, pneumonia, etc. in children, and has obvious effects in relieving asthma and reducing phlegm.
1. Atomized inhalation is convenient, quick and non-invasive:
Atomized inhalation is easy to operate. You can choose an ultrasonic atomizing device at home, or an air compressor pump or oxygen in the hospital. The driving atomization device generally does not require special professional training to operate. Infusions must be punctured and infused by professional medical staff. The aseptic operation technology requires strict requirements, so ordinary people cannot operate it.
Atomized inhalation is a non-invasive operation, children are less alert, and the compliance with treatment is better than intravenous infusion. Venipuncture is an invasive operation, so children will cry when they see the needle. , unwilling to undergo infusion.
2. Local atomized medication has a quick effect:
Nebulized inhalation causes the drug to directly act on the respiratory mucosa and does not need to be transported through the systemic blood circulation, so the drug is only effective Fast, especially bronchodilators and anti-inflammatory glucocorticoids.
3. The adverse reactions of drugs are small:
Since atomized inhalation directly acts on the respiratory mucosa and is based on local administration, the dosage of atomized treatment is Compared with systemic medication, that is, the amount of intravenous infusion is much smaller, especially the glucocorticoid dosage is less than 1/10 of the infusion or oral dose. This alone is safer than infusion, and has relatively few adverse reactions. Intravenous infusion is transported through the blood throughout the body, and its blood drug dose and concentration are large and the drug has a long half-life; therefore, it will increase the burden on the child's liver and kidney functions.
At the same time, no matter how strict the aseptic technique is, the chance of infusion reaction is inevitable. Pyrogenic substances (allergy, agglutination, antigen, etc.) in the liquid will cause sudden high fever, chills, and Hypersensitivity reactions such as skin allergies, severe anaphylactic shock, and life-threatening conditions. This is the biggest hazard of intravenous infusion.
1. Inhaled glucocorticoid: It acts as an anti-inflammatory. It is currently the strongest local anti-inflammatory drug in the airway recognized by experts. It is mainly used for inflammatory hyperresponsiveness in the airway. treatment of bronchial asthma. Commonly used and recommended inhaled steroid drug suspensions include budesonide, beclomethasone dipropionate and fluticasone propionate.
The World Health Organization and the Chinese Academy of Pediatrics have designated budesonide as the only recommended basic drug list for children’s anti-asthma drugs, and the drug is currently suitable for children under 12 years old. Fluticasone propionate is only suitable for the treatment of mild to moderate asthma exacerbations in children aged 4 to 16 years.
2. β2 receptor agonists: This type of drug is the most commonly used bronchodilator in clinical practice. It is characterized by rapid onset of action and short maintenance time. As a short-term medication for bronchial asthma, it usually lasts 4 to 6 hours. It is mainly used to relieve bronchospasm and stenosis. It can be used as needed and takes effect within minutes. This drug is generally used in combination with hormones to have a synergistic effect. Two commonly used nebulized preparations of β2-agonists are terbutaline and salbutamol.
3. Cholinergic M receptor antagonist: It has bronchodilator effect and is mainly used for children with wheezing, coughing and phlegm. This drug has a slow onset of action, but its duration is longer than that of beta2 receptor agonists. Therefore, it is often used in combination with albuterol, which can complement each other. It is mainly used for combined inhalation during acute asthma attacks. The main nebulized drug is ipratropium bromide.
4. Expectorants: These drugs can make sputum thinner and less viscous, making it easier to cough up, or can accelerate the movement of cilia in the respiratory mucosa and improve the transport function of sputum. It mainly promotes the discharge of phlegm accumulated in the respiratory tract lumen, reduces irritation to the respiratory mucosa, indirectly plays an antitussive and asthmatic role, and is also helpful in controlling secondary infections. At present, there are two types of atomized inhalation expectorants in China, acetylcysteine ??solution for inhalation and ambroxol hydrochloride solution for inhalation.
However, after clinical drug investigation, not all drugs and all diseases can be aerosolized. Under normal circumstances, the application and administration of aerosol inhalation should be diagnosed and guided by a doctor. According to individual differences, the diagnosis and treatment plan will also be different. Any treatment methods and drugs cannot be abused casually.
1. Dexamethasone, alpha-chymotrypsin, antibiotics and antiviral drugs (interferon and ribavirin), Chinese patent medicine injection, etc. Especially for children who are highly allergic to antibiotics, even if there is a skin allergy test, the drug is absorbed through the skin and mucous membranes, and there is still a risk of allergy. For Chinese patent medicine preparations, due to the complex types of medicines, the side effects of the medicines have not been confirmed, and there are also potential drug safety risks.
2. Although there are reports of clinical application of ambroxol injection in China, there is currently no safety evaluation statement for atomized inhalation. The 2018 version has designated it as an off-label medication list and does not recommend aerosol inhalation. It is intended for inhalation use. Therefore, for safety reasons, it is not recommended to use it outside the range. Children often choose acetylcysteine ??nebulizer for inhalation.
1. First, clean and disinfect the atomizer device so that it can be disinfected after each use. Especially the mask, distiller and pipe for inhalation should be used by one person only.
2. When doing inhalation therapy, teach children to stay calm and take slow, deep breaths. This will help the drug particles to deposit in the respiratory tract, especially the bronchi and alveoli, and try to achieve better drug absorption.
3. Children should use various methods to make the child breathe as steadily as possible. The child's crying will affect the treatment effect, because the drug particles mainly deliver the drug to the oropharynx through the inertia of the airflow.
4. Nowadays, the mask is suitable for children's age. When wearing a mask for a child, it should fit the face as comfortably and tightly as possible so that the drug particles can be evenly inhaled and not sprayed into the eyes.
5. When atomizing inhalation, parents should pay attention to their children's breathing, coughing, and sputum production. If the child is irritable and crying, they should stop atomizing inhalation or consult a doctor. After treatment, you should give or wash your face to reduce the absorption of the drug in other parts of the body. At the same time, rinse your mouth or drink water to avoid drug residue in the oropharynx.
6. Atomized inhalation is also a medical behavior, especially atomized inhalation is a prescription drug. Parents must use atomized inhalation correctly according to the needs of their condition and under the guidance of a doctor.