What is the order for a breathing treatment?

From the Guidelines

The most effective order for a breathing treatment is to start with supplemental oxygen, followed by bronchodilators such as short-acting beta-agonists (e.g., salbutamol) and ipratropium, and then consider adding corticosteroids if necessary. This approach prioritizes the prevention of tissue hypoxia and addresses the underlying causes of bronchospasm and airway inflammation. According to the most recent and highest quality study 1, for acutely breathless patients not at risk of hypercapnic respiratory failure, treatment should be started with a reservoir mask at 15 L/min to maintain a target saturation of 94-98%.

Key Components of Breathing Treatment

• Supplemental oxygen: Use a reservoir mask at 15 L/min initially, and adjust downwards to maintain a target saturation of 94-98% 1
• Bronchodilators: Use short-acting beta-agonists (e.g., salbutamol) and ipratropium, administered via metered-dose inhaler (MDI) with a spacer or nebulizer 1
• Corticosteroids: Consider adding corticosteroids (e.g., prednisone) for patients with moderate to severe symptoms or those who do not respond to initial treatment 1

Administration and Monitoring

• Administer breathing treatments as needed, with the frequency adjusted based on symptom improvement
• Monitor patients for acidemia and consider noninvasive or invasive mechanical ventilation if CO2 retention occurs 1
• Ensure proper technique by having the patient take slow, deep breaths during treatment and rinse their mouth after steroid treatments to prevent oral thrush

Maintenance Therapy

• Consider budesonide 0.5 mg nebulized twice daily for maintenance therapy in conditions like COPD or persistent asthma
• Transition to metered-dose inhalers with spacers once the acute episode resolves for better portability and convenience 1

From the FDA Drug Label

Remove vial from the foil pouch, twist open the top of one unit-dose vial and squeeze the contents into the nebulizer reservoir (Figure 1). 2. Connect the nebulizer reservoir to the mouthpiece or face mask (Figure 2). 3. Connect the nebulizer to the compressor. 4 Sit in a comfortable, upright position; place the mouthpiece in your mouth (Figure 3) or put on the face mask and turn on the compressor. 5. Breathe as calmly, deeply and evenlyas possible until no more mist is formed in the nebulizer chamber (about 5 to 15 minutes). 6. Clean the nebulizer (see manufacturer’s instructions).

The order for a breathing treatment is:

• Prepare the medication: Remove the vial from the pouch and squeeze the contents into the nebulizer reservoir.
• Assemble the nebulizer: Connect the reservoir to the mouthpiece or face mask, and then connect the nebulizer to the compressor.
• Administer the treatment: Sit comfortably, place the mouthpiece in your mouth or put on the face mask, and turn on the compressor.
• Complete the treatment: Breathe calmly and deeply until no more mist is formed in the nebulizer chamber (about 5 to 15 minutes).
• Clean the nebulizer: Follow the manufacturer's instructions to clean the nebulizer after use 2.

From the Research

Order for a Breathing Treatment

The order for a breathing treatment can vary depending on the specific condition being treated and the medications being used. However, based on the available evidence, here are some general guidelines:

• For patients with COPD, the combination of ipratropium bromide and albuterol sulfate inhalation solution is often used, with treatments administered three times a day 3.
• For patients with acute bronchiolitis, nebulized albuterol may be used, with or without the addition of ipratropium bromide 4.
• For patients with acute asthma, albuterol metered-dose inhaler with a holding chamber may be used, with treatments administered at 30- to 60-minute intervals 5.
• For children with refractory acute asthma, nebulized albuterol with or without magnesium sulfate may be used, although the addition of magnesium sulfate has not been shown to decrease hospitalization rates 6.

Medication Administration

The administration of medications for breathing treatments can vary depending on the specific medication and the patient's condition. However, here are some general guidelines:

• Nebulized medications, such as albuterol and ipratropium bromide, are typically administered using a small-volume nebulizer 3.
• Metered-dose inhalers, such as albuterol, may be used with a holding chamber to improve medication delivery 5.
• The frequency and duration of medication administration can vary depending on the patient's condition and response to treatment 4, 3, 5, 6.

Treatment Frequency and Duration

The frequency and duration of breathing treatments can vary depending on the patient's condition and response to treatment. However, here are some general guidelines:

• For patients with COPD, treatments may be administered three times a day 3.
• For patients with acute asthma, treatments may be administered at 30- to 60-minute intervals 5.
• For children with refractory acute asthma, treatments may be administered every 20-40 minutes, with a maximum of three treatments per hour 6.