What is the recommended breathing treatment to help clear lungs?

Recommended Breathing Treatments to Help Clear Lungs

The recommended breathing treatment to help clear lungs is nebulized bronchodilator therapy, specifically using beta-agonists such as salbutamol (5 mg) or terbutaline (10 mg), which may be combined with ipratropium bromide (500 μg) in more severe cases. 1

Nebulizer Treatment Protocols

Standard Administration Technique

• Nebulizer treatments should last 5-10 minutes, continuing until about one minute after "spluttering" occurs rather than until complete dryness 2
• Patients should tap the nebulizer cup towards the end of treatment to ensure maximum medication delivery 2
• Most nebulizers work effectively with drug volumes of 2-5 ml; if the system has a residual volume >1.0 ml, the drug volume should be made up with 0.9% sodium chloride to a minimum of 4.0 ml 1
• Patients should breathe as calmly, deeply, and evenly as possible until no more mist is formed in the nebulizer chamber (about 5-15 minutes) 3, 4

Medication Selection Based on Condition

For Asthma:

• For acute severe asthma: Nebulized beta-agonist (salbutamol 5 mg or terbutaline 10 mg) 1, 2
• If poor response: Add ipratropium bromide 500 μg to the beta-agonist 1, 2
• Repeat treatments 4-6 hourly until peak expiratory flow (PEF) >75% predicted normal or best 1

For COPD:

• For mild exacerbations: Bronchodilators via hand-held inhaler (salbutamol 200-400 μg or terbutaline 500-1000 μg) 1
• For more severe cases: Nebulized salbutamol (2.5-5 mg) or terbutaline (5-10 mg) or ipratropium bromide (500 μg) given 4-6 hourly 1
• Combined treatment (beta-agonist with ipratropium bromide) should be considered in severe cases, especially with poor response to either treatment alone 1, 5

Special Considerations

• For patients with carbon dioxide retention and acidosis, nebulizers should be driven by air rather than high-flow oxygen 1
• Beta-agonists may rarely precipitate angina in elderly patients; first treatment should be supervised 1
• For patients with glaucoma using ipratropium, a mouthpiece rather than mask should be considered to prevent eye contact with medication 1

Additional Treatments for Specific Conditions

For Tenacious Secretions:

• Normal saline (0.9% sodium chloride, 5 ml six hourly) may be tried to loosen tenacious secretions, though supporting evidence is limited 1

For Cystic Fibrosis and Severe Bronchiectasis:

• Nebulized antibiotics may be considered, but treatment should be supervised by appropriate hospital specialists 1

For Non-Productive Cough:

• Local anesthetics such as 2% lignocaine (2-5 ml) or 0.25% bupivacaine (2-5 ml) may be indicated, particularly if due to large airway tumor or bronchial stent 1
• Pretreatment with a beta-agonist is recommended to prevent bronchospasm 1
• Patients should avoid eating or drinking for about an hour after treatment due to reduced cough reflex sensitivity 1

Delivery Method Considerations

• While nebulizers are traditionally used for acute severe cases, metered-dose inhalers with valved holding chambers (MDI+VHC) can be equally effective for delivering bronchodilators in many situations 6, 7
• MDI+VHC offers practical advantages including home use capability, portability, less setup time, and no need for daily disinfection 6

Common Pitfalls and Caveats

• Using dryness as an endpoint for nebulization can lead to excessive treatment duration; instead, continue until about one minute after "spluttering" occurs 2
• Failure to properly maintain nebulizer equipment can reduce treatment efficacy; disposable components should be changed every 3-4 months and compressors serviced annually 1
• Administering nebulized medications without proper assessment of the underlying condition may lead to inappropriate treatment; a proper diagnosis should guide therapy 1
• Not monitoring oxygen saturation during nebulizer treatments, particularly in patients with severe respiratory compromise 1