How is a nebulizer used to treat bronchitis?

Nebulizer Use in Bronchitis Treatment

Nebulizers are primarily used in bronchitis to deliver bronchodilators, mucolytics, and occasionally antibiotics directly to the airways when hand-held inhalers are insufficient or when patients cannot effectively use them. 1

Types of Medications Used in Nebulizers for Bronchitis

• Bronchodilators: Beta-agonists such as salbutamol (Ventolin) and terbutaline (Bricanyl), and anticholinergics such as ipratropium bromide (Atrovent) are commonly used to relieve bronchospasm 1
• Hypertonic saline (3%): Recommended for patients with bronchiectasis or chronic bronchitis with viscous secretions to improve mucociliary clearance, typically administered before airway clearance techniques 2
• Steroids: For example, budesonide (Pulmicort) respules may be used in some cases 1
• Antibiotics: In specific cases such as bronchiectasis, though less common than in cystic fibrosis 1

Indications for Nebulizer Use in Bronchitis

Nebulizers are preferable to hand-held inhalers when:

• Large drug doses are needed for symptom control 1
• Controlled coordinated breathing is difficult (e.g., in acute exacerbations) 1
• Hand-held inhalers have been found ineffective despite proper technique 1
• The patient is unable to use hand-held inhalers effectively 1
• Specific medications are only available in nebulized form 1

Proper Administration Technique

Equipment Setup:

• Use a compressor (air pump powered by electricity or battery) as the driving gas source 1
• Flow rate should be 6-8 L/min to nebulize particles to 2-5 μm diameter for optimal deposition in small airways 1
• Volume of fluid in the nebulizer chamber is typically 2.0-4.5 mL 1

Administration Steps:

1. Place medication in nebulizer reservoir 3
2. Connect nebulizer reservoir to mouthpiece or face mask 3
3. Connect nebulizer to compressor 3
4. Sit in comfortable, upright position 3
5. Place mouthpiece in mouth or apply face mask 3
6. Turn on compressor 3
7. Breathe calmly, deeply, and evenly until no more mist forms (approximately 5-15 minutes) 3

Choice of Interface:

• Masks are better for acutely ill patients when holding the nebulizer is tiring or for those who have difficulty with coordination 1
• Mouthpieces should be used for nebulized steroids to prevent facial deposition and for antibiotics to allow filter use 1

Medication Dosing for Bronchitis

• Albuterol (Salbutamol): For adults and children ≥2 years weighing at least 15 kg, the usual dosage is 2.5 mg administered 3-4 times daily by nebulization 3
• Hypertonic Saline: Typically 3% concentration, administered once or twice daily before airway clearance techniques 2

Sequence for Multiple Medications

When multiple medications are needed, follow this sequence:

1. Bronchodilator (if prescribed) 2
2. Hypertonic saline (if prescribed) 2
3. Airway clearance techniques 2
4. Nebulized antibiotics and/or inhaled steroids (if applicable) 2

Cleaning and Maintenance

• Wash mouthpiece/mask and nebulizer chamber in warm water with detergent, rinse thoroughly and dry well after each use, or at minimum once daily 1
• Run the nebulizer empty for a few moments after cleaning 1
• Wipe compressor and tubing with a damp cloth weekly 1
• Replace disposable parts (masks, mouthpieces, nebulizers, filters, tubing) every three months, or annually if long-lasting type 1
• Service compressor once a year 1

Important Caveats and Considerations

• Avoid using water as a diluent as it may cause bronchoconstriction when nebulized 1
• Avoid bacteriostatic saline containing benzyl alcohol as it can cause bronchitis in healthy adults 4
• For patients with bronchiectasis, an "n of one" trial is recommended to determine if nebulized therapy is beneficial in their specific case 1
• If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this may indicate worsening condition 3
• In most cases, hand-held inhalers with proper technique are as effective as nebulizers, making nebulizers primarily indicated for specific situations 1

Special Considerations for Different Types of Bronchitis

• Acute Bronchitis: Nebulizers may be used for short-term symptom relief, particularly in patients with underlying respiratory conditions 1
• Chronic Bronchitis/COPD: Regular assessment is needed to determine continued benefit; approximately 30% of patients report subjective benefit but show little objective improvement 1
• Bronchiectasis: Recommendations for cystic fibrosis apply, though with less experimental evidence of benefit; individualized "n of one" trials are recommended 1

By following these guidelines, nebulizer therapy can be effectively used to manage bronchitis symptoms while minimizing potential complications and ensuring optimal medication delivery.