What medications are recommended for use with a mesh nebulizer?

Medications Recommended for Mesh Nebulizers

Mesh nebulizers are suitable for delivering bronchodilators (beta-agonists and anticholinergics), inhaled corticosteroids, antibiotics, mucolytics, and hypertonic saline, with specific FDA approval for dornase alfa (Pulmozyme) using designated vibrating mesh systems.

Primary Medication Categories

Bronchodilators

• Beta-agonists such as albuterol (salbutamol) and terbutaline are the most commonly nebulized medications for acute and chronic airway obstruction 1.
• Anticholinergics including ipratropium bromide (Atrovent) are frequently used, particularly in COPD and when combined with beta-agonists 1.
• These medications can be mixed together in the same nebulizer chamber to achieve the required 2.0-4.5 mL volume 1.

Inhaled Corticosteroids

• Budesonide (Pulmicort) respules are the recommended steroid formulation for nebulization 1, 2.
• A mouthpiece must be used (not a mask) to prevent facial deposition and reduce the risk of oral thrush 1.
• Patients must rinse their mouth after nebulizing steroids to prevent oral candidiasis 1, 2.

Antibiotics

• Colistin and gentamicin are nebulized for patients with cystic fibrosis 1.
• A mouthpiece with a filter must be used to prevent exhalation of antibiotic particles into the air, protecting staff and family members 1.
• Two filters should be supplied and dried between uses to maintain effectiveness 1.

Mucolytics

• Dornase alfa (Pulmozyme) is FDA-approved specifically for use with designated vibrating mesh nebulizers including eRapid, Innospire Go, Pulmogine, AireHealth, and Intelligent Mesh Nebulizer 3.
• This medication must not be mixed with any other inhaled medicines in the nebulizer 3.
• The entire 2.5 mg ampule (1 mg/mL) must be used immediately once opened 3.

Other Medications

• Pentamidine for HIV-positive patients as treatment or prophylaxis for Pneumocystis carinii pneumonia 1.
• Lignocaine (lidocaine) in terminal care to relieve intractable cough, typically 2-5 mL of 2% solution, preceded by a beta-agonist 1.
• 0.9% sodium chloride (normal saline) to assist with physiotherapy and airway clearance 1.

Critical Safety Considerations

Medication Incompatibilities

• Never use water for nebulization as it causes bronchoconstriction when nebulized 1.
• Do not dilute or mix medications unless specifically indicated, as this can lead to adverse physicochemical changes 3.
• Keep all inhaled medication systems completely separate from each other 3.

Device-Specific Requirements

• Mesh nebulizers require specific maintenance including cleaning after each use and disinfection according to manufacturer guidelines 3.
• Check medication ampules for leaks by turning upside down and gently squeezing before use 3.
• Ensure the liquid is clear and free of particles; discard if cloudy or discolored 3.

Administration Technique

• Patients should sit upright, take normal steady breaths (tidal breathing), and keep the nebulizer upright during treatment 1.
• Treatment typically takes 10 minutes for bronchodilators, though antibiotics, steroids, and mucolytics may require longer 1.
• Nebulizers should only be used on a physician's recommendation 1.

Common Pitfalls to Avoid

• Tremor from beta-agonists is dose-related and particularly problematic in elderly patients; verify whether tremor is from the bronchodilator component rather than the steroid 4.
• Glaucoma exacerbation can occur with anticholinergics when using a mask; use a mouthpiece instead 1.
• Inadequate drug delivery occurs if the nebulizer is not held upright or if patients talk during nebulization 1.
• Cross-contamination risk exists if equipment is not properly cleaned; dirty or moist equipment can cause chest infections 1.