Nebulized medications include bronchodilators, anti-inflammatory medications, mucolytics and wetting agents, anti-infective medications and inhaled opiates. A nebulizer is a medical device that uses compressed air, oxygen, ultrasonic power or breath actuation to transform a solution or medication into aerosolized particles for deposition into the lower airways by inhaling through a mouthpiece or mask. The inhalation of medication provides a quicker onset of action and reduced side effects when compared to other routes of drug administration such as oral, intravenous or intramuscular injections. The medication prescribed will determine the nebulizer that should be used.
Bronchodilators
Bronchodilators prevent and treat bronchospasm by relaxing the smooth muscles that surround the airways. It is important to note the additional effects that certain drugs will have on the body; alpha drugs (A) increase blood pressure, beta-1 (B1) drugs increase the heart rate, and beta-2 (B2) drugs cause bronchodilation. Short-acting B2 bronchodilators, such as albuterol, levalbuterol and bitolterol, provide symptom relief within five to 10 minutes and usually last four to six hours.
The following medications also cause bronchodilation, but in addition to other responses. For instance, racemic epinephrine causes an increase in blood pressure (A response) and an increase in heart rate (B1 response), and is used in emergent situations to reduce edema, or swelling in the upper airway, but it also produces the B2 effect of bronchodilation. Other such medications include isoetharine (B1, B2), isoproterenol (B1, B2), metaproterenol (B1, B2) and epinephrine (A, B1, B2).
Anti-Inflammatory Medications
Budesonide, also called Pulmicort or Pulmicort Respules, is an inhaled corticosteroid anti-inflammatory drug that can be nebulized. Pulmicort Respules cannot be used with an ultrasonic nebulizer or any unit that generates heat. Cromolyn sodium (brand name Intal and Crolom) is a nonsteroidal anti-inflammatory drug (NSAID) that, when nebulized, has a 20- to 30-minute onset of action and lasts approximately two to six hours.
Mucolytics and Wetting Agents
Mucolytics thin and liquefy thick mucus or secretions. These drugs increase the production of fluids from the respiratory tract to reduce the viscosity, or thickness, of secretions, enabling them to be coughed up. The downside of mucolytics is that they can cause bronchospasm, so physicians will order a nebulizer treatment with a bronchodilator prior to giving nebulized mucolytics. Mucolytics include acetylcysteine (brand name Mucomyst) and dornase alfa (brand name Pulmozyme).
A wetting agent humidifies and thins secretions and is mixed with a bronchodilator to prevent bronchospasm. Wetting agents, such as saline, are also drug diluents.
Inhaled Opiates
Inhaled opiates, such as morphine, relieve shortness of breath in patients with end-stage pulmonary disease when other drugs have become ineffective. Inhaled morphine causes substantially fewer side effects than other routes of administration.
Anti-Infective Medications
Tobramycin (brand name Nebcin) is an antibiotic that can be nebulized and used to treat cystic fibrosis and many bacterial pulmonary infections. Pentamidine isethionate (NebuPent) is used to treat and prevent Pneumocystis carinii pneumonia. Ribavirin (brand name Virazole) is an antiviral used to treat respiratory syncytial virus and as a prophylactic for patients at risk for severe infection, such as those with a compromised immune system.
