Nebulizer side effects

Ipratropium bromide has a slower onset of action than short-acting /J2-agonists (15 to 20 minutes vs. 5 minutes for albuterol). For this reason, it may be less suitable for as-needed use, but it is often prescribed in this manner. Ipratropium has a more prolonged bronchodilator effect than short-acting /l2-agonists. Its peak effect occurs in 1.5 to 2 hours and its duration is 4 to 6 hours. The recommended dose via MDI is two puffs four times a day with upward titration often to 24 puffs/day. It is also available as a solution for nebulization. The most frequent patient complaints are dry mouth, nausea, and, occasionally, metallic taste. Because it is poorly absorbed systemically, anticholinergic side effects are uncommon (e.g., blurred vision, urinary retention, nausea, and tachycardia). 

Corticosteroids remain the main hallmark for the treatment of allergic disease/ asthma despite their adverse side effects. Although their administration via inhalers and nebulizers has alleviated some concerns because of their less detrimental side... 

These act on beta-2 adrenergic receptors, which relax bronchial smooth muscle. The primary side-effects are tachyarrhythmias and hypokalaemia, both of which tend to become clinically significant at high doses (i.e. when they are given in nebulized form or are intravenously administered, compared with the inhalation of aerosol or dry powder). 

Burges and Blackburn (1972) found that salbutamol selectively activated rat lung adenylate cyclase at concentrations that had no effect on the rat heart enzyme. Nebulized salbutamol can be as effective as that given intravenously (Lawford et al. 1978) but has the added advantage of fewer metabolic and symptomatic side-effects. The S isomer of salbutamol had no activity at extrapulmonary P2-adrenoceptors in man (Lipworth et al. 1997). The R isomer demonstrates approximately equivalent activity to racemic salbutamol when compared on a 1 2 microgram ratio. This suggests that the R isomer may offer possible therapeutic advantages over racemic salbutamol in view of less adverse airway effects with comparable systemic adverse effects. 

Add base balance p-Agonists including salbutamol could cause tachypnoea and paradoxical respiratory failure through the development of lactic acidosis, which is a rare side effect to nebulized salbutamol, has been reported [49 ]. The authors warn that medical staffs in the emergency department handling acute asthma should be aware of this paradox, though the condition may resolve in spite of continued treatment with salbutamol. 

Although the results indicate a good ionization stability, the problem of the unwanted formation of relatively large droplets could not be completely solved. This is likely due to the injection geometry since liquid is injected from one side, a liquid film occurs at one side of the nebulization channel. Further optimization of the injection geometry, such that the liquid is enclosed by the nebulization gas at both sides, might reduce this unwanted effect. 

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