Hi all! By now you know that a nebulizer (also called an SVN, or small-volume nebulizer) is a great way to deliver medicine and cool, soothing mist deep into the lungs for all kinds of conditions. But what are some of the most commonly prescribed medicines for use in nebulizers, and what do they do? Here’s a top-6 rundown of common FDA-approved medicines. Remember, always consult your doctor before using a prescription medicine! She knows WAY more about the interactions and indications of various drugs than we do here!
Anticholinergic Agents: Used to treat COPD and sometimes acute asthma, among other conditions. They work by inhibiting certain nerve impulses that affect involuntary muscle movements. In lung conditions, anticholinergic medicines can decrease overproduction of mucus. Ipratropium bromide is the FDA-approved drug for use in nebulizers in this category; doctors may also prescribe glycopyrrolate or atropine, but these are considered less effective. Fun fact: the earliest known anticholinergic drug was derived from the plant belladonna, or deadly nightshade, a relative of tomatoes and eggplants.
Antibiotics: used to treat bacterial infections that often affect people with cystic fibrosis and bronchiectasis, as well as certain pneumonia infections. To be very clear, antibiotics do NOT affect viruses and are NOT a solution for coronavirus or flu. They only kill bacteria. Pentamidine is FDA-approved for use in nebulizers; doctors also prescribe amikacin, colistin, gentamicin, and tobramycin. Fun fact: Alexander Fleming discovered the first antibiotic, penicillin, in 1928 when a blob of Penicillium notatum mold (possibly from his sandwich bread!) fell into a petri dish of staphylococcus bacteria and killed everything it touched.
Mucolytic Agents: Mucolytics are medicines that thin mucus, making it less thick and sticky and easier to cough up. They are used to treat respiratory conditions characterized by excessive or thickened mucus, such cystic fibrosis. The main FDA-approved mucolytic drugs for use with nebulizers are dornase alfa and N-acetylsteine. These can cause bronchospasm (sharp contractions of the bronchial muscles) so are often prescribed together with a beta-agonist drug. Fun fact: Guaifenesin, the mucolytic agent in over-the-counter treatments such as Mucinex, is derived from beech wood.
Anti-inflammatory Agents (including corticosteroids): reduce the swelling inside airways and decrease the amount of mucus in the lungs. This is the cornerstone treatment for asthma, as well as being useful for COPD. Cromolyn sodium is the FDA-approved non-steroid drug for this use; widely used inhaled corticosteroids include budesonide, fluticasone, beclomethasone, flunisolide, mometasone, and triamcinolone. Fun fact: Corticosteroids are closely related to cortisol, the body’s natural stress hormone, and don’t function the same way as anabolic steroids, which are related to testosterone and contested home-run records. Many foods, such as green tea, also have anti-inflammatory properties.
Beta-agonist: A bronchodilator medicine that opens the airways by relaxing the muscles around the airways that may tighten during an asthma attack or in COPD (chronic obstructive pulmonary disease). The most common of these is albuterol, which is commonly prescribed alongside other drugs to control asthma. Fun Fact: beta-agonists offer quick relief to open constricted air passages, and have fewer side effects when inhaled through a nebulizer than when they’re taken in pill form.
Saline solution: A sterile saline solution (usually 0.9%) is used to help increase lung function and decrease the number of lung infections by thinning mucus in the airways. If the cool mist of the nebulizer feels good to the patient, it’s the best way of using the nebulizer without taking any extra prescription medicine. Sometimes doctors will prescribe a hypertonic saline solution, which means a much higher concentration of salt (3-7%) that can be a bit more irritating to breathe and is often paired with albuterol. Fun fact: normal saline solution has the same concentration of salt as your tears or sweat, and hypertonic solutions mimic seawater (which is 3.5% salt on average).
O’Donohue, Walter J., Jr. “Guidelines for the use of nebulizers in the home and at domiciliary sites: report of a consensus conference.” Chest, vol. 109, no. 3, Mar. 1996, p. 814+. Gale OneFile: Health and Medicine, https://proxy.multcolib.org:2809/apps/doc/A18157801/HRCA?u=multnomah&sid=HRCA&xid=224cf371. Accessed 24 Mar. 2020.