Nebulisation side effects
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Nebulisation Side Effects: An Overview
Nebulisation is a common method for delivering medication directly to the lungs, particularly for patients with respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and other pulmonary diseases. While effective, nebulisation can have various side effects, which are important to understand for both patients and healthcare providers.
Common Side Effects of Nebulised Therapy
Dry Mouth, Tremor, and Chest Tightness
Patients using nebulisers frequently report experiencing dry mouth, tremor, and chest tightness. These side effects are commonly associated with the medications used in nebulisers, such as bronchodilators and corticosteroids1.
Cardiovascular and Endocrine Effects
Nebulised beta-2 agonists, often used for asthma exacerbations, can lead to significant cardiovascular changes, including tachycardia and palpitations, as well as reductions in potassium levels. These side effects are frequently observed but their overall impact on the patient's condition remains unclear2.
Cough and Hemoptysis
In the treatment of Pneumocystis carinii pneumonia with nebulised pentamidine, side effects such as cough and hemoptysis (coughing up blood) have been reported. These side effects were more frequent in patients using nebulisers that produced larger aerosol droplets3.
Bronchoconstriction
Nebulised iloprost, used for severe pulmonary hypertension, can cause bronchoconstriction, particularly in patients with additional obstructive lung diseases. This side effect led to the discontinuation of treatment in some patients4.
No Significant Adverse Events with Hypertonic Saline
In the treatment of acute bronchiolitis in infants, nebulised hypertonic saline has not been associated with significant adverse events. This treatment has been shown to reduce the length of hospital stay and improve clinical severity scores without notable side effects5.
Non-Drug Constituent Reactions
Adverse reactions can also occur due to the non-drug constituents of nebuliser solutions. These reactions can include irritation and allergic responses, which are important to consider when selecting nebuliser solutions for patients6.
Morphine Nebulisation
Low dose nebulised morphine, used to relieve dyspnoea in chronic lung disease, has shown minimal side effects. In a study, no significant adverse effects were reported, suggesting that this treatment is relatively safe for managing dyspnoea7.
Surfactant Nebulisation in Preterm Infants
Nebulised surfactant for preterm infants with respiratory distress syndrome has not shown significant side effects in the limited studies available. However, more research is needed to fully understand the safety profile of this treatment8.
Improved Drug Delivery with Ventstream Nebuliser
The Ventstream nebuliser system, which provides a more efficient delivery of salbutamol, has been associated with increased systemic absorption and bronchodilator effects. While this improved delivery can enhance treatment efficacy, it also increases the potential for systemic side effects9.
Positional Effects on Drug Deposition
A study on the effects of side lying during nebulisation found that this position can significantly improve drug deposition in the apical regions of the lungs in healthy adults and those with mild cystic fibrosis. This method did not significantly alter overall lung deposition or cause additional side effects10.
Conclusion
Nebulisation is a valuable method for delivering respiratory medications, but it is not without side effects. Common issues include dry mouth, tremor, chest tightness, cardiovascular changes, and bronchoconstriction. Understanding these side effects and their management is crucial for optimizing patient care and ensuring the safe use of nebulised therapies.
Sources and full results
Most relevant research papers on this topic
How do patients use their nebuliser in the community?
Patients with asthma and COPD show poor compliance with nebuliser care and maintenance instructions, suggesting a new patient information leaflet could improve compliance.
Observational StudyEffects of nebulised beta-2 agonists on clinical observations in asthma exacerbations
Nebulised beta-2 agonists show therapeutic effects in asthma exacerbations, but their impact on overall patient condition remains unclear due to unclear cardiovascular and endocrine side effects.
Systematic ReviewNebulised pentamidine as treatment for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.
Nebulised pentamidine (8 mg/kg) delivered by Respirgard II nebuliser is as effective as conventional treatment for Pneumocystis carinii pneumonia of mild to moderate severity in acquired immunodeficiency syndrome patients.
Effects of nebulised iloprost on pulmonary function and gas exchange in severe pulmonary hypertension.
Nebulized iloprost improves functional improvement in severe pulmonary hypertension without systematic adverse effects on pulmonary function tests or gas exchange, but may cause bronchoconstriction in patients with additional obstructive lung disease.
Non-RCTNebulised hypertonic saline solution for acute bronchiolitis in infants.
Nebulized hypertonic saline solution significantly reduces hospital stay duration and improves clinical score in infants with acute viral bronchiolitis compared to 0.9% saline.
Meta-Analysis
Very Rigorous Journal
Highly CitedAdverse reactions to the non-drug constituents of nebuliser solutions.
Nebulisation is effective in treating respiratory disorders, but adverse reactions to non-drug constituents in nebuliser solutions may occur.
Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease.
Low dose nebulised morphine significantly increases exercise endurance in patients with chronic lung disease, potentially due to its direct effect on lung afferent nerves.
RCTHighly CitedNebulised surfactant in preterm infants with or at risk of respiratory distress syndrome.
Nebulised surfactant administration in preterm infants with respiratory distress syndrome shows insufficient data to support its use in clinical practice.
Meta-AnalysisVery Rigorous JournalNebuliser performance, pharmacokinetics, airways and systemic effects of salbutamol given via a novel nebuliser delivery system ("Ventstream").
The Ventstream nebuliser significantly increases salbutamol delivery to the lung compared to the Hudson nebuliser, leading to increased systemic beta 2 responses and improved bronchodilator effects.
Highly CitedSide lying during nebulisation can significantly improve apical deposition in healthy adults and adults with mild cystic fibrosis lung disease: a randomised crossover trial
Alternating between right and left side lying during nebulisation significantly improves apical deposition in healthy adults and those with mild cystic fibrosis lung disease without significantly detriment to overall deposition.
RCT
Rigorous Journal