Side effects of nebulizer
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Side Effects of Nebulizer Treatments
Nebulizers are commonly used to deliver medication directly to the lungs, providing relief for various respiratory conditions such as asthma, COPD, and cystic fibrosis. However, like all medical treatments, nebulizer use can come with side effects. This article synthesizes findings from multiple studies to provide a comprehensive overview of the side effects associated with nebulizer treatments.
Cardiovascular Side Effects
Heart Rate and Blood Pressure Changes
Several studies have reported changes in heart rate and blood pressure as side effects of nebulizer treatments. For instance, a study comparing continuous and intermittent albuterol nebulization found no significant chronotropic effects, indicating that heart rate changes were minimal at the administered dose1. However, another study noted that high doses of nebulized albuterol in children did not significantly affect heart rate or blood pressure, although side effects like tremor and hyperactivity were observed4.
In contrast, nebulized adrenaline (epinephrine) has been shown to cause a significant increase in heart rate in children, with the mean increase varying from seven to 21 beats per minute up to 60 minutes after treatment7. This suggests that while some nebulized medications may have minimal cardiovascular effects, others can significantly impact heart rate.
Serious Cardiovascular Events
High-dose isoproterenol continuous nebulization in children with status asthmaticus was associated with serious cardiovascular side effects, including elevated heart rates, arrhythmias, and even myocardial infarction in one case10. This highlights the potential risks of high-dose nebulized treatments, particularly in vulnerable populations.
Respiratory and Systemic Side Effects
Tremors and Shakiness
Tremors and shakiness are common side effects of beta-agonist nebulizers. A study comparing fenoterol and isoproterenol found that shakiness or tremor of the hands was the most common side effect, appearing to be dose-related in terms of incidence and intensity3. Similarly, another study reported that both high and low doses of nebulized albuterol in children resulted in side effects like tremor and hyperactivity, although these were not significantly different between the two dosage groups4.
Hypokalemia
Beta-agonist-induced hypokalemia, a condition where potassium levels in the blood drop, was more pronounced in patients receiving intravenous albuterol compared to those receiving nebulized albuterol2. This suggests that while nebulized treatments may be effective, they can still lead to systemic side effects such as electrolyte imbalances.
Mild-to-Moderate Adverse Effects
Nebulized Opioids
Nebulized opioids, used for the palliation of dyspnea in terminally ill patients, have been associated with mild-to-moderate adverse effects. These include claustrophobia due to the nebulizer mask, drowsiness, cough, and a bitter taste5. Despite these side effects, nebulized opioids have been found to provide subjective relief of dyspnea with minimal adverse events.
Ciliary Activity
The influence of nebulized drugs on nasal ciliary activity has also been studied. Salbutamol was found to have a ciliostimulatory effect, while hypertonic saline and dry air had cilioinhibitory effects8. This indicates that some nebulized medications can affect the natural defense mechanisms of the respiratory tract, potentially leading to additional complications.
Conclusion
Nebulizer treatments, while effective for delivering medication directly to the lungs, can come with a range of side effects. These can vary from mild issues like tremors and a bitter taste to more serious cardiovascular events and electrolyte imbalances. It is crucial for healthcare providers to weigh the benefits and risks of nebulizer treatments, especially in vulnerable populations such as children and terminally ill patients. Further research is needed to optimize dosing and minimize adverse effects, ensuring the safe and effective use of nebulizers in clinical practice.
Sources and full results
Most relevant research papers on this topic
Continuous versus intermittent albuterol nebulization in the treatment of acute asthma.
Both intermittent and continuous albuterol nebulization are safe for treating acute asthma, with continuous nebulization showing a higher rate of percent predicted FEV1 increase.
RCT
Highly CitedNebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study.
Nebulized albuterol is more effective and has fewer side effects than intravenous albuterol in hypercapnic acute asthma patients.
RCTHighly CitedBronchodilator effects of nebulized fenoterol: a comparison with isoproterenol.
0.5 to 1.0 mg of fenoterol is a suitable single therapeutic dose for reversible airway obstruction when administered by compressor-powered nebulization, with no significant effect on heart rate and blood pressure.
RCTHigh-versus low-dose, frequently administered, nebulized albuterol in children with severe, acute asthma.
High-dose, frequently administered nebulized albuterol is safe and effective in treating severe, acute asthma in children, with greater improvement in symptoms and lower hospitalization rates.
RCTHighly CitedNebulized opioids for the palliation of dyspnea in terminally ill patients.
Nebulized opioids may provide subjective relief of dyspnea in terminally ill patients with mild-to-moderate adverse effects.
Systematic ReviewIsoetharine versus albuterol for acute asthma: greater immediate effect, but more side effects.
Isoetharine has a greater immediate effect on improving FEV1 levels in acute asthma patients, but has more side effects compared to albuterol.
RCT[The safety of nebulization with 3 to 5 ml of adrenaline (1:1000) in children: an evidence based review].
Nebulization with 3 to 5 ml of adrenaline (1:1000) is a safe therapy with minor side-effects for children with acute inflammatory airway obstruction.
Systematic ReviewThe Influence of Nebulized Drugs on Nasal Ciliary Activity.
Nebulized drugs used off-label may influence nasal ciliary activity, which should be considered when prescribing them for non-CF indications.
In Vitro Study
Rigorous JournalComparison of the bronchodilative effects of salbutamol delivered via three mesh nebulizers in children with bronchial asthma.
All three mesh nebulizers effectively treat bronchial asthma in children, but some differences in lung function improvement are evident.
RCT[Isoproterenol continuous nebulization for childhood status asthmaticus. I. Efficacy and side effects of high-dose method].
High-dose isoproterenol continuous nebulization is effective for childhood status asthmaticus, but may cause serious side effects.
Non-RCT