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成人吸入性药物的给药

Author
Dean Hess, RRT, PhD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
文加斌, 副主任医师，副教授

引言

治疗性气雾剂的给药是很多呼吸疾病治疗的一个重要组成部分。雾化治疗的优势包括：直接输送药物至作用部位、可能更快起效、减少药物的全身利用度以使药物不良反应最小化。

治疗性气雾剂可用给药装置的类型和功能将总结在此。关于吸入器最佳使用方法的患者教育和这些药物在治疗哮喘和慢性阻塞性肺疾病(chronic obstructive pulmonary diseases, COPD)中的作用将单独讨论。 (参见“成人吸入装置的用法”和“The use of inhaler devices in children”和“哮喘管理概述”和“稳定期慢性阻塞性肺疾病的处理”和“慢性阻塞性肺疾病急性加重的处理”)

概述

用于产生治疗性气雾剂的3种主要类型装置是压力定量吸入器(metered dose inhalers, MDI)、干粉吸入器(dry powder inhalers, DPI)和雾化器[1]。雾化器系统的便携性通常不如MDI和DPI。雾化器过去被认为是较昂贵的给药装置；然而，在某些情况下，MDI的商品名氢氟烷烃(hydrofluoroalkane, HFA)剂型可能比雾化器中使用的溶液更为昂贵。在雾化器中，已开发出3种基本类型，即喷射雾化器(又称气动雾化器)、超声雾化器及筛孔雾化器。

吸入(或者气雾剂)治疗可以采用多种药物和装置进行。示例包括：

  • 用于各种慢性阻塞性肺部疾病(例如，哮喘、COPD、支气管扩张、毛细支气管炎)的吸入型β受体激动剂和抗胆碱能支气管扩张剂
  • 用于哮喘、嗜酸性粒细胞性支气管炎和COPD的吸入型糖皮质激素
  • 用于预防肺孢子菌肺炎和治疗呼吸道合胞病毒、囊性纤维化和支气管扩张的吸入型抗生素
  • 用于囊性纤维化的气道分泌调节剂
  • 用于肺动脉高压的吸入型肺血管扩张剂[2]
  • 药物的气雾剂给药(例如，阿片类)可能用于治疗某些非呼吸系统疾病[3-5]

                         

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-22.
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References
Top
  1. Hess DR. Aerosol delivery devices in the treatment of asthma. Respir Care 2008; 53:699.
  2. Olschewski H, Simonneau G, Galiè N, et al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med 2002; 347:322.
  3. Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas 2009; 21:203.
  4. Krajnik M, Podolec Z, Siekierka M, et al. Morphine inhalation by cancer patients: a comparison of different nebulization techniques using pharmacokinetic, spirometric, and gasometric parameters. J Pain Symptom Manage 2009; 38:747.
  5. Nejmi H, Fath K, Anaflous R, et al. [A prospective randomized comparison of nebulized morphine versus thoracic epidural analgesia in the management of thoracic trauma]. Ann Fr Anesth Reanim 2010; 29:415.
  6. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005; 127:335.
  7. Brocklebank D, Wright J, Cates C. Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering corticosteroids in asthma. BMJ 2001; 323:896.
  8. Brocklebank D, Ram F, Wright J, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess 2001; 5:1.
  9. Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med 1997; 157:1736.
  10. Cates CJ, Crilly JA, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2006; :CD000052.
  11. Frei SP. Cost comparison of bronchodilator delivery methods in Emergency Department treatment of asthma. J Emerg Med 2000; 19:323.
  12. Turner MO, Gafni A, Swan D, FitzGerald JM. A review and economic evaluation of bronchodilator delivery methods in hospitalized patients. Arch Intern Med 1996; 156:2113.
  13. Ram FS, Wright J, Brocklebank D, White JE. Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering beta (2 )agonists bronchodilators in asthma. BMJ 2001; 323:901.
  14. National Asthma Education and Prevention Program. Expert panel report III: Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute (NIH publication no. 08-4051), Bethesda, MD 2007, www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on March 21, 2011).
  15. Newman SP. Principles of metered-dose inhaler design. Respir Care 2005; 50:1177.
  16. Fink JB. Metered-dose inhalers, dry powder inhalers, and transitions. Respir Care 2000; 45:623.
  17. Newman SP, Busse WW. Evolution of dry powder inhaler design, formulation, and performance. Respir Med 2002; 96:293.
  18. Atkins PJ. Dry powder inhalers: an overview. Respir Care 2005; 50:1304.
  19. Hess DR. Nebulizers: principles and performance. Respir Care 2000; 45:609.
  20. Rau JL. Design principles of liquid nebulization devices currently in use. Respir Care 2002; 47:1257.
  21. Leung K, Louca E, Coates AL. Comparison of breath-enhanced to breath-actuated nebulizers for rate, consistency, and efficiency. Chest 2004; 126:1619.
  22. Hess D, Fisher D, Williams P, et al. Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996; 110:498.
  23. Fink JB. Aerosol device selection: evidence to practice. Respir Care 2000; 45:874.
  24. Burchett DK, Darko W, Zahra J, et al. Mixing and compatibility guide for commonly used aerosolized medications. Am J Health Syst Pharm 2010; 67:227.
  25. Camargo CA Jr, Rachelefsky G, Schatz M. Managing asthma exacerbations in the emergency department: summary of the National Asthma Education And Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations. Proc Am Thorac Soc 2009; 6:357.
  26. Standaert TA, Vandevanter D, Ramsey BW, et al. The choice of compressor effects the aerosol parameters and the delivery of tobramycin from a single model nebulizer. J Aerosol Med 2000; 13:147.
  27. Standaert TA, Bohn SE, Aitken ML, Ramsey B. The equivalence of compressor pressure-flow relationships with respect to jet nebulizer aerosolization characteristics. J Aerosol Med 2001; 14:31.
  28. Reisner C, Katial RK, Bartelson BB, et al. Characterization of aerosol output from various nebulizer/compressor combinations. Ann Allergy Asthma Immunol 2001; 86:566.
  29. Hess DR, Acosta FL, Ritz RH, et al. The effect of heliox on nebulizer function using a beta-agonist bronchodilator. Chest 1999; 115:184.
  30. Kress JP, Noth I, Gehlbach BK, et al. The utility of albuterol nebulized with heliox during acute asthma exacerbations. Am J Respir Crit Care Med 2002; 165:1317.
  31. Henderson SO, Acharya P, Kilaghbian T, et al. Use of heliox-driven nebulizer therapy in the treatment of acute asthma. Ann Emerg Med 1999; 33:141.
  32. Anderson, M, Svartengren, M, Philipson, K, et al. Deposition in man of particles suspended in air or in helium-oxygen mixture at different flow rates. J Aerosol Med 1990; 3:209.
  33. Anderson M, Svartengren M, Bylin G, et al. Deposition in asthmatics of particles inhaled in air or in helium-oxygen. Am Rev Respir Dis 1993; 147:524.
  34. Habib DM, Garner SS, Brandeburg S. Effect of helium-oxygen on delivery of albuterol in a pediatric, volume-cycled, ventilated lung model. Pharmacotherapy 1999; 19:143.
  35. Svartengren M, Anderson M, Philipson K, Camner P. Human lung deposition of particles suspended in air or in helium/oxygen mixture. Exp Lung Res 1989; 15:575.
  36. Berlinski A, Waldrep JC. Four hours of continuous albuterol nebulization. Chest 1998; 114:847.
  37. McPeck M, Tandon R, Hughes K, Smaldone GC. Aerosol delivery during continuous nebulization. Chest 1997; 111:1200.
  38. Reisner C, Lee J, Kotch A, Dworkin G. Comparison of volume output from two different continuous nebulizer systems. Ann Allergy Asthma Immunol 1996; 76:209.
  39. Berlinski A, Willis JR, Leisenring T. In-vitro comparison of 4 large-volume nebulizers in 8 hours of continuous nebulization. Respir Care 2010; 55:1671.
  40. Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care 2004; 49:666.
  41. Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv 2008; 5:114.
  42. Hardaker LE, Hatley RH. In vitro characterization of the I-neb Adaptive Aerosol Delivery (AAD) system. J Aerosol Med Pulm Drug Deliv 2010; 23 Suppl 1:S11.
  43. Denyer J, Dyche T. The Adaptive Aerosol Delivery (AAD) technology: Past, present, and future. J Aerosol Med Pulm Drug Deliv 2010; 23 Suppl 1:S1.
  44. Skaria S, Smaldone GC. Omron NE U22: Comparison between vibrating mesh and jet nebulizer. J Aerosol Med Pulm Drug Deliv 2010; 23:173.
  45. Yeo LY, Friend JR, McIntosh MP, et al. Ultrasonic nebulization platforms for pulmonary drug delivery. Expert Opin Drug Deliv 2010; 7:663.
  46. Berger W. Aerosol devices and asthma therapy. Curr Drug Deliv 2009; 6:38.
  47. Rau JL, Ari A, Restrepo RD. Performance comparison of nebulizer designs: constant-output, breath-enhanced, and dosimetric. Respir Care 2004; 49:174.
  48. Sabato K, Ward P, Hawk W, et al. Randomized controlled trial of a breath-actuated nebulizer in pediatric asthma patients in the emergency department. Respir Care 2011; 56:761.
  49. Sangwan S, Gurses BK, Smaldone GC. Facemasks and facial deposition of aerosols. Pediatr Pulmonol 2004; 37:447.
  50. Ari A, Harwood R, Sheard M, et al. In vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula. Pediatr Pulmonol 2011; 46:795.
  51. Bhashyam AR, Wolf MT, Marcinkowski AL, et al. Aerosol delivery through nasal cannulas: an in vitro study. J Aerosol Med Pulm Drug Deliv 2008; 21:181.
  52. Coates AL, MacNeish CF, Meisner D, et al. The choice of jet nebulizer, nebulizing flow, and addition of albuterol affects the output of tobramycin aerosols. Chest 1997; 111:1206.
  53. MacNeish CF, Meisner D, Thibert R, et al. A comparison of pulmonary availability between Ventolin (albuterol) nebules and Ventolin (albuterol) Respirator Solution. Chest 1997; 111:204.
  54. Flament MP, Leterme P, Burnouf T, Gayot A. Influence of formulation on jet nebulisation quality of alpha 1 protease inhibitor. Int J Pharm 1999; 178:101.
  55. Hess DR. Liquid nebulization: emerging technologies conference summary. Respir Care 2002; 47:1471.
  56. Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003; :CD001115.
  57. Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta-agonists in the treatment of acute adult asthma: a systematic review with meta-analysis. Chest 2002; 122:160.
  58. Piccuito CM, Hess DR. Albuterol delivery via tracheostomy tube. Respir Care 2005; 50:1071.
  59. Hess D. Aerosol delivery during mechanical ventilation. Minerva Anestesiol 2002; 68:321.
  60. Miller DD, Amin MM, Palmer LB, et al. Aerosol delivery and modern mechanical ventilation: in vitro/in vivo evaluation. Am J Respir Crit Care Med 2003; 168:1205.
  61. Georgopoulos D, Mouloudi E, Kondili E, Klimathianaki M. Bronchodilator delivery with metered-dose inhaler during mechanical ventilation. Crit Care 2000; 4:227.
  62. Dhand R. Aerosol delivery during mechanical ventilation: from basic techniques to new devices. J Aerosol Med Pulm Drug Deliv 2008; 21:45.
  63. Dhand R, Guntur VP. How best to deliver aerosol medications to mechanically ventilated patients. Clin Chest Med 2008; 29:277.
  64. Ari A, Atalay OT, Harwood R, et al. Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation. Respir Care 2010; 55:845.
  65. Guerin C, Fassier T, Bayle F, et al. Inhaled bronchodilator administration during mechanical ventilation: how to optimize it, and for which clinical benefit? J Aerosol Med Pulm Drug Deliv 2008; 21:85.
  66. Dhand R. Basic techniques for aerosol delivery during mechanical ventilation. Respir Care 2004; 49:611.
  67. Ari A, Areabi H, Fink JB. Evaluation of aerosol generator devices at 3 locations in humidified and non-humidified circuits during adult mechanical ventilation. Respir Care 2010; 55:837.
  68. Dhand R, Sohal H. Pulmonary Drug Delivery System for inhalation therapy in mechanically ventilated patients. Expert Rev Med Devices 2008; 5:9.
  69. Dhand R. Inhalation therapy in invasive and noninvasive mechanical ventilation. Curr Opin Crit Care 2007; 13:27.
  70. Dhand R, Duarte AG, Jubran A, et al. Dose-response to bronchodilator delivered by metered-dose inhaler in ventilator-supported patients. Am J Respir Crit Care Med 1996; 154:388.
  71. Lin HL, Fink JB, Zhou Y, Cheng YS. Influence of moisture accumulation in inline spacer on delivery of aerosol using metered-dose inhaler during mechanical ventilation. Respir Care 2009; 54:1336.
  72. Hess DR, Dillman C, Kacmarek RM. In vitro evaluation of aerosol bronchodilator delivery during mechanical ventilation: pressure-control vs. volume control ventilation. Intensive Care Med 2003; 29:1145.
  73. Dhand R, Tobin MJ. Inhaled bronchodilator therapy in mechanically ventilated patients. Am J Respir Crit Care Med 1997; 156:3.
  74. Goode ML, Fink JB, Dhand R, Tobin MJ. Improvement in aerosol delivery with helium-oxygen mixtures during mechanical ventilation. Am J Respir Crit Care Med 2001; 163:109.
  75. Tassaux D, Jolliet P, Thouret JM, et al. Calibration of seven ICU ventilators for mechanical ventilation with helium-oxygen mixtures. Am J Respir Crit Care Med 1999; 160:22.
  76. Devabhaktuni VG, Torres A Jr, Wilson S, Yeh MP. Effect of nitric oxide, perfluorocarbon, and heliox on minute volume measurement and ventilator volumes delivered. Crit Care Med 1999; 27:1603.
  77. Oppenheim-Eden A, Cohen Y, Weissman C, Pizov R. The effect of helium on ventilator performance: study of five ventilators and a bedside Pitot tube spirometer. Chest 2001; 120:582.
  78. Marik P, Hogan J, Krikorian J. A comparison of bronchodilator therapy delivered by nebulization and metered-dose inhaler in mechanically ventilated patients. Chest 1999; 115:1653.
  79. Duarte AG, Momii K, Bidani A. Bronchodilator therapy with metered-dose inhaler and spacer versus nebulizer in mechanically ventilated patients: comparison of magnitude and duration of response. Respir Care 2000; 45:817.
  80. Chatmongkolchart S, Schettino GP, Dillman C, et al. In vitro evaluation of aerosol bronchodilator delivery during noninvasive positive pressure ventilation: effect of ventilator settings and nebulizer position. Crit Care Med 2002; 30:2515.
  81. Branconnier MP, Hess DR. Albuterol delivery during noninvasive ventilation. Respir Care 2005; 50:1649.
  82. Hess DR. The mask for noninvasive ventilation: principles of design and effects on aerosol delivery. J Aerosol Med 2007; 20 Suppl 1:S85.
  83. Pollack CV Jr, Fleisch KB, Dowsey K. Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit. Ann Emerg Med 1995; 26:552.
  84. Nava S, Karakurt S, Rampulla C, et al. Salbutamol delivery during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized, controlled study. Intensive Care Med 2001; 27:1627.