AEROSOLTERAPIA Y

FARMACOLOGIA EN
LA FISIOTERAPIA
CARDIOPULMONAR
Ft. Diana Carolina Coronado Flechas

AEROSOLTERAPIA

VA INHALADA
VENTAJAS
Menor dosis
Lugar especifico
Efecto rpido y eficaz
Menores efectos sistmicos
No dolorosa

VA INHALADA
DESVENTAJAS
Muchos factores afectan la entrega
Dificultades en la dosis
Problemas de coordinacin con los IDM
Desconocimiento en el uso de protocolos y equipos
Falta de estandarizacin y disponibilidad de
informacin tcnica

AEROSOLES
TERAPEUTICOS
Suspensin

de partculas lquidas o slidas con

un agente teraputico en un medio gaseoso

Dimetro

(DMMA)

Partculas

de la masa media aerodinmica

de >10 orofaringe
De 5 a 10 traquea y bronquios
De 1-5 , denominadas fraccin respirable
periferia: bronquiolos, alvolos
< de 1 permanecen y salen

MECANISMOS DEPOSITO
Impactacin

por inercia

Bifurcaciones 10 primeras generaciones

> de 5
A mayor flujo, mayor impactacin

Sedimentacin

por gravedad

ltimas 5 6 generaciones
De 1 a 5
A mayor tiempo, mayor sedimentacin

Difusin

por movimiento browniano

Movimiento aleatorio hace que choquen contra

paredes
< de 3
Regin alveolar

MEJORANDO LA DISTRIBUCIN
Y EL DEPSITO

Patrn respiratorio

Inspiracin profunda
Posicin sedente - bpedo

Flujo gaseoso
Laminar

lento

Inspiracin por boca o nariz

Pausa inspiratoria
Estado y arquitectura del pulmn
Efecto T y humedad
Propiedades

higroscpicas

EQUIPOS PARA
AEROSOLTERAPIA

Nebulizador
ultrasnico
Nebulizador de
grandes volmenes
Nebulizador de
pequeos volmenes:
micronebulizador

EQUIPOS AEROSOLTERAPIA

Nebulizador ultrasnico:
Cristal

piezoelctrico
Energa elctrica en
ondas ultrasnicas
3 micras alveolar
Nube de gran densidad
Inducir expectoracin
Sobrehidratacin, b/e.
Posible alteracin
estructura
medicamento

http://www.lineadecompras.com/archivos_fck/image/imagenes-grandes/hogar/nebulizadores/0717neb-a.jpg

EQUIPOS AEROSOLTERAPIA

Nebulizador Jet: grandes volmenes, partculas

pequeas
300ml

o ms de solucin
Principio Bernoulli
Nebulizacin continua con equipo infusin IV
Oxigenoterapia por Venturi
Calentador inmersin o placa externa

10

NEBULIZADOR
JET
SE UTILIZAN COMO SISTEMA DE OXIGENO

http://solucioneshospitalariaseu.com/images/nebu.jpg

EQUIPOS AEROSOLTERAPIA
Pequeos

volmenes: micronebulizador

Populares,

pequeos, bajo costo, fciles usar

Neumticos
Tipo jet
Principio Bernoulli, efecto Venturi
Partcula de 1 a 7 micras
T de la solucin hasta 10C

12

MICRONEBULIZADOR

EQUIPOS AEROSOLTERAPIA
Volumen

muerto de 0,5 a 1,0 ml

Mayor tiempo de uso
Cambian caractersticas segn
marca
Contaminacin por limpieza
inadecuada
Fuente externa

14

INHALOTERAPIA

HISTORIA
Egipto, hace 3.000 aos
Grecia y Roma
Edad media: Fumigaciones con mercurio y azufre
S. XVIII: Innovaciones
Segunda mitad del S. XIX = Terapia nebulizada
1828: Hidroconion Schneider y Waltz (sistema
manual)

Tto

de la TBC con sales marinas

Mentol, eucalipto,

1902: Aire comprimido

1950: Nuevos medicamentos para el tratamiento de
la EPOC y el asma

EN LA ACTUALIDAD

1956 -57: IDM (Propelente + Isoproterenol)

1970:

-2 como Salbutamol, terbutalina, fenoterol.

1967: Spinhaler: Cpsulas monodsis para asma

1988: Turbohaler, diskhaler, Accuhaler, etc)
1990s: -2 adrenrgicos de accin larga,
anticolinrgicos y costicoesteroides.

INHALADORES DE DOSIS
MEDIDA

Cilindro metlico
Hermtico,

10 ml
Gas propelente

clorofluorocarbono
Hidrofluoroalcano

Vlvula Dosificadora
Envase externo de plstico

INHALADORES DE DOSIS MEDIDA

Son dispositivos de
produccin de aerosol
que utilizan como fuente
de poder la
descompresin sbita de
un gas propelente para
entregar medicamentos
suspendidos en una
mezcla.

IDM

Presin del contenedor sobre el orificio de salida

Descompresin

INHALADOR DE DOSIS
MEDIDA

Difcil coordinacin
Velocidad y Temperatura del
gas
Partculas adheridas a la
orofaringe
Efecto irritante

Conocimiento del personal de

salud
Comprensin del paciente
sobre uso adecuado

IDM + INHALOCMARA

TECNICA

23

IDM ACTIVADOS AL
INHALAR

ESPACIADORES Y
AEROCMARAS
Dispositivos

diseados para
que unidos al
Inhalador,
puedan mejorar
la entrega del
frmaco
especficamente
al rgano diana

ESPACIADORES Y
AEROCMARAS

ELEMENTOS CASEROS
Aunque

no son los
adecuados,
cumplen con la
funcin y son una
alternativa
Estudios muestran
que aunque no es
lo mismo, pueden
ayudar cuando no
hay disponibilidad
de inhalocmara
Metered-Dose inhalers with home-made spacers versus nebulizers to treat moderate wezing attacs in children, Jornal de pediatria, 2003
Home-made Spacers For Bronchodilatador Therapy In Children With Actue Asthma. Lancet, 1999, 354: 979-982

ELEMENTOS CASEROS

Inhaladores de polvo seco

INHALADORES DE POLVO SECO

Unidosis

Multidosis

Handihaler
Spinhaler
Rotahaler
Turbohaler
Diskus
Accuhaler

Pr
D e sta p a r

C arg ar

Lejos del dispositivo

E s p i r a r ( s o p la r )

I n sp ir a r ( c o g e r a ir e e n e r g ic a m e n t e )

Co

A g u a n t a r l a r e s p ir a c i n

E n ju a g a r la b o c a

INHALADORES DE POLVO SECO

Ventajas

Desventajas

Alta impactacin orofaringea

No requiere coordinacin

No utiliza propelente

Son ms ecolgicos

Flujos inspiratorios 30 -60

litros/minuto

Posibilidad de compactacin por

humedad

Dosificacin exacta y reproducible

Costo

No se percibe la inhalacin
(sobredosificacin, , mala
adherencia)

INHALADORES DE POLVO SECO

Unidosis

Handihaler

Cpsula

Bromuro de tiotropio (Spiriva)

Anticolinrgico
18

mcg/da

Fase de mantenimiento

Reduce exacerbaciones y
hospitalizaciones por EPOC

INHALADORES DE POLVO SECO

Handihaler

INHALADORES DE POLVO SECO

Multidosis

Turbohaler

Reservorio de polvo

Liberacin por rotacin

Quitar

la tapa
Girar dos veces
Espirar
Inspirar
Sostener el aire

Pasos

Inhaladores de polvo
seco

Multidosis

Diskus y Accuhaler

Pasos:
Abrir (1er click)
Preparar (2 click)
Espiracin
Inhalacin (horizontal)
Aguantar
Cerrar (3er click)

Algunos ejemplos
Broncodilatadores
Atrovent (Boehringer Ingelheim)
Berodual (Boehringer Ingelheim)
Onbrize (Novartis)

ALGUNOS EJEMPLOS

Corticoesteroides
Budemar

(Biotoscana)

ALGUNOS EJEMPLOS

Combinados
Fluamar
Seretide

(Biotoscana)

INHALADORES DE POLVO SECO

Entregan el medicamento pulverizado.
Las partculas adquieren velocidad gracias a las
turbulencias creadas al pasar el aire inspirado
por los dispositivos
Es activado por el paciente

INHALADORES DE POLVO
SECO
Unidosis: cpsulas que se pinchan.
Multidosis: blsteres que se desplazan en el
dispositivo o reservorios de polvo.
Requieren flujo > 30 l/min
No coordinacin

INHALADORES DE POLVO
SECO

Accuhaler

Novolizer

Turbuhaler

RESPIMAT

Dosis

NO es IDM

medida
Mecanismo de resorte
Genera niebla lenta de
aerosol 1 1,5 seg
No depende del
propulsor ni del
esfuerzo respiratorio

2,5

mcg
5 mcg/da

Bromuro de tiotropio

RESPIMAT
Rapi2
Rotar
Abrir

Pulsar

Inhalar
2

veces

RESPIMAT
Ventajas

Desventajas

No requiere inhalocmara

No es necesario agitar

Menor velocidad, lo que lo hace ms fcil de

inhalar

Menos impactacin orofaringea

Coordinacin entre Pulsar e

Inhalar

Cmara pequea

FARMACOLOG
A

FARMACODINAMIA

FARMACOCINETICA

TIPO DE MEDICAMENTOS
Antihistamnicos: loratadina, cetirizina
Antitusivos: codeina
Descongestionantes vasoconstrictores

Tpicos:

Afrin
Sistmicos: Efedrina

Expectorantes mucolticos: Robitusin

TIPO DE MEDICAMENTOS
Broncodilatadores: metilxantinas,
Corticoesteroides
Anti-leukotrienos
Estabilizadores de membrana: Intal
Anti infecciosos
Combinados

BRONCODILATADORES

ADRENRGICOS
Simpatico

mimticos
2 selectivos

ANTICOLINRGICOS
Parasimpaticolticos
Bloquean

M3

SISTEMA SIMPATICO

Receptores adrenrgicos
1

Corazn
2 Msculo liso bronquial
3 Lipocitos
1 vasos perifricos
2 neuronas presinapticas

Neurotransmisor: norepinefrina, epinefrina

RECEPTORES ADRENRGICOS

Al estimular aumenta: FC PA por

vasoconstriccin - contractibilidad - azcar en
sangre - flujo sanguneo al corazn y msculos
broncodilatacin en la vasculatura pulmonar
hay vasoconstriccin o vasodilatacin

SISTEMA PARASIMPATICO

Receptores colinrgicos
M1

ganglios parasimpticos, glndulas nasales

submucosas
M2 corazn, nervios simpticos postganglionares
M3
M3, y

msculo liso bronquial

M5

Nicotnicos

RECEPTORES
COLINRGICOS
Al estimular disminuye: FC, conduccin del nodo
AV
Bronco constriccin, aumento secrecin
glndulas mucosas, insulina, saliva, movilidad
del tracto gastrointestinal

BRONCODILATADORES 2
ADRENRGICOS
Anlogos de la epinefrina
Estimulan el sistema simptico
Simpaticomimticos
Ampliamente utilizados
Va inhalada oral
Corta duracin larga duracin

MECANISMO DE ACCIN
Receptor 2 en membrana plasmtica celular
Es una cadena polipeptida atraviesa 7 veces
la membrana celular
Ocupacin del receptor activa proteina G
estimuladora (Gs)
Activa adenil ciclasa que cataliza conversin
ATP en AMPc la sintesis
El AMPc la inactivacin de la miosin
quinasa llevando a relajacin
El AMPc disminuye el Ca intracelular
El AMPc inhibe la degranulacin de
mastocitos y la liberacin de histamina

EFECTOS DESEADOS Y ADVERSOS

Relajacin del msculo

liso bronquial
Inhibicin de la
liberacin de mediadores
inflamatorios
Estimulan la limpieza
mucociliar
Inhibe neurotransmisin
colinrgica.

Taquicardia
PA.
Temblor msculo
esqueltico
Mareo
Nauseas
PaO2 por alt.V/Q

Hipokalemia

BRONCODILATADORES 2
ADRENRGICOS DE CORTA
DURACIN
Efecto: 5 pico 20 - duracin 4-6 hr.
Solucin nebulizar IDM
Conductor o solvente: solucin salina normal,
hipertnica o hipotnica
De 3 a 5 ml.
Flujo de 5 a 8 lpm

CORTA DURACIN
Terbutalina:

5 a 10 mg (7-15 gotas)
Nios: 2 a 5 mg 1 gota/2Kg
0,075 mg/kg 1 gota: 0,45mg

Salbutamol:

Adultos: 2.5 a 5 mg
0.5 a 1ml 10-20 gotas
5mg x 1ml
Nios: 0.15mg/Kg.

BETA ADRENERGICOS E
HIPOKALEMIA
Can J Anaesth. 2009
Feb;56(2):142-6.
Kim DK, Chang SH, Yun IJ,
Kwon WK, Woo NS.

Salbutamol to facilitate
management of acute
hyperkalemia in liver
transplantation: a case
report.

Incorporating nebulized
salbutamol with a
conventional antihyperkalemia strategy can
provide an effective
therapeutic option to treat
hyperkalemia, even during
the anhepatic stage

Nephron. 2002;92 Suppl

1:33-40.
.
Kim HJ, Han SW.

Therapeutic approach to
hyperkalemia

As the first choice among

these available options, we
favor an intravenous bolus of
10 units of insulin with 50 ml
of 50% glucose alone or in
combination with 10-20 mg
of albuterol by nebulizer

LARGA DURACIN

Inhalador de dosis medida (IDM) Inhlador de

polvo seco (IPS)
Albuterol:

Ventolin: nebulizar
Salmeterol: Seretide diskus e IDM
Formoterol: Fesema y turbohaler (IPS)

ANTICOLINERGICOS
Parasimpaticolticos
Antagonista de la acetilcolina
Bloquean o inhiben la accin del parasimptico
Accin en el receptor muscarnico M
3

MECANISMO DE ACCIN
Receptor M3
Bloquea o inhibe a la acetilcolina
Inactiva a la fosfodiesterasa disminuyendo la
conversin y aumento del GMPc y la degradacin
del AMPc

Disminuyendo la concentracin citoplasmtica de

Ca

EFECTOS DESEADOS Y ADVERSOS

Inhibe

la
broncoconstriccin
Disminuye la
produccin de moco
Potencializa la
accin del 2

Boca seca
Tos
Dilatacin pupila
presin
intraocular
Irritabilidad
Cefalea
Palpitaciones
FC

ANTICOLINRGICOS
Bromuro

de Ipratropio

Atrovent:

IDM Nebulizar: 0.25mg en 1ml

Dosis: 2 ml, 40 gotas = 0,5 mg

nios 6 a 12: poca informacin 1ml = 0.25 mg = 20g

nios < 6: 0.4 a 1ml = 8-20 gotas = 0.1 0.25 mg

Cada 6 8 horas max 2mg x 24h

Efecto: 10 a 4 - 6 hr.

Ciplatropium

Bromuro

de tiotropio: IPS

ANTICOLINRGICOS BETA
ADRENRGICOS

Combivent (inh sol)

Bromuro

de ipratropio
y salbutamol
Vial dosis nica
En nios hasta 12
aos 3 gotas/Kg

Bromuro

Berodual (inh sol)

de ipratropio
y fenoterol
1 a 2,5 ml

ANTICOLINRGICOS BETA
ADRENRGICOS
Indian J Pediatr. 2004
Feb;71(2):121-4
Sharma A, Madaan A.

Nebulized salbutamol vs
salbutamol and
ipratropium combination
in asthma.

Fifty asthmatic
children,6-14 years.
Group I nebulized with
three doses of
Salbutamol (0.03
ml/kg/dose) and Group
II combined Salbutamol
and Ipratropium bromide
(250 microgm/dose for
three doses) at 20
minutes interval

CONCLUSION:
Frequent combined
nebulization with
Salbutamol and
Ipratropium bromide is
beneficial in acute
asthma of moderate
severity.

Ann Allergy Asthma

Immunol. 2006
May;96(5):701-6
.
Watanasomsiri A,
Phipatanakul W.

Comparison of
nebulized ipratropium
bromide with salbutamol
vs salbutamol alone in
acute asthma
exacerbation in children

prospective, doubleblind randomized control

trial, 74 patients aged 3
to 15 years, acute
asthma exacerbation,
receive 3 doses of
nebulized salbutamol
mixed with isotonic
sodium chloride solution
(control) or ipratropium
bromide (treatment)
every 20 minutes.

Although this study did

not demonstrate a
significant advantage in
clinical score and peak
expiratory flow rate the
trend toward additional
effect of ipratropium
bromide was consistent
with previous studies.

VASOCONSTRICTOR BRONCODILATADOR
EPINEFRINA RACMICA
Receptores: alfa y beta
Efectos : Vasoconstrictor local, disminucin edema y
broncodilatador
Efectos colaterales: aumento TA, FC, Vol lat.,
Dosis: menores de 20 kilos: 0.25 ml (0.1 %).
Entre 20 y 40 kilos de peso: 0.5 ml
Mayor de 40 kilos: 0.75 ml
0,05 ml/kg hasta un mximo de 1,5 ml diluidos en
solucin salina normal a un volumen de 5 ml.
Efecto: 5 a 3 hr.

VASOCONSTRICTOR BRONCODILATADOR

EPINEFRINA amp.
Nebulizada

1 o amp diluida o pura en SSN.

Seguimiento y monitoreo estricto

VASOCONSTRICTOR BRONCODILATADOR
Acad Emerg Med. 2008
Apr;15(4):375-6.
Walsh P, Caldwell J,
McQuillan KK, Friese S,
Robbins D, Rothenberg SJ.

Comparison of nebulized
epinephrine to albuterol in
bronchiolitis.

Sixty-six patients between 0

and 12 months, randomized
in a double-blind fashion to
receive 0.9 mg/kg of 2.25%
racemic epinephrine or 0.15
mg/kg 0.5% albuterol sulfate
(n = 32) at 0, 30, and 60
minutes.

CONCLUSIONS: Although
the patients treated with
epinephrine were judged
well enough for ED
discharge significantly earlier
than the patients treated
with albuterol, epinephrine
was not found to be more
efficacious than albuterol in
treating moderately ill infants
with bronchiolitis.

Acad Emerg Med. 2008

Apr;15(4):375-6.
.
Walsh P, Caldwell J,
McQuillan KK, Friese S,
Robbins D, Rothenberg SJ.

Comparison of nebulized
epinephrine to albuterol in
bronchiolitis

double-blind randomized
controlled trial. 703 patients
received either three doses
of racemic albuterol or one
dose of racemic epinephrine
plus two saline nebulizers.

CONCLUSIONS: In children
up to the 18th month of life,
treatment of bronchiolitis
with nebulized racemic
albuterol led to more
successful discharges than
nebulized epinephrine

BMC Pediatr. 2005 May

5;5(1):7.
Langley JM, Smith MB,
LeBlanc JC, Joudrey H,
Ojah CR, Pianosi P.

Racemic epinephrine
compared to salbutamol in
hospitalized young children
with bronchiolitis; a
randomized controlled
clinical trial

Randomized, double-blind
controlled trial of aerosolized
racemic epinephrine
compared to salbutamol
every one to 4 hours in 62
children aged 6 weeks to <
or = 2 years

CONCLUSION: Racemic
epinephrine relieves
respiratory distress in
hospitalized infants with
bronchiolitis and is safe but
does not abbreviate hospital
stay.

VASOCONSTRICTOR

Clorhidrato de oximetazolina
Vasoconstrictor

local
Receptores Alfa 1
Uso por experiencia

ESTABILIZADORES DE
MEMBRANA

Cromoglicato de sodio: Intal

Inhibe

la liberacin de mediadores qumicos que

participan en la respuesta inflamatoria de la reaccin
alrgica.
Previene la respuesta inmediata y tarda en el
proceso asmtico.
Inhalador
Solucin para nebulizar
Ampolleta: Cromoglicato de sodio 20 mg

CORTIOCOESTEROIDES
Mecanismo: bloquea receptores intracelulares
previniendo la cascada del acido araquidonico
Efectos: disminucin respuesta inflamatoria y
edema
Colaterales: resequedad mucosa, candidiasis,
disfona, tos, efectos sistmicos insuficiencia
adrenal

CORTIOCOESTEROIDES
Fluticasona: IDM
Beclometasona: IDM
Dexametasona: amp. IV

Nebulizar:

1 ampolla no evidencia

Budesonida: pulmicort IDM y nebulizar

Dosis: Adultos: 0.5 a 1 mg ( 1mg en 2ml)
Nios: 0.25 a 0.5 mg

CORTICOESTEROIDES
Gac Med Mex. 2007 MayJun;143(3):189-92.
Comparative clinical study of
dexamethasone vs.
nebulized salbutamol in
acute bronchiolitis

Gmez-y-Lpez RE,
Hernndez-Sierra JF, TorresRuvalcaba BA, MartnezPuente E, del Carmen
Martnez-Garcia M.

A blinded clinical trial was

performed with 49 patients
between 1-18 months
diagnosed with bronchiolitis

CONCLUSIONS: The
administration of salbutamol
plus dexamethasone is more
effective in the control of
respiratory distress in
bronchiolitis compared with
the use of salbutamol alone.

Acta Paediatr. 2005

Jul;94(7):866-71.

Dexamethasone inhalations
in RSV bronchiolitis: a
double-blind, placebocontrolled study.

Compared nebulization of
dexamethasone versus
nebulization of 0.9% saline.
Both groups were treated
with epinephrine nebulization.
Sixty-one infants with
bronchiolitis aged 3 to 12 mo

CONCLUSION: Inhaled
dexamethasone may reduce
the length of hospitalization
among infants with acute
viral bronchiolitis, especially
among those born
prematurely.

Steroids in acute
exacerbations of chronic
obstructive pulmonary
disease: are nebulized and
systemic forms comparable?

Review

Findings from recent studies

are giving a positive
impression on the role of high
dose nebulized budesonide
in exacerbations of COPD.
However, larger and
statistically high powered
trials testing different types of
nebulized corticosteroid
solutions with varying
dosages are still lacking

Bentur L, Shoseyov D,
Feigenbaum D, Gorichovsky
Y, Bibi H.

Curr Opin Pulm Med. 2009

Mar;15(2):133-7. Links

MUCOLTICOS

Mucolticos: N acetil-cisteina (Fluimucil) diversas

presentaciones
Efectos:

rompe cadenas mucopolisacridos

Dosis: 3 a 5 ml al 20%

Alfa Dornasa (pulmozyme)

Fibrosis

quistica
2,5 mg en nebulizador especial

N-ACETILCISTEINA
J Burn Care Res. 2009
Mar-Apr;30(2):249-56
Miller AC, Rivero A, Ziad
S, Smith DJ, Elamin
EM.

Influence of nebulized
unfractionated heparin
and N-acetylcysteine in
acute lung injury after
smoke inhalation injury.

30 mechanically
ventilated adults who
were confirmed smoke
inhalation injury. The
experimental group was
treated with nebulized
heparin sulfate, Nacetylcystine, and
albuterol sulfate.
Controls received
ventilation support and
albuterol sulfate.

The use of aerosolized

unfractionated heparin
and N-acetylcystine
attenuates lung injury
and the progression of
acute respiratory
distress syndrome in
ventilated adult patients
with acute lung injury
following smoke
inhalation.

FUROSEMIDA
Cochrane Database Syst
Rev. 2001;(2):CD001694.
Brion LP, Primhak RA, Yong
W.

Aerosolized diuretics for

preterm infants with (or
developing) chronic lung
disease.

Systematic review. 8
controled trials.

AUTHORS' CONCLUSIONS:
In preterm infants > 3 weeks
with CLD administration of a
single dose of aerosolized
furosemide improves
pulmonary mechanics

Allergol Immunopathol
(Madr). 2006 MarApr;34(2):54-8.

Effectiveness of nebulized
furosemide added to
nebulized salbutamol in
children with acute asthma.

Double-blind, placebocontrolled study in which

patients with acute asthma
attack were randomized to
receive either nebulized
salbutamol (0.15 mg/kg) plus
nebulized furosemide (10
mg/m(2)) or nebulized
salbutamol (0.15 mg/kg) plus
nebulized saline as placebo

CONCLUSION: Adding
nebulized furosemide to
nebulized salbutamol in
pediatric patients
experiencing an acute
asthma attack did not
produce greater improvement
in clinical or spirometric
parameters than nebulized
salbutamol alone.

Efficacy of nebulized
furosemide in children with
moderate attack of asthma.

Double-blind randomized,
controlled trial, children with
moderate attack of asthma.
Twenty children in group A
received nebulized albuterol,
20 children in group B
received nebulized
furosemide and 19 children in
group C received both
albuterol and furosemide

CONCLUSION: Combination
of furosemide and albuterol
led to significant increase in
peak flow rate but it did not
significantly affect FEV1,
FVC, FEF 25-75, respiratory
rate, SaO2 or clinical scores
as compared to other groups.

Nuholu C, Yaar Kili M,

Ceran O.

West Afr J Med. 2005 JulSep;24(3):246-51.Links

Alshehri M, Almegamesi T,
Alfrayh A.

FUROSEMIDA

Efectos farmacolgicos incluyen accin protectiva

contra el broncoespasmo
En la mucosa de la va area superior disminuye la
resistencia nasal en pacientes con rinitis no allergica
y protege a la mucosa nasal de la reactividad a
alergenos en pacientes atpicos.
Se sugiere que interfiere con el transporte epitelial
de electrolitos, prostanglandinas, actividad celular
inflamatoria y regulacin vascular.
Tambin se ha observado una disminucin en la
sensacin de disnea inducida de manera
experimental

Cavaliere F, Masieri S. Furosemide protective effect against airway

obstruction. Curr Drug Targets. 2002 Jun;3(3):197-201

SOLUCIN SALINA
Isr Med Assoc J. 2006
Mar;8(3):169-73.
Tal G, Cesar K, Oron A,
Houri S, Ballin A, Mandelberg
A.

J Pediatr. 2007
Sep;151(3):266-70

Hypertonic
saline/epinephrine treatment
in hospitalized infants with
viral bronchiolitis reduces
hospitalization stay: 2 years
experience.

In a continuing, second-year
randomized, doubleblind
controlled trial, an additional
41 infants.

CONCLUSIONS: This
second-year experience and
our 2 year pooled data
analysis strengthen the
evidence that the
combination of 3% saline/1.5
mg epinephrine benefits
hospitalized infants with viral
bronchiolitis

Nebulized hypertonic saline

in the treatment of viral
bronchiolitis in infants.

a prospective, randomized,
double-blinded, controlled,
multicenter trial. 96 infants
range 0.3 to 18 months, viral
bronchiolitis. Patients
received repeated doses of
nebulized 3% or 0.9%
normal saline

CONCLUSIONS: The use of

nebulized 3% HS is a safe,
inexpensive, and effective
treatment for infants
hospitalized with moderately

Systematic review

CONCLUSIONS: Current
evidence suggests nebulized
3% saline may significantly
reduce the length of hospital
stay and improve the clinical
severity score in infants with
acute viral bronchiolitis

Kuzik BA, Al-Qadhi SA, Kent

S, Flavin MP, Hopman W,
Hotte S, Gander S.

: Cochrane Database Syst

Rev. 2008 Oct 8;
(4):CD006458.
Zhang L, Mendoza-Sassi RA,
Wainwright C, Klassen TP

Nebulized hypertonic saline

solution for acute
bronchiolitis in infants

severe viral bronchiolitis

MEZCLA DE
MEDICAMENTOS
Respir Care. 2008
Dec;53(12):1716-22.
Bonasia PJ, McVicar WK, Bill
W, Ong S.

Ann Pharmacother. 2008

Oct;42(10):1416-24.
Akapo S, Gupta J, Martinez E,
McCrea C, Ye L, Roach M

Acad Emerg Med. 1996

Nov;3(11):1019-24.
Khine H, Fuchs SM, Saville AL

Chemical and physical

compatibility of levalbuterol
inhalation solution concentrate
mixed with budesonide,
ipratropium bromide, cromolyn
sodium, or acetylcysteine
sodium.

To determine the chemical and

physical compatibility of
levalbuterol with ipratropium
bromide, cromolyn sodium,
acetylcysteine sodium, and
budesonide

With all the admixtures, both

drugs were chemically stable
for at least 30-min. Admixture
pH had not changed
significantly. CONCLUSIONS:
The 2-drug admixtures we
studied were compatible for at
least 30 min at room
temperature.

Compatibility and aerosol

characteristics of formoterol
fumarate mixed with other
nebulizing solutions.

Evaluate the physicochemical

compatibility and aerodynamic
characteristics of formoterol 20
microg/2 mL mixed with
budesonide 0.5 mg/2 mL,
ipratropium bromide 0.5
mg/2.5 mL, cromolyn sodium
20 mg/2 mL, or acetylcysteine
10% (100 mg/mL).

CONCLUSIONS: Our results

indicate that admixtures of
formoterol with budesonide,
ipratropium, cromolyn, or
acetylcysteine are physically
and chemically compatible.

Continuous vs intermittent
nebulized albuterol for
emergency management of
asthma.

Prospective, randomized,
single-blind, patients aged 2 to
18 years with moderate to
severe asthma exacerbation
received IN albuterol (0.15
mg/kg/dose every 30 min) or
CN albuterol (0.3 mg/kg/hr) for
a maximum of 2 hours

CONCLUSION: There was no

difference in efficacy or safety
between CN therapy and IN
therapy. Moreover, CN therapy
provided a significant time
savings in the delivery of
asthma therapy.