AEROSOLTHERAPY (the aero evils [i] + grech, therapeia treatment) — the method of physical therapy consisting in introduction of aerosols of biologically active agents to respiratory tracts of the patient, to various cavities of an organism or drawing them on affected areas of a body surface.
Inhalation of aerosols — one of the most ancient methods of treatment. Traditional medicine widely used aerosols (in the form of vapors of various balsam substances and aromatic plants, and also smoke at their burning — so-called smoking, fumigating) for treatment of diseases of a respiratory organs. The most wide spread occurance And. received after World War I. The foundation of scientific and practical use of aerosols was laid by Dotreband (L. Dautrebande, 1951).
Development And. it is closely connected with achievements of physics, chemistry, pharmacology and technology of receiving aerosols (see). Especially was widely used And. in connection with opening of antibiotics.
At And. apply natural and artificial aerosols. Carry aerosols of the air of seaside resorts differing in the increased content of iodine, bromine and sea salts, the air of resort and medical areas containing impurity of the phytoncides, terpenes and other aromatic substances emitted by big vegetable arrays to natural aerosols.
Artificial aerosols receive in aerozolgenerator (see the section Devices for an aerosoltherapy) by means of generation of dispersive aerosols with a liquid phase and with a solid phase (ready powdery substances in suspension). It is most eurysynusic Ampere-second use of artificial aerosols.
And. carry out generally as the procedure of a systemic effect — by aerosol inhalation of antibiotics, hormones, nek-ry narcotic analgetics, enzymes, serums, vaccines, anatoxins, vitamins, phytoncides, solutions of salts, infusions of various officinal herbs, etc. Most often use aerosols of atropine, Fubromeganum, adrenaline, ephedrine, a phenylephine hydrochloride, an Euspiranum as bronchodilatory means. For fluidifying and department of a phlegm usually appoint aerosols of isotonic solution of sodium chloride, mineral waters, essential oils, salt and alkaline, warm and wet aerosols. In recent years apply aerosols of nek-ry enzymes (trypsin, Pancreatinum, a lidaza) to these purposes, however their appointment demands care and shall be limited to those cases when aerosols of other substances do not give effect. Apply warm and wet aerosols to treatment of diseases of the upper respiratory tracts which are followed by cough — water or isotonic solution of sodium chloride; aerosols of novocaine, codeine with terpin hydrate or dionine have good effect.
Various classifications of medical aerosols — Dot-rebanda (1962), M. Ya. Polunov (1964), etc. are offered. Fullestly reflects the mechanism of action and basic purpose of aerosols S. I. Eydelypteyn's classification (1967).
In 60 — the 70th years gains distribution and local And., to-ruyu apply at treatment of burns, wounds, trophic ulcers, nek-ry damages of skin, and also in gynecology, stomatology, a proctology, etc.
Main indications for inhalation And.: diseases of upper respiratory tracts, quinsy, hron, tonsillitis, laryngotracheitis, bronchitis, pneumonia, bronchial asthma, pulmonary tuberculosis I upper respiratory tracts, suppurative diseases of lungs, occupational diseases of a respiratory organs.
Contraindications for inhalation And.: pulmonary bleedings and bent to them, spontaneous pheumothorax, violent emphysema of lungs, pulmonary and cardiac and heart failure of the III Art., individual intolerance of separate medicinal substances.
Optimum particle sizes of aerosols of 0,5 — 5 microns; at inhalation the most fine particles of aerosols can reach the most deeply located departments of respiratory tracts, being besieged on a significant area (apprx. 100 m 2 ) a mucous membrane of respiratory tracts and lungs, coming into direct contact to fabrics and getting into a blood stream through an alveolar epithelium.
In the form of aerosols it is possible to use drugs, the use to-rykh in any other form causes undesirable reactions in the patient; drugs in the form of aerosols work more quickly and effectively. Economic value A. is defined by the fact that at this way much less drug is required, than at injections and intake. And. is not an independent method; it is applied in system of complex treatment. At use And. together with other methods terms of treatment and number of days with temporary disability are considerably reduced. At inhalation And. (see. Inhalation ) procedures appoint daily or every other day, lasting from 5 to 10 min. The course of treatment consists of 10 — 15 procedures.
Usually apply aerosol cans with the portioning device to local influence, from to-rykh a stream of aerosols direct to the struck surface or in the corresponding perigastrium. At local And. appoint up to 20 procedures to a course of treatment. Duration of the procedure depends on an individual dosage of an aerosol, at a cut consider the area of defeat and a therapeutic dose of the sprayed medicinal substance. Procedures are carried out daily.
One of the most difficult questions And. the dosage of aerosols is. At the same time it is necessary to proceed from a single, daily and course dose of medicine (in a usual form) for the adult or the child. At appointment And. it is necessary to consider productivity of the sprayer (quantity of the aerosol in liters formed for a unit of time), density of an aerosol (content of the sawn substance in liter of an aerosol) and its dispersion (a ratio of particles in an aerosol by the size), and also the vital capacity of lungs of this patient and loss of an aerosol during inhalation.
An electroaerosoltherapy — medical use of aerosols, modular particles to-rykh have a unipolar charge (either only positive, or only negative) or represent mix of particles of a different charge with considerable overweight of particles of one polarity. If all particles of an aerosol have excess of electrons on the surface, the aerosol possesses unipolarly negative charge; at a lack of electrons — unipolarly positive (see. Aeroionization ). Charges of particles of electrical aerosols can reach about 103 — 104 e (e — the elementary charge equal 1,6-10 19 pendent).
Spraying of solutions is followed by electrization of the sprayed particles owing to balloelectric effect (see. Aeroionization ). Use special devices to receiving electrical aerosols, to-rye give to the sprayed particles this or that unipolar electric charge (see below Devices for an aerosoltherapy). Unipolar electric charge of particles of electrical aerosols counteracts surface intention and interferes with coagulation of particles. With increase in dispersion of particles electrical aerosols get more deeply into respiratory tracts. High dispersion of electrical aerosols considerably increases the total area of particles and consequently, and the area of their contact with a mucous membrane of respiratory tracts, promoting thereby increase in activity of the sprayed medicines. The negative electric charge given to aerosols of antibiotics, napr of penicillin and streptomycin, promotes their higher accumulation in lungs and blood.
The electroaerosoltherapy is carried out as the general procedure (elektroaerozolyingalyation) and as local influence.
Influence of electrical aerosols at inhalation is defined not only by pharmacological properties of medicinal substance, but also electric charge of aerosol particles. In Kruger's researches (A.Krueger, 1957 — 1969) with soavt, and E. K. Siyrde (1957 — 1969) noted a promoting effect of particles with a negative charge on function of a ciliary epithelium of a trachea of rabbits, mice, Guinea pigs, rats, primacies and people and adverse influence of positively charged particles (reduction and dead stop of blinkings of cilia of an epithelium, drying, increase in vulnerability of a mucous membrane of a trachea).
Unlike usual aerosols, at generation of electrical aerosols higher dispersion of particles is noted that raises the general surface of medicinal substances and cuts a consumption of medicinal substances; besides, their ability to get into depth of fabrics increases. Special value has the desensibilizing action of a negative charge at use of aerosols of nek-ry antibiotics.
At assessment of action of electrical aerosols of various polarity on a complete organism it is necessary to consider a reference functional state of the autonomic nervous system and its reaction to the procedure. At adverse reaction to inhalation of electrical aerosols of negative polarity it is reasonable to apply positively charged electrical aerosols.
Indications (for the general electroaerosoltherapy) — prevention and treatment of a pneumoconiosis, professional lead poisoning (electrical aerosols of sodium salt of methionine) and other occupational diseases. At many enterprises and mines in the USSR and abroad for these purposes there are powerful electroaerosol installations (fig. 1). Indications for an elektroaerozolyingalyation is also pneumonia (especially postgrippal) at adults and children, a number of nonspecific diseases of upper respiratory tracts, an idiopathic hypertensia of I and II Art., atherosclerosis in early stages (the subjective state improves, headaches, dizzinesses decrease or disappear, arterial pressure decreases). Indications for a local electroaerosoltherapy are burns, long not healing wounds and ulcers.
Contraindications for an electroaerosoltherapy the same, as for aero ionization (see) and for inhalation And., and also intolerance of a certain drug.
The technique of carrying out an elektroaerozolyingalyation is similar to a technique of carrying out an aerozolyingalyation, the equipment — see the section Devices for an aerosoltherapy. The question of one-time and course doses at an electroaerosoltherapy is not completely resolved. So, according to F. G. Portnov, on exposure within 10 min. concentration apprx. 100 billion elementary charges on the procedure is optimum; according to E. K. Siyrde and other authors — 150 billion elementary charges on the procedure. In some cases during inhalation of electrical aerosols at patients the headache, increase of pulse, rise in arterial pressure, a bronchospasm are noted, to-rye can be caused by overdose of an electrical aerosol. In these cases it is necessary to stop procedures on 1 — 2 day, and further to reduce their duration. It is reasonable to try action of an electrical aerosol of opposite polarity also.
The electrical aerosol generator — the so-called electroaerosol gun (fig. 2) is applied to a local electroaerosoltherapy of long not healing wounds and ulcers. The toilet of a wound before the procedure is carried out by a usual way. The device establish at distance 15 — 20 cm from a wound surface. Duration of the procedure depending on the area of a wound from 5 to 15 min. daily; on a course of treatment of 15 — 20 procedures. After the procedure apply the bandage moistened with sterile normal saline solution, novocaine, etc. a wound. In case of an aggravation of process of the procedure it is necessary to stop temporarily (on 1 — 2 day).
The general electroaerosoltherapy mostly is used as one of methods in complex treatment of patients. The local electroaerosoltherapy can be an independent method of treatment or be applied in quality of training of wound surfaces to further operational treatment.
Devices for an aerosoltherapy
Devices for introduction of aerosols of biologically active agents through respiratory tracts are called aerosol inhalers. They are divided on individual (the closed type) and chamber (open type). During the use of individual inhalers the aerosol moves directly from the device in respiratory tracts by means of a connecting element; chamber inhalers create an aerosol cloud, and the patients who are in the procedural room inhale an aerosol of medicinal substances. The same principles are the cornerstone of aerogenic vaccination (see. Vaccination , aerogenic).
The general in the device of inhalers of individual and chamber use are the aerosol generator, the heater of an aerosol and the device for regulation of quantity of the aerosol generated or given to the patient. Connecting elements (fig. 3) and the device for inclusion of generation of an aerosol or its giving to the patient only in the act of a breath are specific to individual aerosol inhalers (chamber inhalers generate an aerosol continuously). In individual inhalers pneumatic and supersonic generators of an aerosol, and in chamber, besides, are used and centrifugal (disk). The principles of their design — see. Aerosol devices .
The greatest distribution is found by aerosol inhalers with pneumatic generators of an aerosol — sprayers. As raspylivayushchy gas the air given from the compressor, or the compressed oxygen is usually used. In the second case And. it is combined with oxygen therapy.
The elementary aerosol inhaler — a pocket inhaler of IKP-M (fig. 4) — is supplied with a rubber bulb (pear). The compressors used for aerosol inhalers more often happen membrane type; piston or rotary compressors are supplied with filters for a delay of aerosols of the lubrication substances which are formed during their work. As heaters of an aerosol electric heaters are, as a rule, used, but also other sources of heat, in particular water vapor are possible, to-ry can be at the same time and the raspylivayushchy agent as, e.g., in a steam inhaler of IP-2 (fig. 5).
Depending on type of the generator of an aerosol used in an inhaler by means of the device for regulation of quantity of the aerosol generated or given to the patient change pressure or air consumption (in the pneumatic generator), intensity of ultrasonic fluctuations (in the supersonic generator) or range of speeds of disks (in the centrifugal generator).
For implementation of generation or giving of an aerosol to the patient only during a breath use various devices, e.g., the device for air delivery or medicinal substance in the generator of an aerosol which are switched on by the patient or managed by his breath. The most perfect individual inhaler is the universal inhaler of aerosols of Aerozol-U1 (fig. 6). It is supplied with pneumatic sprayers for generation of aerosols of liquid and powdery medicinal substances, oils, electrical aerosols and performing warm and wet inhalation. A source of compressed air is the membrane microcompressor, and heating of aerosols is carried out by means of electric heaters.
Kind of individual inhalers are the prefixes to medical ventilators intended for moistening of inhaled air and And. In practice And. the electroaerosol inhalers differing from described above by the fact that the generated aerosol particles in various ways, napr, inductive charging, are given electric charge of this or that sign and size find application. The chamber electroaerosol inhaler of GEK-1 (fig. 7) is supplied with the pneumatic sprayer of liquid medicinal substances and can generate aerosols with negative or positive charge.
The main characteristics of nek-ry inhalers are presented in the table.
Bibliography: Glukhov S.A. and Eydelypteyn S. I. Hardware of an aerosoltherapy, M., 1974, bibliogr.; Zlydnikov D. M. Chronic pneumonia, L., 1969, bibliogr.; To a floor novm.ya. Bases of inhalation therapy, Kiev, 1962, bibliogr.; Π about r τη about in F. G. Aeroionoterapiya and an electro-aerosoltherapy, in book: Probl. a wedge, biophysics, under the editorship of F. G. Portnov, page 80, Riga, 1972, Eydelstein S. I. Bases of an aerosoltherapy, M., 1967, bibliogr.; Böhlau V. u. Böhl au E. Die Inhalationsbehandlung mit Aerosolen, Lpz., 1958, Bibliogr.; Dautrebande L. L’a6rosologie, P., 1951, bibliogr.; it is e, Microaerosols, N. Y., 1962; Medizintechnik, hrsg. v. H. Borrmann, B., 1958; Pickroth G. Ultraschall-und Düsen-Aerosole in der Medizin, Jena, 1963, Bibliogr.; WehnerA.P. Electroaerosols, air ions and physical medicine, Amer. J. phys. Med., v. 48, p. 119, 1969, bibliogr.
F. G. Portnov; S. A. Glukhov (medical tekhn.).