INHALATION (Latin. inhalatio) — a method of introduction to an organism by inhalation of various medicinal or biologically active agents in the treatment-and-prophylactic purposes.
Allocate two look And. — so-called natural and artificial. At natural And. (long stay in areas with the pure, enriched with aeroions air — in mountains, near falls, at the coast of the sea in time priboyev, etc.) to lay down. the effect is caused by influence of a certain temperature, humidity or an ionic charge of the air inhaled by the patient (see. Aeroionization , aero ionotherapy). During the carrying out artificial And. inhaled air is saturated with medicinal substance, usually by means of more or less difficult inhalation devices.
According to physical. a condition of the inhaled substances I. subdivide on gas, steam, aero ionic, aerosol (inhalation weighed in air liquid or solid particles of medicinal substances); electroaerosol (inhalation of aerosols of medicinal substances which particles were given unipolar electric charge, see. Aerosoltherapy, electroaerosoltherapy ).
With the help And. apply also an anesthesia (an inhalation anesthesia) which is carried out by steam inhalation or gases of the anesthetizing substances (see. Inhalation anesthesia ).
Mechanism of action
And., as a rule, makes combined effect on an organism, however in it it is possible to allocate the following main mechanisms: local physical. - chemical influence directly on a mucous membrane of respiratory tracts, including bactericidal and bacteriostatic; resorptive and reflex, carried out by impact through receptors of a mucous membrane of respiratory tracts on internals.
Inhalation administration of medicinal substances has a number of advantages before other ways of their receipt to an organism (peroral and parenteral). The substance entered in the way by P., sprayed (dispersed) on the most fine particles possesses a bigger contact surface (area) and widely adjoins to the surface of mucous membranes of respiratory tracts, getting up to alveoluses, is quickly soaked up and through blood is delivered to fabrics in not changed look. Unlike a peroral way of introduction, And. barrier» — a liver circumvents natural «, in a cut a number of medicinal substances can collapse and be inactivated to a greater or lesser extent. Opportunity direct physical. - chemical impacts of the inhalated medicine on a mucous membrane of respiratory tracts has particular advantages at respiratory diseases. So effectively inhalation use of antibacterial substances for immediate effect on microflora of respiratory tracts, and also the special inhalation solutions and mixes facilitating removal from respiratory tracts of slime, a phlegm, pus, clots, etc. The mechanism which is the cornerstone of a reflex effect of P. is that receptors of a mucous membrane of respiratory tracts perceive the irritation caused by the inhalated substance, further the impulse comes to the relevant centers of a nervous system where it forms and transferred to effector bodies in the form of this or that reaction.
Penetration depth of the inhalated substance in respiratory tracts depends on the size of its particles in inhaled air. Coarse particles (to dia, over 10 microns) settle generally on a mucous membrane of upper respiratory tracts (a nasal cavity and adnexal bosoms of a nose, a nasopharynx, a throat, a trachea). Particles to dia. apprx. 10 microns reach bronchial tubes of the second and third order. Inhalation mixes with particles to dia, from 0,5 to 5 microns get more deeply, into bronchioles and alveoluses. And. the aerosols consisting of particles to dia, less than 0,5 microns have no such efficiency since they only in insignificant quantity settle on a mucous membrane of respiratory tracts and on walls of alveoluses and for 50% and are more removed with expired air.
1. Acute and hron, respiratory diseases: rhinitis, antritis, frontal sinusitis, pharyngitis, tracheitis, bronchitis; and also bronchoectatic disease, hron, pneumonia.
2. Attacks of bronchial asthma (for removal of a bronchospasm).
3. Administration of medicinal substances for the purpose of local anesthesia of a mucous membrane of upper respiratory tracts.
4. Administration of the medicinal and anesthetizing substances which hit in an organism some other way is impossible (And. gas mixtures, vapors of ether, amyle nitrite, etc.) or difficult or less reasonablly and conveniently for one reason or another.
5. Protection of a mucous membrane of respiratory tracts against harmful effect of some chemical substances (e.g., carrying out oil And. with the preventive purpose on some productions where air contains the increased amount of the chemical substances irritating a mucous membrane of respiratory tracts).
«Natural» And. it is used generally in system of complex treatment in resorts not only at diseases of upper respiratory tracts, bronchial tubes and lungs, but also bodies of blood circulation (an idiopathic hypertensia of I and II stages).
The general contraindications
Cannot be carried out And. medicinal substances on which in the past at the patient allergic reactions were noted. Are not carried out And. the medicinal substances possessing strong irritant action on a mucous membrane with sharp off-flavor or taste.
During the carrying out And. the way of inhalation is defined by the purpose of influence: if influence shall be directed to a mucous membrane of a nose and adnexal bosoms, the patient should breathe a nose; if on a mucous membrane of a throat, a throat, a trachea, bronchial tubes — the way of inhalation (in Nov or a mouth) has no basic value and is defined by features of the used equipment. The nature of breath (its depth) is also defined by to what site of respiratory tracts influence of this or that procedure is directed. So, if purpose I. impact on a mucous membrane of small bronchial tubes or an alveolus is, deeper breath is recommended. In time And. in some cases (e.g., at bronchial asthma) recommend carrying out special complexes of medical and sports breathing exercises for the purpose of improvement of function of external respiration and the best digestion of the inhaled medicinal substance. At reception And. it is not necessary to read or talk, it is also impossible to accept them directly after food or physical. tension. After the procedure I. it is necessary to have a rest within 10 — 15 min. Within an hour it is impossible to talk, smoke, eat food.
Distinguish chamber And., And., carried out by means of special devices, and And., not demanding any devices.
At chamber And. saturate air of specially equipped rooms (chamber ingalyatoriyev open type) with vapors or aerosols of medicinal substances, and in some cases (by means of aero ionizers) — negative or positive ions, to-rymi patients breathe without use of respirators. Chamber And. are often carried out by alkaline or salt and alkaline waters — borzhy, Yessentuki No. 17, etc., including directly in resorts. This method is simple, provides carrying out And. to big group of patients at the same time, however it is connected with losses of significant amounts of medicinal substances and need of careful selection of patients with homogeneous diseases that limits its use.
Much more often And. carry out by means of stationary, figurative and pocket inhalers of the closed type (see. Aerosoltherapy, devices ), in which intake of medicinal substance is carried out by means of the special devices brought directly to respiratory tracts of sick (fig. 1-3).
In some cases And. are carried out without use of the special equipment, e.g. And. amyle nitrite at stenocardia carry out by couples from the crushed ampoule; at an attack of bronchial asthma inhale the smoke which is formed during the burning of the corresponding dose (1/2 chayn, l.) antiasthmatic collecting or smoking of the Asthmatinum cigarette; at faints to a nose bring the small piece of cotton wool moistened in spirit of ammonia, etc.
Efficiency of inhalation therapy is defined by correctness of the choice of medicine or their combinations, doses, a way and method I., duration of the procedure and course of treatment, frequency and sequence of procedures; all these moments are considered in each case individually depending on character and a phase of a disease (an aggravation or remission), age of the patient, existence of associated diseases and other factors.
For use at And. strong substances it is reasonable to give preference to more low concentrations of their solutions, but to keep a necessary single therapeutic dose due to increase in time of the procedure. At the same time it is necessary to be guided by the established therapeutic highest single and daily doses of medicinal substances listed in a pharmacopeia.
By drawing up copy-books of drugs for inhalation therapy it is necessary to consider their compatibility, a possibility of antagonism and a synergism of action (e.g., at And. antibiotics). At purpose of two types of inhalation procedures it is necessary to choose their optimum sequence.
As a rule, the inhalation method of administration of medicines is transferred by patients well and does not cause complications. In rare instances, generally at the wrong selection of medicinal substances and techniques And., short-term dryness of respiratory tracts directly after the procedure is possible; at intolerance allergic reactions can be noted by the patient of separate pharmaceuticals.
Main types And. depending on physical. conditions of the inhaled substances are the following.
For steam And. use more often a simple steam inhaler which consists of the tank filled with water and the heating unit. During the heating of water to temperature of boiling steam which, passing through the sprayer, sucks in medicinal substance and disperses it is formed. Temperature of steam at receipt in a respirator (usually it is the wide glass tube which is coming to an end with a bell) makes 57 — 63 °. Duration of the procedure 5 — 10 min. Steam And. most often carry out with menthol, eucalyptus oil, methyl-isopropyl phenol, sometimes with antibiotics. On a course 8 — 10 procedures. Lech. the effect is reached by impact of warm steam on a mucous membrane of respiratory tracts that reduces their irritation, dry cough; addition of the medicinal substances possessing local antiinflammatory action does steam And. more effective.
Steam And. apply to treatment of tonsillitis, acute laryngitis, tracheitis, bronchitis. These procedures are contraindicated at a hypertension, stenocardia, heart failure, active forms of a pulmonary tuberculosis and a throat, bent to pulmonary bleedings.
For these And. apply the sprayed solution of medicinal substance, temperature to-rogo is usually maintained in limits> 38 — 40 °. And. carry out by means of inhalers, various on the device, duration of the procedure 5 — 10 min., on a course — 10 — 15 procedures daily or every other day. On one procedure use from 25 to 200 ml of solution. Heatwet And. carry more often out with solutions of hydrosodium carbonate, alkalis, mineral waters, biologically active agents and hormones. These apply And. for treatment acute and hron, pharyngitises, laryngotracheitis, bronchitis, aggravations of a bronchoectatic disease. Contraindications are same, as to steam And.
These And. carry out using water solutions of bronchial spasmolytics, antibiotics, streptocides, mestnoanesteziruyushchy medicines, fermental, hormonal drugs and pharmaceuticals of resorptive action. Wet And. apply generally room temperature. At the same time use more concentrated solutions of medicinal substances and short procedures on time: the volume of the used solutions usually 2 — 6 ml. In certain cases, napr, for the purpose of removal of the attack of bronchial asthma which arose on the street in cold season it is necessary to use broncholitic mix of low temperature.
The main indications to wet And. — attacks of bronchial asthma, acute and hron, inflammatory diseases of upper respiratory tracts, lungs, including tuberculosis.
carry out Oil inhalations by means of stationary and figurative inhalers with the special sprayer for oils or by means of a pocket inhaler. Duration oil And. 5 — 7 min., on one procedure are used by 0,25 — 0,5 ml of oil; usually oil And. appoint warm (not above t ° 38 °). The course of treatment consists of 5 — 15 procedures. For oil And. it is preferable to use vegetable oil of an origin (more often solution of menthol in vegetable oil) which in lungs are gradually split and completely resolve. Long appointment And. the liquid paraffin is undesirable since it badly resolves. Oil And. apply for the purpose of local impact on a mucous membrane of respiratory tracts, they render the softening and soothing effect, calm dry cough at bronchitis a little, protect a mucous membrane from the irritating physical. and chemical influences; some essential oils possess also weak antiseptic action. Sometimes these And. appoint in a combination with heatwet And. (e.g., alkaline); such combination removes irritation of a mucous membrane of respiratory tracts more effectively. At the same time in the beginning carry out heatwet aerosol And., and in 30 — 40 min. — oil since otherwise existence of a thin coat of oil on a mucosal surface of a cover of respiratory tracts will interfere with absorption of the medicinal substances entered in the inhalation way. Addition of a small amount of menthol strengthens soothing action oil And. Indications to oil And. — acute Qatar of upper respiratory tracts, tracheitis, bronchitis, atrophic and subatrophic laryngitis. These And. apply also with the preventive purpose at the persons occupied on productions where at air there can be chemical substances, the irritating respiratory tracts. Oil And. are not recommended to the persons working at productions with dusty air (flour, cement, asbestos dust and so forth) since inhalation of oils can lead to formation of crusts, traffic jams or paraffinomas.
carry out Dry inhalations (so-called kertingovsky) by means of an inhaler «the Aerosol of U1». At these And. the sprayed solution mixes up with a dry hot air, in Krom water evaporates; the particles of substance which are in suspension in inhaled air freely get to the smallest bronchial tubes and alveoluses. Dry And. are especially shown at acute inflammatory diseases of upper respiratory tracts; contraindications are same, as to steam And.
Inhalations of the anesthetizing substances
apply Inhalations of the anesthetizing substances at operations in nasal cavities, nasopharynxes, throats, at a bronkhoskopiya and a bronchography, an ezofagoskopiya, introduction to a trachea and bronchial tubes of catheters, probes, etc. Apply solutions of novocaine, cocaine, Dicainum to inhalation anesthesia, etc. It is possible to add the adrenaline or ephedrine having vasoconstrictive properties to the anesthetizing solutions.
Compatible with And. procedures are the thermotherapy, electrotreatment (currents and fields VCh, UVCh and microwave Oven); incompatible — the cooling hydrotherapeutic and air procedures, UF-radiation.
Bibliography: Glukhov S.A. and Eydelstein S. I. Hardware of an aerosoltherapy, M., 1974, bibliogr.; The methodical letter on inhalation therapy at LOR-diseases, sost. A. R. Hanamirov, Rostov N / D., 1974; Polunov M. Ya. Bases of inhalation therapy, Kiev, 1962, bibliogr.; Eydelstein S. I. Bases of an aerosoltherapy, M., 1967, bibliogr.; T about-dorov N. of imikhayl of St. Inkha-latsionno treatment, Sofia, 1972, bibliogr.
A. L. Grebenev.