Nebulisation in the treatment of adult asthma and chronic obstructive pulmonary disease (COPD)

Nebulisation is an efficacious form of treatment for asthma and COPD. Pneumatic atomizer with an oral-nasal interface are the most widely used form (low cost and not incompatible with the contents), the oral interface being preferred for treatment over a long period. There are not many drugs that are now marketed for use in nebulisers: general practitioners are limited to using bronchodilators, beta2-adrenergic agonists (salbutamol and terbutaline), ipratropium bromide and corticoids (budesonide and beclomethasone). In acute asthma and exacerbations of COPD, nebulised beta2-adrenergic agonists are the treatment of first intention because they have been shown to be as efficacious as intravenous administration. Atropinic drugs add an additional benefit and their use is generally accepted. In less severe exacerbations, nebulised corticoids are an acceptable alternative to systemic corticotherapy. The indications for nebulisation over extended periods remain poorly defined, but it is not a substitute for classic forms of inhalation (spray with inhalation chamber and dry powders). Education of the patient remains obligatory. (C) 2007 Elsevier Masson SAS. Tous droits reserves.