Hess Dean R
Department of Respiratory Care, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
Respir Care. 2008 Jun;53(6):699-723; discussion 723-5.
Nebulizers convert solutions or suspensions into aerosols with a particle size that can be inhaled into the lower respiratory tract. There are pneumatic jet nebulizers, ultrasonic nebulizers, and mesh nebulizers. Newer nebulizer designs are breath-enhanced, breath-actuated, or have aerosol-storage bags to minimize aerosol loss during exhalation. Nebulizers can be used with helium-oxygen mixture and can be used for continuous aerosol delivery. Increased attention has recently been paid to issues related to the use of a facemask with a nebulizer. The pressurized metered-dose inhaler (pMDI) is a very commonly used device for aerosol delivery. There are press-and-breathe and breath-actuated pMDI designs. Issues related to pMDIs that have received increasing attention are the conversion to hydrofluoroalkane propellant and the use of dose counters. Many patients have poor pMDI technique. Valved holding chambers and spacers are used to improve pMDI technique and to decrease aerosol deposition in the upper airway. In recent years increasing attention has been paid to the issues of electrostatic charge and facemasks related to valved holding chambers. Many newer formulations for inhalation have been released in dry-powder inhalers, which are either unit-dose or multi-dose inhalers. Systematic reviews and meta-analyses have suggested that each of these aerosol delivery devices can work equally well in patients who can use them correctly. However, many patients use these devices incorrectly, so proper patient education in their use is critical.
雾化器可将溶液或混悬液转化为粒径适宜的气雾剂，以便吸入下呼吸道。常见的雾化器类型有气动喷射雾化器、超声雾化器和网式雾化器。新型雾化器设计具有呼吸增强、呼吸驱动功能，或配有气雾剂储存袋，以尽量减少呼气时的气雾剂损失。雾化器可与氦氧混合气配合使用，也可用于持续气雾剂给药。近来，雾化器面罩使用相关问题受到了更多关注。压力定量吸入器（pMDI）是一种非常常用的气雾剂给药装置。有按压呼吸式和呼吸驱动式pMDI设计。与pMDI相关且日益受到关注的问题包括向氢氟烷烃推进剂的转换以及剂量计数器的使用。许多患者使用pMDI的技术欠佳。带阀储物罐和储雾罐可用于改善pMDI使用技术，并减少气雾剂在上呼吸道的沉积。近年来，与带阀储物罐相关的静电荷和面罩问题受到了越来越多的关注。干粉吸入器已推出许多新型吸入制剂，包括单位剂量和多剂量吸入器。系统评价和荟萃分析表明，对于能够正确使用这些气雾剂给药装置的患者，每种装置的效果相当。然而，许多患者使用这些装置的方法不正确，因此对患者进行正确使用方法的教育至关重要。
