Acute upper respiratory tract infection, unspecified (cold). Acute and chronic diseases of the upper respiratory tract

Article outline

Description

The respiratory system is a group of interconnected organs human body, providing oxygen inhalation, blood gas exchange, and the release of carbon dioxide. The human respiratory system consists of:

• Upper respiratory tract;
• Lower respiratory tract;
• Lungs.

The respiratory system begins to function at the moment of birth, and ends its functioning after the death of a person. The operation of the presented system is to perform the following functions:

• Thermoregulation of the human body;
• Ability to talk;
• Ability to distinguish odors;
• Humidifies the air that a person inhales;
• Takes part in lipid and salt metabolism.

In addition, the clarity of the structure respiratory system performs an important function in the immune system, providing additional protection to the human body from the environment. There are several types of breathing, such as:

• Breast, which is most often present in females;
• Abdominal, which is most often present in males.

The upper respiratory tract is located in the human head and consists of the following basic elements:

• Nose;
• Parts of the oral cavity;
• Oropharynx;
• Nasal pharynx.

At the moment of inhalation, the air first ends up in the nose, and it is there that the first stage of its purification takes place, which takes place with the help of hairs. A mesh consisting of blood vessels nasal mucosa, warms the air that is inhaled by a person.

Droplets of mucus in a person's nose have a moisturizing effect. In this way, the air is prepared for the conditions that prevail in the human lungs.

After this, the air passes to the pharyngeal cavity, which in turn is divided into several sections. Moreover, it is in this place that the paths of the respiratory system and the esophagus intersect. The air a person inhales passes down the throat to the lower respiratory tract.

Today, there are a huge number of diseases of the respiratory system of the human body, and each of them in one way or another causes some discomfort to the patient, thereby complicating his life.

Some of the most common symptoms of respiratory disease are, for example, a runny nose and cough, and some symptoms can even be fatal. The functioning of the respiratory system must be stable, because deviation from the norm can lead to clinical death, as well as irreversible changes in the human brain.

As a rule, such well-known diseases as:

• Pharyngitis;
• Angina;
• Tonsillitis;
• Acute respiratory disease;
• tracheitis;
• acute respiratory viral disease;
• sinusitis;
• rhinitis;
• laryngitis.

Symptoms

One of the most common diseases of the upper respiratory tract counts acute symptoms inflammation. The disease presented has many names, such as acute respiratory disease or respiratory viral disease. Most often, inflammation of the respiratory tract occurs for the following reasons:

• influenza virus;
• rhinoviruses;
• enteroviruses;
• streptococcus;
• mycoplasma;
• meningococcus;
• severe hypothermia of the human body;
• colds.

Typically, inflammation of the upper respiratory tract is manifested by symptoms that are caused by the penetration of a virus that causes intoxication of the entire body as a whole. What are the symptoms of this disease?

So, the main symptoms of the upper respiratory tract:

• Strong headache;
• Poor sleep;
• High temperature;
• Prostration;
• Pain in the muscles;
• Poor appetite;
• Vomiting;
• Convulsions;
• Difficulty breathing;
• Pain when eating;
• The whole body hurts;
• Dry throat;
• Sore throat;
• The appearance of hoarseness;
• Enlarged lymph nodes;
• The appearance of white spots on the tonsils;
• Fever;
• Body temperature can reach 39⁰С;
• Brief loss of consciousness;
• Weakened reaction;
• Increased or, conversely, decreased activity.

For example, rhinitis is an inflammation of the mucous membranes of the nose, which causes a severe runny nose, difficulty breathing, and frequent sneezing. Pharyngitis is called inflammation of the mucous membranes of the pharynx, and a distinction is made between acute and chronic forms of the disease.

With pharyngitis, a certain soreness and pain when eating food is noticed. Laryngitis is called laryngitis, which can spread to the vocal cords and is accompanied by hoarseness, as well as a barking cough.

Tonsillitis refers to an infectious disease that manifests itself in acute inflammation of the lymphadenoid rings of the pharynx, usually the tonsils. With this disease, there is an enlargement of the tonsils, redness of the mucous membranes and painful sensations when consuming food. Tracheitis is an inflammation of the mucous membranes of the trachea, which causes a dry cough and heaviness in the chest.

Treatment

Inflammation of the respiratory tract is not one of the most serious diseases, and therefore treatment is not very difficult. What is the treatment for airway inflammation? When treating laryngitis, doctors recommend less strain on the vocal cords. The most important thing in the treatment of pharyngitis, laryngitis, tonsillitis, tracheitis and bronchitis is to exclude from your diet foods that can irritate the throat.

That is, get rid of sour, salty, hot, cold and spicy foods. It is also contraindicated to use alcoholic drinks and smoke because tobacco smoke and alcohol also lead to irritation of the mucous membranes.

If you have a sore throat, you need to drink plenty of fluids, and the ideal option would be to drink vitamin drinks, such as rosehip infusions or berry fruit drinks.

Antipyretic drugs are used to reduce body levels. As a rule, the doctor prescribes drugs that include interferon and lysozyme, as well as mineral and vitamin complexes.

Naturally, if the disease is bacterial, the doctor may prescribe antibiotics, but taking them at your own discretion is strictly contraindicated, since you may incorrectly analyze the symptoms that have arisen and decide on treatment.

Treatment of pharyngitis, laryngitis, tonsillitis, tracheitis and bronchitis with antibiotics is necessary only for acute forms, and for chronic pharyngitis, the use of antibiotics is generally necessary to prevent the occurrence of various complications of the disease.

Incorrect or inadequate treatment of the acute form of the disease, inflammation of the respiratory tract can progress to chronic forms. Moreover, pay attention to the fact that the chronic form has less pronounced symptoms than the acute form.

Therefore, with this form of the disease, they do not look too much at the symptoms, but treat the disease itself, thereby muffling the symptoms. Since bacterial pharyngitis can become chronic, we will also consider its treatment methods.

Treatment of chronic forms of inflammation of the respiratory tract is quite lengthy, since it includes not only the elimination of foci of infection, but also simultaneous treatment diseases of the gastrointestinal tract, endocrine system disorders and many others.

Usually, hypertrophic form Chronic disease is treated by cauterization of lymphoid tissue, using electric current or cold. And the treatment of the atrophic form of the disease consists of increasing mucus secretion and reducing the level of dry throat, as well as stimulating the regenerative processes of the mucous membranes.

Prevention

To reduce the risk of this disease, you need to use the following methods of prevention:

• Temper the body;
• Refuse bad habits such as alcohol abuse and smoking.
• Restore impaired nasal breathing;
• Strengthen immunity.

• Do not buy various cough drops as they are a waste of money. They cannot cure the throat, but only ease the discomfort.
• There is no need to rely only on gargling. In addition, inflammation of the mucous membranes with chronic pharyngitis cannot be treated at all by rinsing with a soda solution, as this greatly dries out and complicates the treatment of the disease.
• There is no need to use nasal drops very often. Frequent use of nasal drops can cause inflammation and irritation of the throat as the drops flow from the nose into the throat.

-k

Video

The video talks about how to quickly cure a cold, flu or acute respiratory viral infection. Opinion of an experienced doctor.

Attention, TODAY only!

Bacteria, respiratory disease, URTI... All these concepts mean one thing - diseases of the upper respiratory tract. The list of their causes and manifestations is quite voluminous, so let’s look at what a respiratory tract infection is, treatment and drugs used in therapeutic methods, which medicine is the most effective, and how viral and bacterial respiratory tract infections differ.

Respiratory tract diseases are the most common reasons for visiting general practitioners and pediatricians. This disease is mainly seasonal in nature, with the peak incidence for such diseases as viral and bacterial respiratory tract infections occurring in the autumn-winter months. Upper respiratory tract diseases - infections include both trivial illnesses and life-threatening conditions.

In the vast majority of cases, respiratory tract diseases (acute infectious diseases) occur in children, but there is also infection in adults, which is predominantly of viral origin. Even in the absence of complications, the first choice drugs are often antibiotics. One of the reasons for their use in children and adults is to comply with the requirements of the patient or the child's parents, aimed at better and more effective treatment. It is clear that antibacterial therapy should be used for bacterial infections. It is estimated that in approximately 80% of cases antibiotics are used to treat a condition such as acute infection respiratory tract and respiratory diseases. The situation is alarming for children. In approximately 75% of cases, drugs from the group of antibiotics are prescribed for inflammation of the upper respiratory tract. However, the so-called Prophylactic antibiotic therapy administered for upper respiratory tract infections does not speed up or shorten the treatment period, nor does it prevent possible complications that arise later. Therefore, in most cases, symptomatic therapy is recommended for people without immunological disorders or other risk factors, and without the presence of underlying chronic diseases.

For uncomplicated upper respiratory tract infections and in immunocompetent people, the basis for treatment is symptoms. Acute rhinitis, sinusitis, otitis media, pharyngitis and laryngitis are caused by viruses in 80-90% of cases. Antibiotic therapy has virtually no effect on their clinical course. In cases where the course of the disease is confirmed by evidence of bacterial agents from the selected biological material and when inflammatory parameters increase, antibiotics are prescribed. In addition, if the level remains high for a long time (longer than a week), bacterial involvement may be recognized. For common pathogens - Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Mycoplasma pneumonie and Chlamydia pneumonie - aminopenicillins or cotrimoxazole, macrolides or tetracycline preparations are prescribed.

Upper respiratory tract infection treatment of complications

Acute epiglottitis with bacterial etiology And streptococcal sore throat are diseases for which it is necessary penicillin antibiotics. In particular, in the case of epiglottitis, hospitalization with parenteral administration of broad-spectrum penicillin or a second or third generation cephalosporin is advisable; therapy is supplemented with corticosteroids.

Similar recommendations apply for the treatment of lower respiratory tract infections such as tracheobronchitis and acute bronchitis. Viral etiology is the most common, accounting for up to 85% of cases. But, even in these cases, treatment with antibiotics, both in children and adults, is not necessary, it is considered only in cases of serious disease or in a person with immunodeficiency. If during a long period of time serious illness the presence of intracellular pathogens (mycoplasma pneumoniae, chlamydia pneumoniae) will be proven; the first choice drugs are macrolides, cotrimoxazole or doxycycline.

The most common infectious respiratory attacks include acute exacerbations of chronic obstructive pulmonary disease (COPD). Although it is known that exacerbation can be caused by several non-infectious causes, in practice antibiotics are also administered in these cases. The etiological agent, according to many studies, in COPD can be identified in 25-52% of cases. However, it is questionable whether the disease is caused by the bacterium pneumococcus or Haemophilus influenzae, which chronically colonizes the respiratory tract (difficulty breathing) and leads to pathogenic exacerbations of the disease.

If upper respiratory tract infections occur, symptoms include increased production of colored, purulent sputum, decreased breathing, and shortness of breath along with bronchitis symptoms and sometimes heat. Administration of antibiotics is indicated when inflammatory markers are detected, including C-reactive protein, leukocytes, sedimentation.

Procalcitonin is a sensitive acute phase reagent for distinguishing between bacterial and non-infectious causes of inflammation. Its value increases within 3-6 hours, peak values ​​are reached after 12-48 hours at the time of infection.

The most commonly administered antibiotics include aminopenicillin, tetracycline, and from the macrolide generation - clarithromycin, azithromycin. Quinolone drugs are suggested for the treatment of infections in which bacterial agents have been demonstrated. The benefits of macrolides include a wide range of antibacterial spectrum, high concentration antibiotic in bronchial secretions, well tolerated and relatively low resistance. Despite these positive sides, macrolides should not be administered as the first choice of antibiotics. No less important are factors such as the relatively low cost of treatment. Therapy usually lasts 5-7 days. Its effectiveness and safety are comparable.

Influenza is a viral infectious, highly contagious disease that affects everything age groups– both a child of any age and an adult can get sick. After the incubation period, that is, from 12 to 48 hours, the rapid onset of fever, chills, headache, muscle and joint pain, and a feeling of weakness. The disease is accompanied by cough, stomach upset and can cause other serious secondary symptoms. infectious complications. In adults who already suffer from certain chronic diseases, the flu can be worse. Young children and the elderly are the most vulnerable group. It is estimated that on average there are about 850,000 cases of illness during the flu season. Necessary symptomatic treatment With bed rest. In case of secondary complications or in patients with serious risk antibiotics are administered.

Pneumonia

The main criteria for diagnosing pneumonia and its difference from lower respiratory tract infections are the following factors: acute cough or significant deterioration chronic cough, shortness of breath, rapid breathing, high fever lasting more than four days, new infiltrates on x-ray chest. Many studies have shown that consistently the most common cause community-acquired pneumonia in European countries is pneumococcus, in second place are Haemophilus influenzae, Moraxella catarrhalis, staphylococcus, and less often - gram-negative bacteria.

In the treatment of community-acquired pneumonia, two approaches are used, which are based on the findings of retrospective studies. This is about combination therapy with a beta-lactam antibiotic together with macrolides or doxycycline, or monotherapy with a quinolone. The first option makes positive use of the immunomodulatory effect of macrolides, which are also effective in cases of simultaneous infection with Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella.

Mixed infection with the presence of more pathogenic microorganisms occurs in 6-13% of cases. If after 3 days there is no improvement in the clinical condition or progression of radiological findings, it is necessary to reconsider the initial option and change the antibiotic treatment. This condition can be prevented by new collections of biological material from the respiratory tract, including bronchoscopic aspirates, so that treatment is completely targeted. In these cases, it is necessary to cover not only the usual bacterial spectrum, but also often resistant strains - pneumococcus, Pseudomonas aeruginosa, Staphylococcus aureus and anaerobic bacteria.

In hospital-acquired pneumonia, in which the infectious agent originates from the hospital environment, we are most often talking about enterobacteria - Pseudomonas aeruginosa, pneumococcus, staphylococcus, and anaerobic bacteria. In this case, early treatment within 4 hours is very important, which is initially non-target. Typically, therapy involves a combination of aminoglycosides to target gram-negative bacterial populations and drugs effective against anaerobic pathogens and fungi.

Among the most serious and life-threatening complications, epiglottitis should be noted. In severe cases, it can even lead to suffocation. Pneumonia is another serious illness, whose progress is accompanied by symptoms affecting the entire body. In some cases, a serious condition develops very quickly, requiring hospitalization. TO frequent complications Pneumonia includes pleurisy. Sometimes effusion may develop. In the case of these complications, the pain subsides and breathing deteriorates, since the lungs become oppressed by the fluid formed between the sheets of the pleura. In some cases, pneumonia is accompanied by a lung abscess, rarely by gangrene in patients with immunodeficiency, or by extensive bacterial infection.

Severe pneumonia can lead to sepsis, etc. septic shock. This - fortunately rare - complication involves severe inflammation of the entire body with the risk of multiple organ failure. In this case, it is necessary artificial ventilation lungs, the introduction of the combination is very strong antibiotics and vital support important functions. It should be expected that the move is relatively light respiratory infections may be complicated by the adverse effects of multiple human risk factors. The most common include chronic smoking, including passive smoking, age over 65 years, alcohol abuse, contact with children, pets, poor social conditions, and poor oral hygiene. Some people have chronic diseases - diabetes, ischemic disease heart disease, liver disease, kidney disease, immunosuppressive therapy for various other diseases - represent serious factor risk, which can seriously complicate the situation in case of respiratory tract diseases and lead to a life-threatening condition.

Voluntary vaccination and vaccination of risk groups remains the only effective preventive measure. There are currently three main types of flu vaccines. They vary in composition, containing either inactivated virus, inactivated viral particles, or only hemagglutinin and neuraminidase antigens. Another difference is reactogenicity and immunogenicity. The most commonly used is inactivated vaccine from trivalent inactivated viral particles. The World Health Organization (WHO) recommends the use of a trivalent vaccine against only two subtypes of influenza A virus and one influenza B virus. Subtype selection is carried out annually by WHO, in particular for the northern and southern hemispheres.

Vaccination against pneumococcal infection

Primary source pneumococcal infection are pneumococcus bacteria, of which there are more than 90 serotypes. Invasive pneumococcal infection is considered dangerous, which causes pneumococcal pneumonia, meningitis, otitis media, sepsis, and arthritis. Risk groups include people over 60 years of age, as well as children under 5 years of age. The source of infection is a sick person or a carrier of the pathogen; the disease is transmitted by droplets. Incubation time is short, within 1-3 days. Vaccination against pneumococcal infection with a polysaccharide vaccine is carried out for persons in medical institutions and nursing homes, as well as for long-term patients. In addition, immunization against pneumococcal infection is indicated for patients suffering from chronic respiratory diseases, diseases of the heart, blood vessels, kidneys, and for insulin treatment of diabetes. Patients after organ transplantation, people with cancer diseases receiving immunosuppressive therapy for a long time.

The most commonly used vaccine for vaccination is a 13-valent conjugate vaccine containing serotype 13 polysaccharide, or a 23-valent vaccine.

Respiratory infections are very common and affect almost all categories of the population. The majority of victims are being treated in outpatient setting, and this trend is expected to expand in the future. One of the most important points in making decisions regarding therapeutic options is determining whether symptomatic treatment alone is reasonable or antibiotic treatment is mandatory. Particularly in the case of upper respiratory tract infections and acute bronchitis without a visible bacterial agent, a combination of antipyretic drugs, plenty of fluids and vitamins is effective. The impact of this therapy is often underestimated.

The person's risk factors and possible complications should be taken into account. Currently, a wide variety of drugs are used to treat bacterial infections. antibacterial drugs. In addition to the undoubted benefits of such treatment, adverse effects should also be expected. They are individual and can have different manifestations for each person.

In addition, the ongoing risk of the spread of antibiotic resistance and the increase in the number of initially susceptible pathogens must be taken into account.

Skillful use of antibiotics can reduce the problem and prevent the devaluation of these drugs. Vaccination, healthy image life and reducing the risk factors mentioned above, a person can reduce the incidence and risk of complications of respiratory infections.

Upper respiratory tract infections (URTIs) are the most common diseases, especially during the cold season. They are most often diagnosed in people with weakened immune systems, children and elderly patients. The form of URTIs can be acute or chronic.

What indicates how an upper respiratory tract infection manifests itself, and how is it treated? This is exactly the topic that our conversation today will focus on. Let's briefly look at the main diseases and find out how to drug treatment and consider one effective folk recipe for every ailment.

Infectious diseases upper respiratory tract

Let's list some of the most common ones:

- Rhinitis (runny nose)– inflammatory process of the nasal mucosa. May have an acute or chronic course.

Main symptoms: swelling of the mucous membrane, dryness, itching, difficulty breathing. At the initial stage, liquids appear, transparent discharge from the nasal cavity. Subsequently, the discharge becomes thick, mucopurulent, and then gradually disappears. Everything is accompanied by a general malaise.

Treatment

They use vasoconstrictor, anti-inflammatory and decongestant drugs: Naphthyzin, Ephedrine hydrochloride, Galazolin (the instructions for use of each drug before use must be studied personally from the official annotation included in the package!). For children - Nazivin. Treatment with antibiotics is possible, but only if rhinitis is bacterial in nature and if there are complications.

Folk recipe:

Mix 1 tsp freshly squeezed carrot juice and the same volume of unrefined olive oil. Add 3 drops. fresh garlic juice. Place 2-3 drops on each nostril. Use only freshly prepared mixture.

- Sinusitis, rhinosinusitis- infectious-inflammatory process paranasal sinuses nose, with sharp or chronic course. It can be viral, bacterial, fungal or allergic in nature. It can develop in isolation, but more often it is a complication of other pathologies: measles, rhinitis, influenza or scarlet fever.

Main symptoms: general malaise, weakness and headaches, the person’s body temperature rises, and copious mucous discharge appears from the nose.

Treatment

Sinusitis that is bacterial in nature is treated with antibiotics. They are prescribed by a doctor, depending on the type of bacteria and their sensitivity to a particular drug. If it is viral in nature, it is prescribed antiviral drugs- Neovir, Isoprinosine. Additionally, decongestant drops and sprays are used: Naphthyzin, Sanorin, Galazolin.

If sinusitis is a complication of another disease, measures are taken to treat the pathology that caused it.

Folk recipe:

Prepare freshly squeezed black radish juice. Place 2 drops per nostril into the nasal passages. If it burns too much, you can dilute it with water.

- Sore throat (acute tonsillitis)– can be catarrhal, follicular, phlegmous and lacunae. Moreover, one variety rarely develops in its pure form. Most often, the patient has signs of at least two types.

Characteristic common symptoms are: pain, redness of the throat, enlarged tonsils, present catarrhal phenomena. There is general malaise, weakness, fever, chills, and enlarged lymph nodes.

Treatment

Depending on the variety, antimicrobial, antifungal, anti-inflammatory drugs, local antiseptics, and symptomatic drugs are prescribed. Use disinfectant solutions to gargle. If the disease is caused by a bacterial infection, antibiotics of a certain group are prescribed.

Folk remedy:

Mix equal amounts of elderberry, clover and linden blossoms. Add the same amount of crushed rowan berries, viburnum, peppermint leaves and black currant leaves. Mix well. Infuse 4 tablespoons of the mixture in a thermos for 2 hours, pouring a liter of boiling water over it. It is recommended to take half a glass several times a day.

- Pharyngitis– inflammatory disease of the mucous membrane of the upper pharynx, tonsils and uvula. Most often it is viral in nature. It can be an independent illness, or manifests itself as a complication of other infections, in particular, ARVI, rhinitis, sinusitis, etc. It can occur as a result of alcohol abuse and smoking.
Characterized by acute or chronic course.

Main symptoms: dryness, redness in the throat, pain when swallowing. The pharynx may become covered with purulent plaque, and follicle grains may appear. Accompanied by weakness, malaise, and possibly a slight increase in temperature.

Treatment

In the presence of viral infection The following drugs are prescribed: Faringosept, Falimint and Laripront. To reduce painful symptoms Anaferon, Tamiflu, etc. are used in the throat. Antibiotics are prescribed if the process is bacterial in nature.

Folk remedy:

Inhale several times a day using soda solution: 1 tsp per glass of boiling water. Breathe hot steam while covering your head with a towel.

- Bronchitis– inflammatory disease of the bronchial mucosa. It usually develops against the background of other respiratory tract infections.

Main symptoms: cough (dry or wet), weakness, malaise, other symptoms of general intoxication of the body are observed.

Treatment

A bacterial infection that occurs in an acute form is eliminated with the help of antibiotics of a certain group. If necessary, drugs of the sulfonamide group are prescribed: Etazol, Sulfadimethoxine. If there is a fever, antipyretic drugs are used: Aspirin, Paracetamol, etc. Steam inhalations are used to treat cough. For better discharge sputum is prescribed: ACC, Libexin, Mucaltin, etc.

Folk remedy:

Grind 0.5 cups of beeswax to a powder. Place in a saucepan. Add 0.5 cups sunflower oil, bee honey and resin (pine resin). Melt the mixture in a water bath until very hot, but do not boil. Cool, pour into a jar. Treatment beeswax, resin and honey, take 1 tsp of the composition in the morning, with warm milk or weak tea. Strong black tea will weaken the effect of the medicine, and therefore it is undesirable, just like coffee. Keep the jar in the cold.

- Tracheitis– inflammatory process of the tracheal mucosa. It can manifest itself in acute or chronic form.

Main symptoms: severe dry cough, worse at night and in the morning, after sleep. Coughing attacks also occur when talking loudly, laughing, crying or deep breath. Very often, a cough begins when the air temperature changes.

After an attack, a stinging pain is felt that occurs behind the sternum and throat. If there is sputum, it may be scanty and viscous. Or profuse, with mucopurulent discharge.

Treatment

If there are signs of intoxication, sulfonamide drugs are prescribed. For bacterial infections, antibiotics are used. To treat cough, medications are prescribed: Codeine, Libexin, etc. Mustard plasters are placed to warm the chest (instructions and application are on the website in the “Drugs” section).

Folk remedy:

Place 60 g of crushed propolis in a small saucepan and add 40 g of wax. Melt in a water bath. Use the hot mixture for inhalations for 10 minutes in the morning and before bed.

In conclusion of our conversation, we note that any infection of the upper respiratory tract is quite difficult for most patients.

These diseases cause maximum unpleasantness, painful sensations, knocked out of the usual rhythm of life.

Therefore, it is important to promptly consult a doctor for help and begin treatment prescribed by a specialist. The sooner this is done, the less likely it is to develop complications and the higher the chance of quickly, effectively getting rid of the infection. Be healthy!

Diseases upper sections respiratory tract infections may be caused by exposure to viruses or bacteria. The latter lead to damage to the mucous membrane much more often, and for their treatment it is advisable to use antibacterial agents. Local physicians and pediatricians often do not have enough time to establish the exact factor that led to the development of rhinitis or tonsillitis, so it is necessary to use broad-spectrum drugs: penicillins, cephalosporins, fluoroquinolones, macrolides.

Treatment of upper respiratory tract diseases

Diseases of the upper respiratory system include:

• rhinitis, or runny nose;
• otitis, or inflammation in the middle ear;
• infection of the lymphopharyngeal ring of the pharynx, or tonsillitis, adenoiditis;
• inflammation of the sinuses, or sinusitis;
• hoarseness due to pathology in the larynx - pharyngitis;
• inflammation back wall mouth and pharynx.

Doctors use various drugs, the choice of which depends on the cause of the disease: for a viral infection, they are prescribed antivirals, and when identifying bacteria in the mucous membrane of an organ, antibacterial drugs are used. The main antibiotics used to treat diseases of the ENT organs include:

• Penicillins, the main representatives of which are Ampicillin, Amoxiclav, Flemoxin Solutab and others.
• Fluoroquinolones are “reserve” drugs prescribed for allergic intolerance to drugs from the penicillin group. The most commonly used are Levofloxacin, Avelox, Moximac, etc.
• Cephalosporins are broad-spectrum drugs. The names of the representatives are Kefsepim, Ceftriaxone, Zinnat.
• Macrolides have a mechanism of action similar to penicillins, but are more toxic. This group includes Summamed, Azithromycin, Hemomycin.

Penicillins

Penicillins are broad-spectrum antibacterial agents that were discovered in the middle of the last century. They belong to beta-lactams and are produced by fungi of the same name. These antibiotics fight many pathogens: gonococci, staphylococcus, streptococcus, pneumococcus, etc. The mechanism of action of penicillins is associated with a specific effect on the wall of the microbe, which is destroyed, which makes it impossible for the infection to reproduce and spread.

The drugs are used for:

• inflammatory diseases of the respiratory system (otitis media, pharyngitis, tonsillitis, pneumonia, tracheitis);
• kidney diseases, Bladder, urethra, prostate;
• infections of the musculoskeletal system;
• pathology gastrointestinal tract(gastritis, enteritis, pancreatitis).

Ampicillin is one of the very first drugs in this group, so many pathogens have developed resistance and do not die when treated with it. Now doctors prescribe improved medications - this is Amoxiclav, to which clavulanic acid has been added - it protects the main substance and facilitates its entry into the microbe.

Flemoxin Solutab contains amoxicillin in different dosage, it is also available in tablet form. However, its price is almost 10 times higher than the domestic drug.

Ampicillin helps cure diseases caused by the following microbes: streptococcus, staphylococcus, clostridia, Haemophilus influenzae and neisseria. Contraindications for prescribing the drug are allergic intolerance to penicillins, liver failure, drug-induced colitis and age under one month.

For the treatment of diseases of the upper respiratory system, children over 10 years of age and adult patients are prescribed one tablet - 500 mg 2 times a day. Patients from 3 to 10 years old are recommended to take 375 g (250 mg and half a tablet) 2 times a day. Children over one year old should take only 1 tablet of 250 mg twice. The course of treatment lasts no more than 7 days, after which a re-examination is necessary.

Fluoroquinolones

Fluoroquinolones are powerful antibacterial agents, and therefore are used only for the treatment of diseases with severe complications or in cases of intolerance to beta-lactam drugs. The mechanism of their action is associated with inhibition of the enzyme responsible for gluing protein chains into nucleic acids bacteria. When exposed to the drug, vital processes are disrupted and the pathogen dies. With long-term use of fluoroquinolones, addiction may develop as a result of improved bacterial defense mechanisms.

These antibiotics are used to treat:

• acute inflammation of the nasal sinuses;
• chronic tonsillitis and adenoiditis;
• recurrent bronchitis and tracheitis;
• diseases of the urinary system;
• pathologies of the skin and its appendages.

Levofloxacin is one of the very first drugs in this group. It has a wide spectrum of action: it kills many gram-positive and gram-negative bacteria. Contraindications for prescribing Levofloxacin are epilepsy, amnesia, allergic intolerance to the drug, pregnancy, breastfeeding, and minor age. For treatment acute inflammation nasal sinuses, the drug is prescribed in a dose of 500 mg - this is 1 tablet, which must be taken for 2 weeks. Therapy for laryngitis and tracheitis lasts less - 7 days at the same dosage.

Avelox is a fluoroquinolone and is used to treat respiratory diseases. It contains moxifloxacin, which also has a bactericidal effect against many microorganisms. The drug should not be used for young children with pathology of the nervous system ( convulsive syndrome), arrhythmias, myocardial infarction, renal failure, pregnancy, breastfeeding and for patients with pseudomembranous ulcerative colitis. For treatment, Avelox is prescribed at a dose of 400 mg once a day for 5 days, after which the patient must consult a doctor again. Side effects are often headaches, drop in blood pressure, shortness of breath, confusion, and loss of coordination. After these symptoms occur, it is necessary to stop treatment and change the drug.

Moximac is a drug with a wider spectrum of action, as it suppresses the activity of sporogenic Legionella, chlamydia, and methylene-resistant strains of staphylococcus. After oral administration, the drug is absorbed instantly and is detected in the blood within 5 minutes. It binds to transport proteins in the blood and circulates in the body for up to 72 hours, and after 3 days it is excreted by the kidneys. Moximac should not be used on children under 18 years of age as it is highly toxic. The drug inhibits the activity of the nervous system and disrupts metabolic processes in the liver. Moximac is also not recommended for use by pregnant women, especially in the first trimester, since the pathological effect is exerted on the fetus as a result of the passage of fluoroquinolones through the placental barrier. For the treatment of respiratory organs, the drug is prescribed 1 tablet per day, they must be taken for 5 days.

Fluoroquinolones can be taken only once a day, since the half-life of the drug is more than 12 hours.

Cephalosporins

Cephalosporins belong to beta-lactam antibiotics and were first isolated chemically from the fungi of the same name. Mechanism of action medicines this group is to oppress chemical reactions, which are involved in the synthesis of the bacterial cell wall. As a result of this, pathogens die and do not spread throughout the body. Currently, 5 generations of cephalosporins have been synthesized:

• 1st generation: Cephalexin, Cefazolin. They affect mainly gram-positive flora - staphylococcus, streptococcus, Haemophilus influenzae, Neisseria. Cephalexin and Cefazolin do not affect Proteus and Pseudomonas. For the treatment of respiratory organs, 0.25 mg per 1 kg of body weight is prescribed in 4 divided doses. The duration of the course is 5 days.
• 2nd generation: Cefaclor, Cefuroxime. Bactericidal against staphylococcus, beta-hemolytic and common streptococcus, Klebsiella, Proteus, Peptococcus and acne pathogens. Resistance to Cefaclor is present in several species of Proteus, Enterococcus, Enterobacteriaceae, Morganella, and Providence. The treatment method is to take 1 tablet every 6 hours for a week.
• 3rd generation: Cefixime, Cefotaxime, Cefpodoxime. Help in the fight against staphylococcus, streptococcus, Haemophilus influenzae, Morganella, coli, Proteus, the causative agent of gonorrhea, Klebsiella, Salmonella, Clostridium and Enterobacteriaceae. The half-life of the drugs lasts no more than 6 hours, so for the treatment of diseases it is recommended to follow the following dosage regimen - 6 days, 1 tablet 4 times a day.
• 4th generation: Cefepime and Cefpirom. Drugs are prescribed when resistance (resistance) of the pathogen to 3rd generation cephalosporins and aminoglycosides is detected. It has a wide spectrum of action and helps cure diseases caused by staphylococcus, streptococcus, enterobacteria, neisseria, gonococcus, Haemophilus influenzae, Klebsiella, clostridia, Proteus, etc. For the treatment of respiratory organs, the 4th generation of cephalosporins is used only in the event of severe complications in the form of purulent meningitis with acute bacterial otitis. These drugs are available only in injection form, therefore they are used during inpatient treatment.
• To modern drugs on the 5th, latest generation cephalosporins include Ceftobiprole medocaril sodium. It is a broad-spectrum antibacterial agent and affects all types of respiratory pathogens, including protected forms of streptococcus. It is used only in severe cases, when serious complications have arisen and the patient is on the verge of life and death. Available in the form of ampoules for intravenous administration, therefore used in hospital settings. After taking Ceftopribol, an allergic reaction in the form of a moderate rash or itching is observed.

Cephalosporins are used to treat inflammatory diseases of the nasopharynx and throat, pneumonia, bronchitis, tracheitis, gastritis, colitis, pancreatitis. Contraindications for their use are minors, pregnancy, lactation, liver failure and kidney disease.

Common side effects include fungal diseases skin, vagina and urethra. Headaches, dizziness, itching, redness, a local increase in temperature at the injection site, nausea and changes are also observed. laboratory parameters blood (decrease in red blood cells and hemoglobin, increase in the level of cellular transaminases and other enzymes). During treatment with cephalosporins, it is not recommended to use drugs from the group of monobactams, aminoglycosides and tetracyclines.

Macrolides

Macrolides are a separate group antibacterial agents with a wide spectrum of action. They are used to treat many diseases in all areas of medicine. Representatives of this group have a powerful bactericidal effect against gram-positive microorganisms (staphylococcus, streptococcus, meningococcus and other cocci) and intracellular obligate pathogens (chlamydia, legionella, campylobacter, etc.). Macrolides are produced synthetically based on the combination of a lactone ring and carbon atoms. Depending on the carbon content, preparations are divided into:

• 14-membered - Erythromycin, Clarithromycin. Their half-life ranges from 1.5 to 7 hours. It is recommended to take 3 tablets per day one hour before meals. The course of treatment lasts 5-7 days, depending on the type of pathogen and the severity of the course.
• 15-membered - Azithromycin. It is eliminated from the body within 35 hours. For the treatment of respiratory organs, adults take 0.5 g per 1 kg of body weight for 3 days. Children are prescribed 10 mg per 1 kg per day, which also must be consumed within 3 days.
• 16-membered ones are modern drugs, which include Josamycin, Spiramycin. They are taken orally an hour before meals, in a dose of 6-9 million units for 3 doses. The course of treatment lasts no more than 3 days.

When treating diseases with macrolides, it is important to observe the timing of administration and diet, since absorption in the mucous membrane of the gastrointestinal tract decreases in the presence of food in it (food residues do not have a detrimental effect). After entering the blood, they bind to proteins and are transported to the liver and then to other organs. In the liver, macrolides are transformed from proactive to active form using a special enzyme - cytochrome. The latter is activated only at 10-12 years of age, so the use of antibiotics in children younger age Not recommended. Cytochrome in the child’s liver is in a less active state, and the effect of the antibiotic on the pathogen is impaired. For young children (over 6 months), a 16-membered macrolide can be used, which does not undergo an activation reaction in this organ.

Macrolides are used for:

• Diseases of the upper respiratory tract: tonsillitis, pharyngitis, sinusitis, rhinitis.
• Inflammatory processes in the lower parts of the respiratory system: pneumonia, bronchitis, tracheitis.
• Bacterial infections: whooping cough, diphtheria, chlamydia, syphilis, gonorrhea.
• Diseases skeletal system: osteomyelitis, abscess, periodontitis and periostitis.
• Bacterial sepsis.
• Diabetic foot when infection occurs.
• Acne, rosacea, eczema, psoriasis.

Adverse reactions are extremely rare, including discomfort in the abdominal area, nausea, vomiting, loose stools, hearing impairment, headache, dizziness, prolongation of electrocardiogram readings, allergic urticaria and itching. Macrolides should not be prescribed to pregnant women, since azithromycin is a factor contributing to the development of abnormalities in the fetus.

Antibiotics for diseases of the upper respiratory tract should be used only when the cause of the disease has been identified, since misuse it is possible to develop many complications in the form of fungal infections or dysfunctions of the body.

BENEFITS OF INHALATION THERAPY

Inhalation (nebulizer) therapy is one of the main types of treatment for inflammatory diseases of the respiratory tract.

Inhalations have whole line advantages over other methods of drug delivery:

1. the possibility of direct and rapid impact on the area of ​​inflammation in the mucous membranes;
2. the inhaled substance is practically not absorbed into the blood and has no effect side effects on other organs and systems, as happens when taking pills or injections;
3. it's more cheap way achieve rapid relief of symptoms and recovery;
4. inhalation through a nebulizer - the only way possible method aerosol therapy in children under 5 years of age, as well as in many elderly patients;
5. the nebulizer produces an aerosol, 70% of the particles of which have a size of less than 5 microns (up to 0.8 microns);
6. Freon is not used in nebulizer therapy;
7. there is the possibility of combining medications;
8. simultaneous oxygen inhalation is possible.

WHAT DISEASES ARE TREATED WITH INHALATIONS?

• First of all, acute respiratory diseases, accompanied by symptoms such as cough, dryness, sore or sore throat, and sputum production.
  Everyone knows that it is quite easy to suppress the temperature by taking paracetamol or aspirin, but the remaining “tail” of the listed catarrhal phenomena will drag on for a long time, causing inconvenience to the patient and his environment. If you use inhalations, then, according to a number of data, recovery will occur 1.5 - 2 times faster.
• Another group of diseases for which inhalations are simply irreplaceable are chronic inflammatory processes respiratory tract (such as Chronical bronchitis, bronchial asthma, chronic pharyngitis, laryngitis). In countries with high level developments in medicine, most patients with asthma and bronchitis have home inhalers and constantly use them. There are medications that allow such patients to relieve an attack of shortness of breath or suffocation without resorting to the services of an ambulance.

TYPES OF INHALERS

Currently, three main types of inhalers are used in medical practice: steam, ultrasonic and compressor (jet). The last two are united by the term “nebulizers” from the Latin word “nebula” - “fog”, “cloud”. They do not generate vapor, but an aerosol cloud consisting of microparticles of the inhaled solution.

Action of steam inhalers based on the effect of evaporation of the drug substance. It is clear that only volatile solutions with a boiling point below 100 degrees, most often essential oils, can be used in them. This significantly narrows the range of possible components for inhalation. But the biggest drawback of steam inhalers is the low concentration of the inhaled substance. As a rule, it is less than the threshold for therapeutic effect.

Ultrasonic nebulizers spray the solution with ultrasonic vibrations. They are compact, silent and reliable, but a number of drugs (such as antibiotics and sputum thinners) are destroyed in the ultrasonic environment and cannot be used in this type of inhaler.

Compressor nebulizers They form an aerosol cloud by forcing a powerful air stream pumped by a compressor through a narrow hole in a chamber containing a medicinal solution. The size of the particles formed in this case is on average 5 microns, which allows them to penetrate into all parts of the bronchial tree, including the smallest bronchi, and deposit on the mucous membranes, creating high therapeutic concentrations there. All standard solutions for inhalation produced by pharmaceutical companies in finished form, can be used in compressor (aka jet) nebulizers.

DRUGS USED FOR INHALATION THROUGH NEBULIZERS

1. Bronchial dilators(Berotec, salbutamol, Berodual, Atrovent, magnesium sulfate).
2. Mucus thinners(lazolvan, fluimucil, physiological sodium chloride solution (0.9%), degassed Borjomi, Narzan, hypertonic sodium chloride solution (3 - 4%).
3. Antibacterial agents(fluimucil antibiotic, gentamicin, dioxidin).
4. Anti-inflammatory drugs (hormonal drugs- dexamethasone, budesonide, pulmicort and herbal medicines - rotokan).
5. Antitussives(lidocaine 2%).

1. Bronchial dilators:

a) b-2 agonists

FENOTEROL

In the form of a ready-made solution trade name Berotek(Boehringer Ingelheim, Austria) in 20 ml bottles at a dose of 1 mg/ml.

Indications for use of Berotek are: bronchial asthma and chronic obstructive bronchitis, especially in the acute stage, as well as acute bronchitis, accompanied by bronchospasm. The dose per inhalation is 1-2 mg Berotek (1-2 ml), peak action - 30 minutes, duration of action - 2-3 hours. The number of inhalations per day depends on the severity of bronchospasm. During an exacerbation, as a rule, the patient inhales the medicine 3-4 times a day, during a period of remission - 1-2 times a day or as needed. For severe attacks of asthma, frequent inhalations of Berotek are recommended - every 20 minutes in the first hour, then at intervals of 1 hour until the condition improves, and then every 4 hours.

In terms of bronchodilating effect, Berotec is approximately 4 times superior to Salbutamol. Advantage of nebulized b-2 agonist before the usual dosed in aerosol cans, in that the first creates significantly higher concentrations in the small bronchi, while the main dose of the second settles in oral cavity and, being absorbed into the blood, causes palpitations, interruptions in heart function, hand tremors and increases blood pressure.

In addition, for effective action balloon inhaler, you must hold your breath after inhalation for 10 seconds, which is almost impossible during an attack. When using a nebulizer, this is no longer necessary due to the creation of a continuous flow of aerosol with an inhalation duration of 5-7 minutes.

This property of nebulizers is especially important in the treatment of childhood asthma, when it is impossible to force a child to correctly perform the technique of inhaling a metered aerosol.
For children, compressor nebulizers come with masks.

SALBUTAMOL

In the form of a ready-made solution under trade names Steri-Neb Salamol or Gene-salbutamol in ampoules of 2.5 ml.

Indications for the use of liquid Salbutamol are the same as for Berotec. The dose per 1 inhalation is usually 2.5 mg of Salbutamol (1 ampoule), but can vary: from 1/2 ampoule in mild cases to 2 ampoules (5 mg) in severe cases. severe attacks shortness of breath (peak action 30-60 minutes, duration of action - 4-6 hours). The number of inhalations per day depends on the severity of the symptoms of the disease.

During an exacerbation, as a rule, the patient inhales the medicine 3-4 times a day, during a period of remission - 1-2 times a day or as needed. In case of severe exacerbations of bronchial asthma, frequent inhalations of Salbutamol are recommended - every 20 minutes in the first hour (up to constant nebulization), then at intervals of 1 hour until the attack resolves against the background basic treatment underlying disease.

b) Combination drugs

FENOTEROL

Fenoterol combined with ipratropium bromide - trade name Berodual(Boehringer Ingelheim, Austria). Available in 20 ml bottles, 1 ml of solution contains 250 mcg of ipratropium bromide and 500 mcg of fenoterol.

Many studies have proven the advantage of combination therapy compared to monotherapy with sympathomimetics, especially in individuals with very severe bronchial obstruction, suffering from chronic obstructive bronchitis in combination with bronchial asthma. For inhalation, take 2-4 ml of Berodual solution, to which 1-1.5 ml of 0.9% sodium chloride solution is added.

The frequency of use is the same as for Salbutamol.

c) M-anticholinergics

IPRATROPIUM BROMIDE

Ready solution for inhalation, trade name - Atrovent(Boehringer Ingelheim, Austria), in 20 ml bottles, 1 ml of solution contains 250 mcg of ipratropium bromide. Single dose through a nebulizer - 500-1000 mcg, peak action - 60-90 minutes.

The bronchodilator effect lasts up to 5-6 hours. The main indication for prescribing Atrovent is chronic obstructive bronchitis. In terms of bronchodilator effect, it is somewhat inferior to Berotek and Salbutamol, but the main advantage of Atro-Vent therapy is the safety of use. Prescription of Atrovent does not lead to hypoxemia, hypokalemia, there are practically no side effects from the cardiovascular system, which is especially important in patients suffering from COPD in combination with heart and vascular diseases.

d) Magnesium sulfate

It is inferior in bronchodilator effect to the above-mentioned drugs, but is more accessible and cheaper. Indications for use are the same as for Salbutamol.

To prepare a solution for inhalation, take 1 ml of a 25% magnesium sulfate solution and add 2 ml to it saline solution.

2. Drugs that thin sputum

LAZOLVAN (Boehringer Ingelheim, Austria)

Solution for inhalation in 100 ml bottles. Is an inhalation analogue Bromhexine. By acting directly on the goblet cells of the bronchial mucosa, it increases their secretion of the liquid component of sputum, resulting in a decrease in the viscosity of sputum, facilitating its coughing and removal by the cilia of epithelial cells. The drug is indicated for any processes in the bronchi when there is viscous, difficult to separate sputum - pneumonia, bronchitis, bronchial asthma, cystic fibrosis. In the first stage of ARVI - when inflammation of the mucous membranes is not yet accompanied by secretion with a feeling of dryness, burning in the trachea and bronchi, dry cough - the use of Lazolvan helps to quickly overcome these symptoms. Dose for inhalation: 2-3 ml of Lazolvan solution 2-4 times a day.

FLUIMUCIL

Active beginning - acetylcysteine. It destroys the polymer bonds in the components of sputum, reducing its viscosity.

The most effective remedy for bronchitis and cystic fibrosis with abundant secretion of difficult to separate sputum, including purulent ones. This drug It makes no sense to use it for “dry” bronchitis and tracheitis with a meager amount of secretion. The standard dose for inhalation is 3 ml of fluimucil solution (1 ampoule) 2 times a day.

Physiological 0.9% solution sodium chloride or slightly alkaline mineral waters such as "Borjomi", "Narzan".

Good products for any colds and mild forms of bronchitis and asthma. Moisturize the mucous membrane throughout its entire length from the oropharynx to small bronchi, softening catarrhal symptoms, and increase the liquid part of the bronchial secretion. Take 3 ml of solution for inhalation (mineral water must be left to degas). Apply 3-4 times a day.

Hypertonic solution NaCl(3 or 4%).

The main indication for use is sticky sputum in the bronchi with the inability to cough effectively. Has a soft disinfectant effect. Can be used when there is a small amount of secretion to obtain sputum for analysis, the so-called “induced sputum”. Use with caution in patients with bronchial asthma, since bronchospasm is often provoked. For inhalation, 4-5 ml of solution is used 1-2 times a day.

3. Antibacterial agents

FLUIMUCIL ANTIBIOTIC

A combined preparation of acetylcysteine ​​and thiamphenicol, a broad-spectrum antibiotic to which the main pathogens of respiratory diseases are sensitive.

Recommended for tonsillitis, pharyngitis, bronchitis bacterial origin, pneumonia, suppurative lung diseases - abscesses, bronchiectasis, cystic fibrosis. Can be used for the prevention of postoperative pneumonia in patients with bed rest. To prepare a medicinal solution, 5 ml of solvent is added to a bottle with dry powder of the drug. For 1 inhalation, take half of the resulting solution. IN medicinal purposes the drug is inhaled 2 times a day, in prophylactic - 1 time a day.

GENTAMICIN 4%

The solution is available in 2 ml injection ampoules. It can also be used for inhalation. Has activity against large group microorganisms. It is especially effective in exacerbating chronic purulent bronchitis in weakened patients, smokers, and diabetics. Inhale 2 ml of ready-made Gentamicin solution 2 times a day.

DIOXIDINE 0.5% solution

Broad-spectrum disinfectant. It should be used in patients with purulent diseases lungs: bronchiectasis, abscesses. Dose: 3-4 ml of solution twice a day.

FURACILLIN

Has moderate disinfectant properties. The most appropriate inhalations with for preventive purposes in patients with ARVI, to prevent the spread of infection deep into the bronchial tree. It is preferable to use a ready-made 0.02% solution, 4 ml per inhalation 2 times a day. You can prepare the solution yourself. To do this, 1 tablet of Furacillin is dissolved in 100 ml of a sterile solution of 0.9% NaCl.

4. Anti-inflammatory drugs

a) Glucocorticosteroids

BUDESONIDE

Suspension for inhalation via nebulizer, available under the trade name Pulmicort in plastic containers of 2 ml in three dosages - 0.125 mg/ml, 0.25 mg/ml, 0.5 mg/ml. The main indication for use is bronchial asthma. The daily dose ranges from 1 to 20 mg, depending on the phase and severity of the disease.

b) Herbal medicine

It is an extract from plants that have anti-inflammatory properties and are traditionally used in herbal medicine - chamomile, calendula and yarrow. Indicated for the treatment of acute inflammatory diseases of the upper and middle respiratory tract. A solution for inhalation is prepared by diluting 1/2 teaspoon of rotokan in 100 ml of physiological sodium chloride solution. Therapeutic dose: 3-4 ml 2-3 times a day.

5. Antitussives

LIDOCAINE

In cases of obsessive dry cough, lidocaine inhalation through a nebulizer can be used as a symptomatic remedy. Lidocaine, having local anesthetic properties, reduces the sensitivity of cough receptors and effectively suppresses the cough reflex. The most common indications for lidocaine inhalation are viral tracheitis, laryngitis, and lung cancer. You can inhale a 2% solution of Lidocaine, available in ampoules of 2 ml twice a day. When prescribing several drugs simultaneously, the order should be observed. The first to be inhaled is a bronchodilator, after 10-15 minutes - an expectorant, then, after sputum is discharged, an anti-inflammatory or disinfectant.

1. All solutions containing oils.
2. Suspensions and solutions containing suspended particles, including decoctions and infusions of herbs.
3. Eufillin, papaverine, platifillin, diphenhydramine and similar drugs as having no substrate effect on the mucous membrane.

PREPARATION OF SOLUTIONS

When preparing solutions, you must follow a number of rules.

Solutions for inhalation must be prepared under sterile conditions using 0.9% sodium chloride as a solvent. Do not use tap water (even boiled water). The containers in which the solution is prepared are pre-disinfected by boiling.

The prepared solution should be stored in the refrigerator for no more than a day. Before use, be sure to heat it in a water bath to a temperature of at least 20°C.