:: Section 6
What hazards are associated with aerosol drug therapy?
The
primary hazard of aerosol drug therapy is an adverse reaction to the
medication being administered. Other hazards include infection, airway
reactivity, systemic effects of bland aerosols, and drug concentration.
-
Infection
- Aerosol generators can contribute to
nosocomial infections by spreading bacteria by the airborne route. The
most common sources of bacteria are contaminated solutions (i.e.,
multiple-dose drug vials), caregivers’s hands, and the patient’s own
secretions. Offending organisms are primarily gram-negative bacilli,
particularly Pseudomonas aeruginosa and Legionella
pneumophila (the cause of the highly virulent legionnaires’
disease)
-
Airway reactivity
-
Cold and high-density aerosols can cause
reactive bronchospasm and increased airway resistance, especially in
patients with preexisting respiratory disease. Medications such as
acetylcystine, antibiotics, steroids, cromolyn sodium, ribavirin, and
distilled water have been associated with increased airway resistance
and wheezing during aerosol therapy.
-
Pulmonary and systemic effects
-
Pulmonary and systemic effects are
associated with the site of delivery and the drug being administered.
However, even bland aerosols present risk. Excess water can cause
overhydration, and excess saline solution can cause hypernatremia.
Animal data indicate that long-term, continuous administration can cause
tissue damage, atelectasis, and pulmonary edema.
-
Drug reconcentration
- During the
evaporation, heating, baffling, and recycling of drug solutions
undergoing jet or ultrasonic nebulization, solute concentration may
increase. This process can expose the patient to increasingly higher
concentration of the drug over the course of therapy. The result is
that a relatively large amount of drug remains in the nebulizer at the
end of therapy. This increase in concentration usually is time
dependent, the greatest effect occurring when medications are
nebulized over extended periods, as in continuous aerosol drug
delivery.
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