Inhalation with salbutamol

Question

Hello,
I have 2 questions on this topic...
1. How becomes the inhalation with salbutamol the most effecitve?
To mix the drops with NaCl/Mucoclear® (hypertonic saline) and inhale with Pariboy or Eflow or to inhale salbutamol with the Vortex® chamber (about 20 minutes) before the inhalation of the NaCl/Mucoclear®?

2. Should salbutamol be inhaled before every inhalation with Pulmozyme®, can Pulmozyme® be then more effective, as it can go deeper in the airways?

Many thanks

Answer

Hello,
first of all one question: do you inhale with Mukoclear®(hypertonic saline) and with Pulmozyme® (rh-DNAse)? And if yes, why?
ad 1: If you use salbutamol drops, you indeed have to solve them in NaCl. How should it happen that you inhale the drops first and then NaCl afterwards? And why do you want to inhale NaCl? If you mean with NaCl Mucoclear®, then you should take at first salbutamol with a pressure metered dose inhaler (Vortex® chamber) and after this inhale Mukoclear®.
ad2: This is correct, first of all salbutamol, then Pulmozyme®, then physiotherapy. Then Pulmozyme® can be more effective.

Best regards,
Joachim Bargon

09.07.2014

9.7.14
Concerning the compatibility of mixing salbutamol with other inhalative drugs, the guidelines (Heijerman et al. in the Journal of Cystic Fibrosis 2009, 8:295-315: “Inhaled medication and inhalation devices for lung disease in patients with Cystic Fibrosis: A European Consensus.”) state, that for salbuatmol and hypertonic saline there is no data. Mixing salbutamol with dornase-alpha (Pulmozyme) is incompatible.
Concerning the question of use of ß2-adrenergic receptor agonists (like salbutamol) the guidelines state (Flume et al :"Chronic Medications for Maintenance of Lung health" in the Am J Respir Crit care Med vol 187 (7):680-689, April1, 2013) that: "...short-term administraton of beta-2-adrenergic receptor agonists can benefit those individuals with airway hyperresponsiveness, which is common in individuals with CF. These medications also have value in preventing bronchospasm associated with inhaled therapies. However, there is insufficient evidence to recommend chronic, daily use of a beta-2-adrenergic receptor agonist. The committee rated the overall certainty of net benefit as low, and therefore, cannot recommend for or against the chronic use of beta-2-adrenergic agonists."
This is a new recommendation, as the guidelines from 2007 still recommended the chronic use of beta-agonists with grade of recommendation B fro patients with CF, 6 years of age or older.
D. d'Alquen