Pulmonary Atelectasis Medication
- Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD more...
Tailor therapy to the underlying disorder whenever possible. Antibiotics are not necessary if the child has asthma and uses oral corticosteroids, frequent inhaled bronchodilators, or high-dose inhaled corticosteroids to address the underlying inflammation and bronchospasm. For more information, see Asthma. The National Asthma Education and Prevention Program (NAEPP) provides detailed information regarding managing children or adults with asthma. For more information see the NAEPP guidelines.
If the child has cystic fibrosis, aggressive antibiotic therapy is indicated in conjunction with chest physical therapy and postural drainage. In children with cystic fibrosis, reducing the load of Pseudomonas species in airways facilitates airway clearance. See Cystic Fibrosis for a more complete discussion on the indications for antibiotics, antibiotics used, and dosing schedule in these patients.
These agents decrease muscle tone in the small and large airways in the lungs, thereby increasing ventilation. They are used in children with asthma and are potentially helpful in children with cystic fibrosis.
Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility. First-line bronchodilator that should be used with spacer if using metered dose inhaler.
These agents effectively reduce airway inflammation in asthma and cystic fibrosis, which allows easier mobilization of secretions. These also reduce airway reactivity, which might increase propensity to atelectasis.
Corticosteroids that are first-line therapies in the United States.
Both are available in tab and syr; Orapred is available in PO dissolving tab. When choosing syr for children, prednisolone syr is more palatable than prednisone syr.
These agents are safer than systemic corticosteroids for long-term anti-inflammatory effect. Dosing is based on the severity of asthma. Some of the most commonly used inhaled corticosteroids in the United States are listed below.
Fluticasone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Available as aerosol, Flovent HFA (44 mcg/actuation, 110 mcg/actuation, or 220 mcg/actuation), also available as Flovent Powder for Inhalation (Diskus) that delivers 50 mcg/actuation, 100 mcg/actuation, or 250 mcg/actuation.
Budesonide is relatively new to US market but has been extensively used in Europe. It has recently been released in a nebulizer solution approved for use in children as young as 12 mo.
Budesonide decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Available as Pulmicort Flexhaler, powder for inhalation (90 mcg/actuation and 180 mcg/actuation, each actuation delivers 80 mcg/actuation and 160 mcg respectively) or Pulmicort Respules inhalation susp (0.25 mg/2 mL, 0.5 mg/2 mL, or 1 mg/2 mL). Nebulization has been used in children aged 1-8 y.
Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Available as 40 mcg/actuation or 80 mcg/actuation.
Corticosteroid and bronchodilator combinations
These agents elicit long-acting beta2-adrenergic agonistic and anti-inflammatory effects for persistent asthma.
Indicated to treat chronic persistent asthma. Salmeterol component elicits long-acting beta2-adrenergic agonist activity, resulting in bronchiole smooth muscle relaxation. Fluticasone is a corticosteroid that provides anti-inflammatory effects.
Available as powder inhalant containing fluticasone (100 mcg, 250 mcg, or 500 mcg) with salmeterol (50 mcg). HFA preparation in metered dose inhalers has 45, 115 or 230 mcg per puff, each with 21 mcg of salmeterol.
Formoterol relieves bronchospasm by relaxing the smooth muscles of the bronchioles in conditions associated with asthma.
Budesonide is an inhaled corticosteroid that alters level of inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response. Available as MDI in 2 strengths; each actuation delivers formoterol 4.5 mcg with either 80 mcg or 160 mcg.
Lutterbey G, Wattjes MP, Doerr D, Fischer NJ, Gieseke J Jr, Schild HH. Atelectasis in children undergoing either propofol infusion or positive pressure ventilation anesthesia for magnetic resonance imaging. Paediatr Anaesth. 2007 Feb. 17(2):121-5. [Medline].
Engoren M. Lack of association between atelectasis and fever. Chest. 1995 Jan. 107(1):81-4. [Medline].
Raman TS, Mathew S, Ravikumar, Garcha PS. Atelectasis in children. Indian Pediatr. 1998 May. 35(5):429-35. [Medline].
Liu J, Chen SW, Liu F, Li QP, Kong XY, Feng ZC. The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015 Apr. 147 (4):1013-9. [Medline].
Bilan N, Galehgolab BA, Shoaran M. Medical treatment of lung collapse in children. Pak J Biol Sci. 2009 Mar 1. 12(5):467-9. [Medline].
Prodhan P, Greenberg B, Bhutta AT, et al. Recombinant human deoxyribonuclease improves atelectasis in mechanically ventilated children with cardiac disease. Congenit Heart Dis. 2009 May-Jun. 4(3):166-73. [Medline]. [Full Text].
Krause MF, von Bismarck P, Oppermann HC, Ankermann T. Bronchoscopic surfactant administration in pediatric patients with persistent lobar atelectasis. Respiration. 2008. 75(1):100-4. [Medline].
[Guideline] National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma (EPR-3). [Full Text].
Bagley CE, Gray PH, Tudehope DI, Flenady V, Shearman AD, Lamont A. Routine neonatal postextubation chest physiotherapy: a randomized controlled trial. Journal of Paedtrics & Child Health. November 2005. 41:592-7. [Medline].
De Boeck K, Willems T, Van Gysel D. Outcome after right middle lobe syndrome. Chest. 1995 Jul. 108(1):150-2. [Medline].
Finder J, Birnkrant DJ, Carl J et al. Respiratory care of the patient with Duchenne muscular dystrophy: An official ATS consensus statement. Am J Respir Crit Care Med. 2004. 170:456.
Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNAse and atelectasis in non-cystic fibrosis pediatric patients. Critical Care. August 2005. 9:351-6. [Medline].
Miske LJ, Hickey EM, Kolb SM, et al. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004 Apr. 125(4):1406-12. [Medline].
Schindler MB. Treatment of atelectasis: where is the evidence?. Crit Care. 2005 Aug. 9(4):341-2. [Medline].
Slattery DM, Waltz DA, Denham B, et al. Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis. Pediatr Pulmonol. 2001 May. 31(5):383-8. [Medline].
Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000 Dec. 118(6):1801-13. [Medline].
Woodring JH. Determining the cause of pulmonary atelectasis: a comparison of plain radiography and CT. AJR Am J Roentgenol. 1988 Apr. 150(4):757-63. [Medline].
Wu KH, Lin CF, Huang CJ, Chen CC. Rigid ventilation bronchoscopy under general anesthesia for treatment of pediatric pulmonary atelectasis caused by pneumonia: A review of 33 cases. Int Surg. 2006 Sep-Oct. 91(5):291-4. [Medline].