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Atelectasis Medication

  • Author: Tarun Madappa, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Feb 11, 2016
 

Medication Summary

Bronchodilators may be used to encourage sputum expectoration; if underlying airflow is present, these agents may also improve ventilation. Some patients may require broad-spectrum antibiotics to treat the underlying infections, which may occur because of bronchial obstruction. N -acetylcysteine aerosol is not routinely recommended because of the risk of bronchoconstriction and the lack of documented efficacy.

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Bronchodilators

Class Summary

Bronchodilators decrease muscle tone in both the small and large airways in the lungs, thereby increasing ventilation. They include subcutaneous medications, beta-adrenergic agents, methylxanthines, and anticholinergics.

Albuterol (Proventil, Ventolin)

 

Albuterol is a beta-agonist for bronchospasm refractory to epinephrine. It relaxes bronchial smooth muscle by action on beta-2 receptors, with little effect on cardiac muscle contractility. Most patients (even those with no measurable increase in expiratory flow) benefit from treatment. Inhaled beta-agonists initially are prescribed on an "as needed" basis. The frequency may be increased; institute a regular schedule in patients on anticholinergic drugs who are still symptomatic.

Albuterol is available as a liquid for nebulizer, metered-dose inhaler (MDI), and dry-powder inhaler.

Metaproterenol (Alupent)

 

Metaproterenol relaxes bronchial smooth muscle by action on beta-2 receptors, with little effect on cardiac muscle contractility. Most patients (even those with no measurable increase in expiratory flow) benefit from treatment. Inhaled beta-agonists initially are prescribed on an as-needed basis. The frequency may be increased; institute a regular schedule in patients on anticholinergic drugs who are still symptomatic.

Metaproterenol is available as a liquid for nebulizer, MDI, and dry-powder inhaler.

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Antibiotics

Class Summary

Antibiotics are used to treat underlying bronchitis or postobstructive infection.

Cefuroxime (Zinacef)

 

Cefuroxime is a second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis.

The condition of the patient, severity of the infection, and susceptibility of the microorganism determine proper dose and route of administration.

Cefaclor (Ceclor)

 

Cefaclor is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Determine the proper dosage and route based on the condition of the patient, severity of the infection, and susceptibility of the causative organisms.

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Mucolytic agents

Class Summary

N -acetylcysteine is only recommended for direct instillation via fiberoptic bronchoscopy or in an intubated patient. Therapy with mucolytics may promote sputum removal of thick mucous plugs and, therefore, helps treat atelectasis in many patients. Inhaled recombinant human deoxyribonuclease is a mucolytic agent successfully used in patients with cystic fibrosis.

N-acetylcysteine (Mucomyst)

 

N-acetylcysteine inhalations may be tried to encourage sputum expectoration in patients with tenacious sputum and mucous plugging.

Dornase alfa (Pulmozyme)

 

Dornase alfa cleaves and depolymerizes extracellular DNA and separates DNA from proteins. This allows endogenous proteolytic enzymes to break down the proteins; thus, decreasing viscoelasticity and surface tension of purulent sputum.

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Contributor Information and Disclosures
Author

Tarun Madappa, MD, MPH Attending Physician, Department of Pulmonary and Critical Care Medicine, Christus Spohn-Shoreline Hospital

Tarun Madappa, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Helen M Hollingsworth, MD Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center

Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, Massachusetts Medical Society

Disclosure: Nothing to disclose.

References
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  2. Priftis KN, Mermiri D, Papadopoulou A, Anthracopoulos MB, Vaos G, Nicolaidou P. The role of timely intervention in middle lobe syndrome in children. Chest. 2005 Oct. 128(4):2504-10. [Medline].

  3. Chen HA, Lai SL, Kwang WK, Liu JC, Chen CH, Huang DF. Middle lobe syndrome as the pulmonary manifestation of primary Sjogren's syndrome. Med J Aust. 2006 Mar 20. 184(6):294-5. [Medline].

  4. Reinius H, Jonsson L, Gustafsson S, et al. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology. 2009 Nov. 111(5):979-87. [Medline].

  5. Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence?. Chest. 2011 Aug. 140(2):418-24. [Medline].

  6. Proto AV, Tocino I. Radiographic manifestations of lobar collapse. Semin Roentgenol. 1980 Apr. 15(2):117-73. [Medline].

  7. Kattan KR, Eyler WR, Felson B. The juxtaphrenic peak in upper lobe collapse. Semin Roentgenol. 1980 Apr. 15(2):187-93. [Medline].

  8. Partap VA. The comet tail sign. Radiology. 1999 Nov. 213(2):553-4. [Medline].

  9. [Urgent fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis]. Anesteziol Reanimatol. 2013 Nov-Dec. 51-4. [Medline].

  10. [Guideline] McCool FD, Rosen MJ. Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):250S-259S. [Medline].

  11. Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care. 2005 Aug. 9(4):R351-6. [Medline].

  12. Kato K, Sato N, Takeda S, et al. Marked improvement of extensive atelectasis by unilateral application of the RTX respirator in elderly patients. Intern Med. 2009. 48(16):1419-23. [Medline].

 
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Atelectasis. Left lower lobe collapse. The opacity is in the posterior inferior location.
Atelectasis. Loss of volume on the left side; an elevated and silhouetted left diaphragm; and an opacity behind the heart, called a sail sign, are present.
Atelectasis. Left upper lobe collapse showing opacity contiguous to the aortic knob, a smaller left hemithorax, and a mediastinal shift.
Atelectasis. CT scan of a left upper lobe collapse with a small pleural effusion.
Complete atelectasis of the left lung. Mediastinal displacement, opacification, and loss of volume are present in the left hemithorax.
Atelectasis. Right lower lobe collapse.
Atelectasis. Both right lower lobe and right middle lobe collapse. The left lung is hyperexpanded.
Complete right lung atelectasis.
Atelectasis. A lateral chest x-ray film confirms the diagnosis of right middle lobe collapse. The minor fissure moves down, and the major fissure moves up, leading to a wedge-shaped opacity.
Atelectasis. The left upper lobe collapses anteriorly on a lateral chest x-ray film.
Atelectasis. Left upper lobe collapse. The top of the aortic knob sign is demonstrated.
Atelectasis. Left lower lobe collapse.
Atelectasis. Right middle lobe collapse shows obliteration of the right heart border.
Atelectasis. The azygous lobe of the right lung may be mistaken for a collapsed right upper lobe.
Atelectasis. Left lower lobe collapse. The sail sign is obvious.
Atelectasis. Left upper lobe collapse. The Luft Sichel sign is demonstrated clearly in this radiograph.
Atelectasis. Chest CT scan showing left upper lobe collapse.
Atelectasis. The right lower lobe collapses inferiorly and posteriorly.
Atelectasis. Right lower lobe collapse without middle lobe collapse, the right major fissure is shifted downward and is now visible.
Atelectasis. Right upper lobe collapse demonstrating Golden sign of S.
Atelectasis. Right middle lobe collapse showing obliteration of the right heart border.
Atelectasis. Right middle lobe collapse on a lateral chest x-ray film.
Atelectasis. Right upper lobe collapse and consolidation.
Atelectasis. Right upper lobe collapse.
Atelectasis. Right upper lobe collapse.
Atelectasis. Left lower lobe collapse on posteroanterior view.
The left lower lobe collapses toward the posterior and inferior aspects of the thoracic cavity; the atelectatic left lower lobe is present as a sail behind the cardiac shadow.
 
 
 
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