- Author: Tarun Madappa, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD more...
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.
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 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 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.
Antibiotics are used to treat underlying bronchitis or postobstructive infection.
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 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.
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 inhalations may be tried to encourage sputum expectoration in patients with tenacious sputum and mucous plugging.
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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