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.

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)

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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)

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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.

Class Summary

Antibiotics are used to treat underlying bronchitis or postobstructive infection.

Cefuroxime (Zinacef)

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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)

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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.

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)

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

Dornase alfa (Pulmozyme)

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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.

Questions

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Partap VA. The comet tail sign. Radiology. 1999 Nov. 213(2):553-4. [QxMD MEDLINE Link].
[Urgent fiberoptic bronchoscopy for diagnostics and treatment of lung atelectasis]. Anesteziol Reanimatol. 2013 Nov-Dec. 51-4. [QxMD MEDLINE Link].
[Guideline] McCool FD, Rosen MJ. Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):250S-259S. [QxMD MEDLINE Link].
Roncin C, Scemama U, Zieleskiewicz L, Loundou A, Lesavre N, Vialet R. Atelectasis prevention during anaesthesia using high-flow nasal cannula therapy: A paediatric randomised trial using MRI images. Anaesth Crit Care Pain Med. 2020 Oct 17. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

Media Gallery

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 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. 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.
Atelectasis. Chest posteroanterior radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
Atelectasis. Chest lateral radiograph demonstrates a right hilar bronchogenic carcinoma causing right upper lobe collapse with upward displacement of the minor fissure.
Atelectasis. CT scan of the chest shows tumor encasing and occluding the right upper lobe bronchus and collapse of the right upper lobe, with superior and medial displacement of the minor fissure.