Use of nebulised saline and nebulised terbutaline as an adjunct to chest physiotherapy.

Abstract

To determine whether sputum clearance is increased by using nebulised saline or terbutaline as an adjunct to chest physiotherapy, a radioaerosol method (using technetium-99m labelled human albumin millimicrospheres) was employed in eight patients with stable bronchiectasis on four occasions, for comparison of sputum clearance with four different regimens. These were: control, with the patient resting in an upright position; chest physiotherapy, by the forced expiration technique with postural drainage; and chest physiotherapy following five minutes' inhalation of either nebulised normal saline or nebulised terbutaline 5 mg. Use of both nebulised saline and nebulised terbutaline immediately before chest physiotherapy gave a significantly greater yield of sputum than did physiotherapy alone, and terbutaline also significantly increased radioaerosol clearance from the whole lung and from regions of interest. The mechanism is unclear, but this method may provide a simple way of increasing the efficacy of conventional chest physiotherapy.Chest physiotherapy is widely used in hospital practice but there is little objective assessment of its value in different settings. A central function of chest physiotherapy in acute conditions is to mobilise excess secretions and enhance expectoration.' The use of an inhaled radio aerosol that is deposited on the tracheobronchial tree allows such secretions to be "labelled" and their subsequent clearance monitored. Use of this method has shown the contribution of cough,2 vibration, or percussion3 to clearance to be limited; greater clearance of airways secretions is obtained by the forced expiration technique in conjunction with postural drainage.45 We have evaluated the use of nebulised saline and nebulised terbutaline as an adjunct to this optimal chest physiotherapy to determine whether sputum clearance is increased further. MethodsWe studied eight patients (six of them women), aged 36-71 years, with stable bronchiectasis on four occasions. Their mean daily sputum production was 36 (range 10-120) g. The results of spirometry before Address for reprint requests: Dr P P Sutton, Hartlepool General Hospital, Hartlepool, Cleveland TS24 9RH. Accepted 10 July 1987 and after each of the four treatment days are shown in the table. No patient smoked, and bronchodilators and domiciliary physiotherapy were withheld on the morning of each study day. PHYSIOTHERAPYThe treatment schedules, given in randomised order, were: (1) control, patient resting upright; (2) chest physiotherapy; (3) chest physiotherapy following five minutes' inhalation of nebulised normal saline; (4) chest physiotherapy following five minutes' inhalation of nebulised terbutaline (5 mg).Chest physiotherapy included the forced expiration technique and postural drainage and lasted for 20 minutes. For treatment 3, 4 ml normal saline was nebulised for five minutes immediately before physiotherapy by a Unicorn jet nebuliser with a mouthpiece and driven by oxygen at 8 1 m-'. For treatment 4, terbutaline respirator solut...

British Thoracic Society guideline for non-CFbronchiectasis

“…These guidelines will focus on the evidence base for each airway clearance technique in the management of non-CF bronchiectasis. A small study (n=8) demonstrated an increase in sputum yield for chest physiotherapy compared with no physiotherapy in non-CF bronchiectasis 385. However, this was a short-term study and measured only sputum yield during and 30 min after the treatment period.…”

“…The use of nebulised terbutaline (5 mg) immediately before physiotherapy (forced expiration technique plus postural drainage or the active cycle of breathing techniques plus modified postural drainage) yielded significantly more sputum385 390 and increased radioaerosol clearance from the whole lung and from regions of interest385 than physiotherapy alone. Nebulised terbutaline may enhance sputum yield as a result of direct hydration and/or β 2 adrenergic stimulation 390.…”

Use of Aerosol Drug Therapy in Pulmonary Rehabilitation

“…Aerosol ilaçların inhalasyon tedavisinde kullanımı akciğer içi hidrasyonu artırıp sekresyonların viskositesini azalatarak mukosilier temizlik açısında pulmoner rehabilitasyonun optimizasyonunu sağlar. Pulmoner rehabilitasyon kapsamında gerçekleştirilmek istenen sekresyon atılımı, göğüs fizyoterapisine ek olarak bronkodilatör ve mukolitik gibi ilaçların inhalasyon tedavisinde kullanımıyla başarılabilir (1).…”

Assessing the Effects of Racemic and Single-Enantiomer Albuterol on Airway Secretions in Long-term Intubated Patients

“…8,9 Formal clinical evaluation of the mucociliary effects of these agents has consisted primarily of subjective symptom questionnaires 10 or single-dose studies either of the clearance of radiolabeled mucus or of bronchoscopic/ fluoroscopic measurements of the movement of tracheobronchial Teflon particles. 6,11 However, one study 12 of eight stable patients with bronchiectasis found that single nebulized doses of saline solution or terbutaline, when used as an adjunct to chest physical therapy, resulted in an increased yield of expectorated sputum when compared to chest physical therapy alone. While the terbutaline, but not the saline solution, also resulted in enhanced clearance of radiolabeled mucus as measured by ␥ scintigraphy, it was not clear if the observed effect on sputum yield was due to an effect of the ␤ 2 -agonist stimulation or to a nonspecific effect of increased hydration of secretions after nebulization therapy.…”