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Abstract: Nebulisation is an efficacious form of treatment for asthma and COPD. Pneumatic atomizer with an oral-nasal interface are the most widely used form (low cost and not incompatible with the contents), the oral interface being preferred for treatment over a long period. There are not many drugs that are now marketed for use in nebulisers: general practitioners are limited to using bronchodilators, beta2-adrenergic agonists (salbutamol and terbutaline), ipratropium bromide and corticoids (budesonide and beclomethasone). In acute asthma and exacerbations of COPD, nebulised beta2-adrenergic agonists are the treatment of first intention because they have been shown to be as efficacious as intravenous administration. Atropinic drugs add an additional benefit and their use is generally accepted. In less severe exacerbations, nebulised corticoids are an acceptable alternative to systemic corticotherapy. The indications for nebulisation over extended periods remain poorly defined, but it is not a substitute for classic forms of inhalation (spray with inhalation chamber and dry powders). Education of the patient remains obligatory. [Copyright &y& Elsevier]

Abstract: The revival of nebulization as a drug delivery route is real. The current delivery systems respond to the new European norms, the new mesh-vibrating nebulizers allow delivering drugs more quickly, other nebulizers, more performant because of less drug losses and of a better lung deposition of the drug, are in progress. Only 12 drugs are commercialized for nebulization. All are available in dispensaries, some requiring a first prescription by a physician working in a hospital (cystic fibrosis drugs), others requiring a prescription from only some specialists as paediatricians or pulmonologists (bronchodilators). Works are in progress concerning the diameter and shape of the drug particles (nanotechnology) and also concerning the use of nebulized drugs for a systemic effect (vaccines, insulin, cyclosporine, anticancerous agents, etc.). [Copyright &y& Elsevier]

Nebulization is a drug delivery mode whose prescription and application remain uncertain. A guide to good practice has been proposed by the work group on aerosol therapy of the French Society for Respiratory Diseases, so-called GAT. The previous recommendations date from 2007. In addition to an update of data on nebulization, these expert recommendations aim to be of real help to the prescriber., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

In the past few years some new inhaled drugs and inhalation devices have been proposed for the treatment of cystic fibrosis. Breath-controlled nebulizers allow increased pulmonary deposition, with a lower variability and a shorter delivery time. The new dry powder formulations of tobramycin, colistine and mannitol require a change in the inhalation technique which must be slow and deep. In the field of the inhaled mucolytic drugs, hypertonic saline and mannitol have an indication in some patients. With regard to antibiotics, dry-powder tobramycin and colistine can be substituted for the same drug delivered by nebulization. Nebulized aztreonam needs more studies to determine its place. These new treatments represent a definite advance for cystic fibrosis patients and need to be known by all practitioners. Their position in our therapeutic arsenal remains to be accurately defined., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Three different devices are available for inhaled medications in children: the pressurized metered dose inhalers (pMDIs, breath-actuator synchronized pMDI, and valved holding spacers), the dry powder inhalers, and the nebulizers. To choose the better device for a particular patient, a perfect knowledge of the available devices, of their mode of use, of their advantages and inconvenient is required. The use of a pMDI coupled to a valved holding spacer is the first mode of delivery to propose in children aged less than 6 years. After 6 years old, the DPIs may be proposed depending on the child's competences. At last, the nebulizations are indicated in some particular and severe indications, but new indications are appearing because of recent progresses., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)