Consensus guidance of nebulizer therapy for acute rhinosinusitis
Introduction
Acute rhinosinusitis is a common upper respiratory tract infection in clinical practice and is defined as symptomatic inflammation of the nose and paranasal sinus persisting 4 weeks with an acute onset that present with respiratory symptoms, such as nasal obstruction, rhinorrhea, post nasal discharge, and coughing, accompanied by headaches, cheek pain, and a sensation of facial compression. In Japan, the practical guideline for management of acute rhinosinusitis was published in 2010 and recommended inhalation antimicrobial therapy denominated nebulizer therapy (inhalation therapy, aerosol therapy) after widening the middle nasal meatus [1,2]. However, there are a limited number of studies on the standard procedures for nebulizer therapy (inhalation therapy, aerosol therapy) and on the assessment of its efficacy for acute rhinosinusitis. This guidance was edited by the Japan Society for Infection and Aerosol in Otorhinolaryngology and the Oto-Rhino-Laryngological Society of Japan to provide the appropriate procedures of nebulizer therapy and to enhance its therapeutic effect for acute rhinosinusitis.
Nebulizer therapy was initially developed by Barach et al. for penicillin aerosol-induced bronchitis, bronchiectasis, and lung abscess [3]. They demonstrated the effectiveness of negative/positive pressure therapy with a penicillin aerosol for rhinosinusitis as “penicillin for maxillary empyema”. In Japan, nebulizer therapy for sinusitis has been covered by public health insurance since 1958 and has been commonly carried out nationwide.
Nebulizer therapy involves effective local inhalation of drugs, i.e., a drug delivery system (DDS). The therapy effectively increases the local drug concentration by promptly and uniformly delivering drugs to a targeted local site. Such local concentrations cannot be achieved by oral or systemic administration. Since drugs administered by nebulizer are particles, the nebulized drugs can be delivered to bended or retracted region was well as to low blood flow sites. Thus, the therapy is safe with less systemic absorption and with few adverse reactions.
Section snippets
Inhalation devices and nebulizing characteristics of liquid medicine
There are many different inhalation devices that are classified into jet (compressor), ultrasonic, and mesh type nebulizers [4]. Both the aerodynamic diameters of drug particles and nebulized drug amounts are important for the clinical use of these devices [5]. The aerodynamic diameters determine the drug delivery efficiency in the nasal and paranasal cavity, and the administration time is directly related to the nebulized drug amounts. The mean aerodynamic diameter used in otolaryngology is
Indication
Rhinosinusitis is divided into the four categories depending on how long the illness lasts: acute, subacute, chronic and recurrent. There have been reported many clinical studies on the efficacy of nebulizer therapy for both acute and chronic rhinosinusitis [8,9]. However, it is difficult to exactly differentiate acute exacerbation of chronic rhinosinusitis due to bacterial infection from recurrent rhinosinusitis. Therefore, in this guide, the nebulizer therapy is recommended to be applied for
Sterilization and disinfection of devices
Since aerosol particles containing infectious microorganisms and/or contaminants cause infections, it is necessary to pay full attention to the handling of the devices and drugs. The most hazardous thing is drug solutions contaminated with infectious microorganisms. It is recommended that nebulizer devices should be replaced after usage. Nevertheless, for both commonly-used jet type nebulizers installed with drug solutions and ultrasound nebulizers, particular parts should be exchanged and
Conclusion
In conclusion, this manual has outlined applications, procedures, and device use of nebulizer therapy for acute rhinosinusitis. Nebulizer therapy is an effective treatment based on a drug delivery system (DDS) to the nasal/paranasal cavity.
Conflict of interest
The authors have no conflicts of interest directly relevant to the content of this article.
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