Inhalation is one of the modern methods of therapy for bronchial asthma and other pathological processes in the bronchi and lungs. The session is carried out using a nebulizer inhaler, which is pre-filled with medication.
The medicine market offers many drugs for the treatment of pulmonary and bronchial defects. The inhalation medicine Berodual is one of them. Berodual's instructions for inhalation indicate that the medication is an extended-spectrum bronchodilator.
Release form, composition
Berodual solution for inhalation is a colorless or transparent liquid with an almost imperceptible odor, in which there are no suspended particles. The main components that provide the therapeutic effect: fenoterol hydrobromide and ipratropium bromide monohydrate. Auxiliary components:
- purified water;
- sodium chloride;
- disodium edetate dihydrate;
- hydrochloric acid;
- benzalkonium chloride.
The solution is poured into dark glass bottles of 20 ml, which have a polyethylene dropper for easy dosing of the drug.
Pharmacodynamics
Berodual is a combined bronchodilator. The therapeutic effect is achieved through 2 components: fenoterol hydrobromide (beta-adrenergic agonist) and ipratropium bromide (m-cholinomimetic). Ipratropium bromide has anticholinergic properties. It inhibits the vagus nerve reflexes and counteracts acetylcholine (a neurotransmitter released from the vagus nerve endings).
The maximum effect in people with bronchospasm associated with emphysema or bronchitis appears after 1.5 - 2 hours and can last up to 6 hours, while the condition improves after 5 -10 minutes. Ipratropium bromide does not have a negative effect on mucus secretion in the respiratory tract and gas exchange in the lungs. Fenoterol in therapeutic dosage selectively affects beta-adrenergic receptors.
It relaxes the smooth muscles of the vascular wall and bronchi, preventing bronchospasm reactions. After inhalation, fenoterol prevents the release of inflammatory mediators and bronchospasm from mast cells. Fenoterol also affects the activity of the heart - it increases the strength and frequency of heart contractions, which occurs due to its effect on the adrenergic receptors of cardiac tissue.
The combined action of fenoterol and ipratropium bromide gives a bronchodilator effect by acting on cell receptors. They enhance the effect of each other, thereby achieving an antispasmodic effect on the muscle tissue of the bronchi and a therapeutic effect for lung diseases associated with airway obstruction. In case of acute bronchial obstruction, the use of the drug is justified due to its rapid action.
The main effect of the drug
Active inhalation of the Berodual solution normalizes the functioning of the respiratory system almost immediately, even if approximately 10-39% of the total inhaled mass is deposited in the tissues. Everything else settles on the walls of the inhaler, as well as in the oral cavity.
The main active ingredient has a pronounced therapeutic effect within 15 minutes after using the medicine. It consists in forcing exhalation in a second, which is considered a very significant parameter for assessing the functioning of the respiratory organs, as well as achieving a peak rate of exhalation of air. The maximum effect of the active component is observed 1-2 hours after using the drug. It is worth noting that the therapeutic effect lasts for 6 hours.
Pharmacokinetics
After using Berodual, its components reach the lungs up to 39% of the initial dose, the percentage may vary depending on the dose of the drug and the method of inhalation. The rest of the solution remains on the oropharynx, oral cavity and inhaler mouthpiece. The solution from the mouth and oropharynx is swallowed and enters the gastrointestinal tract. Within a few minutes, the main dose of the drug reaches the lung tissue.
Fenoterol interacts with plasma proteins by 40%. It is excreted by the kidneys with urine; the drug that enters the gastrointestinal tract is excreted through feces. Ipratropium bromide is 20% protein bound. Metabolized in the liver and excreted from the body similarly to fenoterol.
Indications for use
The drug is used for preventive and therapeutic purposes for:
- chronic obstructive pulmonary disease;
- bronchial asthma;
- obstructive bronchitis (with or without emphysema);
- pneumonia.
Indications for use in children are similar to those in adults.
Inhalations for bronchitis
With bronchitis, the inhalation phase becomes difficult and wheezing occurs. When these symptoms are mild or moderate, ambroxol-based products, such as Lazolvan, are more often used. Berodual is not a mandatory drug for the treatment of bronchitis. But if it is severe, it is possible to use Berodual first and then Lazolvan.
For pneumonia
First, when treating pneumonia, pulmonologists prescribe antibacterial drugs; in order to restore drainage function, expectorants and mucolytics are prescribed. Berodual for pneumonia is indicated if it is accompanied by symptoms of bronchospasm.
For laryngitis
Laryngitis is not an indication for the use of the medication, but it can be prescribed for laryngitis accompanied by difficulty breathing (stenotic laryngitis, laryngotracheitis). With this disease, inhalations do not always help eliminate swelling of the larynx and glottis, so Berodual for laryngitis is an additional drug in complex treatment.
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For dry and suffocating cough
Berodual is not a cough medicine. A dry cough is more often associated with bronchial asthma, which is accompanied by bronchial obstruction. In this case, the drug will have a therapeutic effect. For other diseases associated with wet cough, sputum, pus, the use of the medication is not indicated. For suffocating cough, which can occur with laryngeal stenosis, obstruction of the respiratory tract with liquid, and infectious laryngotracheitis, inhalation treatment is very effective.
When are inhalations indicated?
The main effect of Berodual is to relax the smooth muscles of the bronchi and normalize the natural production of mucus in the lower respiratory tract. This allows you to quickly stop reflex spasms of the bronchi when irritating substances enter the body. The use of Berodual is indicated for adults and children as a means for the symptomatic treatment of emphysema, bronchial asthma, COPD, as well as for the prevention of various obstructive diseases accompanied by reversible bronchospasm.
Instructions for use
Berodual for inhalation should only be prescribed by a doctor, since the dosage, number of inhalations per day, and duration of treatment are determined individually. The instructions indicate standard dosages.
How to dilute, use Berodual, can you drink it?
The drug is used only for inhalation; you cannot drink it or put it in your nose. Inhalations begin with the minimum recommended dosage. Berodual is diluted with only 0.9% sodium chloride solution to a total volume of 3 - 4 ml. 20 drops of the drug make up 1 ml, 10 drops – 0.5 ml, etc., the rest up to 4 ml is sodium chloride.
It is forbidden to dilute the drug with distilled water and especially with tap water. The solution for inhalation is prepared immediately before use; you cannot make it in advance or use the drug left after the last inhalation.
The duration of the session is controlled by the quantity and as the solution is consumed. For inhalation there is no specific requirement for a nebulizer or inhaler, so different models can be used. But, the dose that reaches the body depends on the type of device, and it may be higher than when using similar doses of the dosage form of Berodual N in the form of an aerosol.
How and how much to inhale
Inhalations are carried out at regular intervals, but not more than 3 times a day. An increase in the number of inhalations per day is possible only in severe cases of the disease; the duration of the procedure can be increased to 8 minutes. The duration of inhalation is determined by the consumption of the solution in the nebulizer; as soon as it is finished, inhalation is stopped, on average it takes 3 to 7 minutes. 7 minutes is the maximum inhalation time, after which the procedure is stopped. The duration of treatment should be determined only by the doctor, taking into account the patient’s condition and the severity of the pathology. On average, treatment lasts from 5 to 10 days.
Before the procedure, the mouthpiece or mask, as well as the solution container, are washed. The required amount of the drug is instilled into the solution container in the nebulizer or inhaler. Add sodium chloride solution to the same container to the required amount of solution (up to 3 or 4 ml). The container is tightly closed. When using a nebulizer, the mouthpiece is tightly wrapped around the lips so that the substance in the form of vapor does not leave the mouth.
When using an inhaler, the mask is pressed tightly against the face. During the procedure, you need to breathe evenly and calmly; you do not need to try to take deep breaths and exhales. After inhalation, the remaining drug in the container is poured out, since it cannot be stored in diluted form until the next inhalation.
How to give inhalations to children
For children, you can use a nebulizer, which is used by adults, although nebulizers for children are sold in pharmacies; they attract the child’s attention, as they are very bright, and many are made in the shape of animals. Giving inhalations to small children is not difficult, the main thing is to attract him. It is always difficult for them to sit in one place, therefore, in order to distract him, you need to give him a bright toy, a book, preferably a new one that the baby has not seen yet, this will definitely distract him.
Before the procedure, children over 3 to 4 years old need to be explained why they need to do this, and that if they breathe in the steam, they will immediately feel better. To motivate a child for the procedure, you need to say that after inhalation the baby will receive something tasty, something he loves.
Before the procedure, it is always necessary to measure the temperature; if it increases, inhalation is prohibited.
Pharmacological effects
Berodual inhalations for a child using a solution can be prescribed by a pediatrician from birth.
The procedure is accompanied by the following therapeutic effect:
- facilitating deep inhalations and exhalations and normalization of breathing;
- long-term elimination of bronchospasm and prevention of its development when exposed to a pathogen (allergies, asthma attack, dry or cold air);
- destruction of infection and dilution of sputum, followed by removal from the lungs;
- Relieving swelling and eliminating inflammatory processes;
- the production of excess mucus in the bronchi and nasal cavity is reduced;
- oxygen supply to the whole body improves by improving the functioning of the bronchi and dilating the pulmonary vessels.
The effectiveness of the drug is noted even when used in small doses. Thanks to the speed of action of the elements, attacks of suffocation are quickly stopped. The drug penetrates the bronchopulmonary system, bypassing the digestive tract, thereby not disrupting its functioning.
Berodual dosage
The number of drops for children and adults in some situations may differ from those in the instructions. Only a doctor can determine the exact amount of the drug, taking into account the patient’s condition, the presence of concomitant pathology and the severity of obstruction.
Berodual is not one of those medications that you can buy and use yourself, especially for children. The dosage is selected individually based on the severity of the attack. Inhalations begin with the minimum recommended dose, the course of treatment is stopped after the symptoms of the disease decrease.
Dosage for adults and elderly
When prescribing the drug, indicate the number of drops per dose. In the presence of moderate bronchospasm, 0.5 ml of Berodual is prescribed - 10 drops. During an acute attack, the number of drops is from 20 (1 ml) to 50 (2.5 ml). For severe attacks, the number of drops can be increased to a maximum of 80 drops (4 ml).
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Dosage for children
For children over 12 years of age, the dosage is the same as for adults. From 6 to 12 years, the number of drops during an acute attack can vary from 10 (0.5 ml) to 40 (2 ml). The maximum number of drops may be exceeded in severe cases.
Inhalations for babies
Berodual can be used in children under 6 years of age only under medical supervision, since there is very little information on the use of the drug in young children. The amount of the drug for children in this group is calculated based on body weight. The number of drops per 1 kg is 0.1 ml (2 drops), but the amount of the drug should not exceed 0.5 ml (10 drops) per procedure.
Use during pregnancy
According to clinical studies, the components of the drug do not have a negative effect on the fetus and the course of pregnancy, but it must be used with caution, especially in the first 3 months of pregnancy. It is also necessary to take into account that fenoterol affects uterine contractility, that is, in the last months of pregnancy it can cause premature birth or the threat of miscarriage. In this regard, in the third trimester it is used under the strict supervision of a gynecologist.
Studies have shown that fenoterol is excreted in mother's milk; there is no such data about ipratropium bromide. Fenoterol does not have a negative effect on a newborn - there are no identified cases of pathology in fetal development under the influence of this substance. Its amount in breast milk is minimal, so it does not cause disruption to the development of the newborn. But, despite these facts, the drug is used with caution during lactation.
How to carry out the procedure correctly
When carrying out inhalation using stationary inhalers or nebulizers, you must follow a number of rules:
- The required dose of the drug, calculated for one procedure, must be diluted only with saline solution (3-4 ml).
- Berodual should not be diluted in distilled water.
- The prepared dose of the substance must be used completely in one inhalation.
- For each procedure, a fresh solution should be prepared. It is unacceptable to prepare the composition for several sessions at once. The diluted drug cannot be stored.
- The duration of the procedure is always different and largely depends on the amount of solution and the operating characteristics of the device, but inhalation can be completed only when the prepared dose of the substance is completely consumed.
When using an aerosol can, it must be remembered that the injection of the medicine must be carried out simultaneously with a deep breath so that the substance enters the respiratory tract. In adults, in most cases the procedure is not particularly difficult, but in children it may require some training.
The tip of the plastic adapter must always be kept clean. It is important to remember that the inhaler supplied with the medicine bottle must be used exclusively with this medicine. Do not use the drug with another inhaler, or place other medications in the device.
Reviews about use in children
Olga, 29 years old
My child is asthmatic, exacerbations rarely occur, but the last time there was a very severe attack, and therefore we were admitted to the hospital. The doctor prescribed us inhalations with Berodual and other drugs to stop the attack. I don’t remember how many drops we were prescribed, since the baby is 4 years old and I didn’t give him inhalations myself. I would like to note the very fast effect of the drug, we did inhalations 3 times a day for an average of 5 minutes, and after the first procedure the child felt better.
Lyubov, 34 years old
My daughter is 9 years old. And in winter she caught a very bad cold, a strong dry cough appeared, which changed to a wet one. She simply couldn’t breathe, and the phlegm wouldn’t go away; she kept trying to take a deep breath, but it didn’t work. The pediatrician prescribed us to drink Lazolvan to clear the lungs of phlegm and to breathe Berodual to relieve the spasm. Within 3 days all symptoms disappeared. There were no side effects, the only thing was that my daughter had a sore throat during inhalation, but after the procedure everything went away.
Stefania, 23 years old
My son was 8 years old when he developed a very strong cough with phlegm, which turned out to be bronchitis. The pediatrician prescribed us many medications, including inhalations with Berodual. I read the instructions and was horrified by the number of contraindications and the list of side effects. As a result, I was afraid to do inhalations with him, and the child simply breathed only saline solution, as with a normal cough with a cold, and we got rid of bronchitis, of course, not only thanks to inhalations, but also to other prescribed drugs.
A few important points
It must be remembered that the drug should never be taken orally, as this can cause many serious complications. The substance is designed exclusively for inhalation.
If during the procedure the patient begins to experience shortness of breath or episodes of difficulty breathing, it is necessary to immediately stop inhalation and seek help from a doctor.
Patients with any form of bronchial asthma, including allergic, can use the drug only to eliminate attacks with additional anti-inflammatory therapy.
With uncontrolled use of the drug or a constant unreasonable increase in dosage, a sharp exacerbation of the underlying disease may occur. Increasing the dosage of the drug on your own can lead to very dangerous consequences.
When prescribing Berodual, each patient must be instructed on the correct conduct of inhalations. It is unacceptable for vapors of the substance to get into the eyes, so they should be inhaled through a special mouthpiece of the device, and if it is not available, a tight-fitting mask should be used. When using an aerosol pocket inhaler, it is important to ensure that at the time of injection the patient tightly wraps his lips around the tube of the device.
Author: Irina Vaganova, doctor, especially for Moylor.ru
Contraindications
The use of the solution for inhalation is contraindicated when:
- tachyarrhythmias;
- high sensitivity to atropine-like medications;
- intolerance to at least one component included in the solution;
- hypertrophic obstructive cardiomyopathy.
Inhalations with the drug are used carefully and under the supervision of a physician for:
- severe pathologies of the cardiovascular system;
- diabetes mellitus (not well controlled);
- angle-closure glaucoma;
- recent myocardial infarction;
- pheochromocytoma;
- cystic fibrosis;
- occlusion of the urinary tract;
- high blood pressure;
- hyperthyroidism.
The drug is not contraindicated for pregnant and lactating women, but it is also used with caution and according to strict indications.
Pulmicort
The drug in the form of a dosed suspension is a corticosteroid for local use. The therapeutic effect is provided by the main component - budesonide.
If the recommended treatment regimen is followed, it relieves the inflammatory process in the bronchi, which reduces the intensity of the symptoms of bronchial asthma and the frequency of its attacks. Reduces swelling of the bronchial mucous membranes, secretion, sputum formation and bronchial hyperreactivity. The substance is well accepted by most patients and can be used for a long time.
Composition of the medicine
The drug is available with budesonide contents of 100 and 250 mcg per 1 ml of liquid.
Auxiliary components of the medicinal suspension are sodium chloride, sodium citrate, disodium edetate, citric acid, polysorbate and water.
A thoughtful combination of drug components helps deliver the active substance to the site of inflammation in an unchanged form and thereby ensure the therapeutic effect of inhalation.
Indications for use
Pulmicort is prescribed for therapy:
- COPD
- Bronchial asthma, when there is a need to use GCS
- Stenosing laryngotracheitis.
For whom the medicine is not suitable
One of the reasons for the popularity of Pulmicort is due to the minimum of contraindications. It should not be used for inhalation only for very young children who have not yet turned 6 months old, and for individual hypersensitivity to the constituent substances of the drug.
The risk group consists of patients with various types of infectious diseases of the respiratory system (viral, microbial or fungal), as well as cirrhosis of the liver and open form of tuberculosis. If the patient has these pathologies, then treatment with Pulmicort is possible only in extreme cases, and the progress of treatment should be constantly monitored by a doctor.
The drug is allowed to be prescribed with caution to pregnant and nursing mothers. The drug is a bronchodilator, it is mainly used in the treatment of diseases in which bronchospasms are possible
The bronchodilator effect is provided by two active substances - ipratorium bromide and fenoterol. Each of them has its own effect: the first component expands the bronchi by activating beta-2 adrenergic receptors, and the second one affects the smooth muscles of the bronchi. The result of the joint action is the removal of increased muscle tone and normalization of breathing. At the same time, Berodual has a slight anti-inflammatory effect
The drug is a bronchodilator; it is mainly used in the treatment of diseases in which bronchospasms are possible. The bronchodilator effect is provided by two active substances - ipratorium bromide and fenoterol. Each of them has its own effect: the first component expands the bronchi by activating beta-2 adrenergic receptors, and the second one affects the smooth muscles of the bronchi. The result of the joint action is the removal of increased muscle tone and normalization of breathing. At the same time, Berodual has a slight anti-inflammatory effect.
Another advantage of the drug is that the combination of two substances allows them to be used in lower doses, as opposed to using each separately.
Compound
1 ml of the drug contains 0.5 mg of fenoterol and 0.25 mg of ipratropium bromide.
Additionally, the drug contains benzalkonium chloride, disodium edateate, sodium chloride and hydrochloric acid and water.
Indications for use
The drug in the form of an inhalation solution is designed for the treatment and prevention of:
- Obstructive respiratory diseases with concomitant reversible bronchospasm
- Bronchial asthma
- COPD
- Chronic bronchitis (including complicated by emphysema).
Who should not be treated with Berodual
Absolute contraindications are:
- Hypersensitivity to components or other atropine-like drugs
- Hypertrophic cardiomyopathy in obstructive form
- Pregnancy (1st and 3rd stages).
Relative contraindications are:
- Glaucoma (angle-closure)
- Hypertension
- SD
- Recent myocardial infarction
- Pathologies of the cardiovascular system
- Increased content of thyroid hormones in the body
- BPH
- 2nd trimester of pregnancy, period of pregnancy
- Cystic fibrosis.
Side effects
Negative effects are most often associated with the beta-adrenergic and anticholinergic effects of the drug. During inhalation, local irritation of the mucous membranes is possible. The most common adverse reactions are:
- headache;
- dizziness;
- cough;
- dysphonia;
- urge to vomit;
- tachycardia;
- pharyngitis;
- nausea;
- tremor.
Rare and extremely rare side effects are noted systemically:
- On the metabolic side – hypokalemia.
- From the nervous system - excitement, nervousness, severe headaches.
- From the immune system - urticaria, hypersensitivity, anaphylactic reactions.
- From the cardiovascular system - increased systolic or diastolic blood pressure, atrial fibrillation, myocardial ischemia, palpitations.
- On the part of the visual organs - redness of the conjunctiva, glaucoma, impaired visual acuity, corneal edema, soreness in the eyes, increased intraocular pressure.
- From the respiratory system - irritation and swelling of the mucous membranes of the pharynx, paradoxical bronchospasm, pharyngitis.
- From the digestive system - dysfunction of the gastrointestinal tract, vomiting, stomatitis, diarrhea or constipation, glossitis.
- From the urinary system - impaired urine output.
- From the musculoskeletal system - myalgia, weakness and muscle spasms.
- On the part of the skin – hyperhidrosis and itching.
These side effects were not identified during research, but on the basis of data obtained on the use of the drug.
special instructions
The manufacturer does not provide data on the effect of the medication on driving vehicles and machinery. But, given the side effects, you need to be careful, as dizziness, visual impairment and tremors are possible. Fenoterol, as part of the drug, can give a positive result for doping in athletes.
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The drug cannot be used on an ongoing basis; symptomatic treatment is indicated for bronchial asthma, and inhalations are used only to relieve an attack. When using the medication, shortness of breath may increase and paradoxical bronchospasm may develop, which can be life-threatening. If they develop, as well as the appearance of other side effects, the drug is discontinued and drugs with similar effects are switched to.
When inhaling, it is necessary to ensure that the drug does not get into the eyes, especially for people with closed-angle glaucoma. Since when the inhalation solution gets into the eyes during the procedure, there are known cases of complications in the form of pain in the eyes, increased intraocular pressure, and blurred vision. To prevent them, you need to press the inhaler mask tightly to your face or press the nebulizer mouthpiece tightly with your lips.
Interaction with other drugs
Parallel use of Berodual with glucocorticosteroids improves the effectiveness of the latter. Caution is required when using MAO inhibitors and tricyclic antidepressants simultaneously, as they enhance the effect of Berodual. There is very little data on long-term co-administration of the inhalation solution and other anticholinergics, so their concomitant use is not recommended.
When the drug is used together with beta-agonists and anticholinergic drugs, an increased bronchodilator effect may be observed. The combined use of Berodual with beta-agonists that have systemic effects may increase the manifestation of side effects.
When using the drug, hypokalemia is possible, which is dangerous for the development of arrhythmia; its manifestations may intensify if the drug is used in conjunction with Digoxin. The use of anesthetics in the form of inhalations can cause side effects from the cardiovascular system.
Storage conditions, shelf life, sale
The solution for inhalation is stored in a place protected from direct sunlight. Children should not have access to the drug, as well as to other medicines. Storage temperature should not exceed 25 C. The solution should not be frozen. The shelf life of the therapeutic effect is 3 years, from the release date indicated on the drug packaging. Berodual refers to drugs that are dispensed from pharmacies only on a prescription form.
The average cost of Berodual inhalation solution in Russia is 280 rubles.
