Inhalation therapies are a group of respiratory, or breathing, treatments designed to help restore or improve breathing function in patients with a variety of diseases, conditions, or injuries. The treatments range from at-home oxygen therapy for patients with chronic obstructive pulmonary disease to mechanical ventilation for patients with acute respiratory failure. Inhalation therapies usually include the following categories:
Inhalation therapies are ordered for various stages of diseases that are causing progressive or sudden respiratory failure. Although physicians generally follow guidelines to assign specific therapy according the type and stage of a disease, the ultimate decision is based on a number of tests indicating pulmonary function and the presence or absence of oxygen in body organs and tissues.
Oxygen therapy
In the case of COPD, oxygen therapy does not treat the disease but can prolong life, quality of life, and onset of more serious symptoms. Effective oxygen therapy for any patient should lead to improved or sustained levels of oxygen in arterial blood.
Incentive spirometry
With proper use of incentive spirometry, the physician should observe improved pulse rate, decreased respiratory rate, improved respiratory muscle performance, and other indicators of improved function. Lung function following lung resection should show marked improvement following incentive spirometry.
Continuous positive airway pressure (CPAP)
The effectiveness of CPAP may be limited if patients do not cooperate. Possible side effects of CPAP include skin abrasions from the mask, leakage from the tube or mask, nasal congestion, nasal or oral dryness, or discomfort from the pressure of delivery.
Oxygen chamber therapy
Divers undergoing emergency treatment in a hyperbaric chamber should show immediate improvement in oxygen levels throughout the body, regardless of blood flow restrictions, after one or two treatments. Those patients receiving oxygen chamber therapy for difficult wounds may continue to receive treatments daily for several weeks before satisfactory results are reached. Patients with carbon dioxide poisoning should show improvement in or recovery of neurologic function. Results of hyperbaric chamber therapy depend largely on how quickly the patient was brought to the chamber, as well as the severity of the initial condition.
Mechanical ventilation
Successful mechanical ventilation will result in gradual decrease in dependence on the ventilator and weaning from the machine. Reduction of therapy to another form, such as CPAP or oxygen therapy, indicates that ventilation has worked as expected. In the case of COPD, exacerbation may be successfully treated with mechanical ventilation and the patient may return to home oxygen therapy. Pediatric patients will demonstrate normal growth and development as a normal result of long-term mechanical ventilation at home. Some patients, particularly those in a hospital intensive care unit, will not be able to breathe again without the ventilator; and families and physicians will face tough choices about continued life support.
Newborn life support
Neonates will be constantly monitored to measure lung function. Those measurements will help caregivers determine if and when mechanical ventilation can be reduced and CPAP or oxygen mask begun. CPAP is considered successful when the infant's respiratory rate is reduced by 30–40%, a chest radiograph shows improved lung volume and appearance, stabilization of oxygen levels is documented and caregivers observe improvement in the infant's comfort. Evidence that there is no infection from ventilation is also considered normal. In some cases, inhalation therapy, including mechanical ventilation, will not work and the infant's parents and physicians will face tough decisions about invasive procedures with associated high risks or cessation of life support.
Precautions
There are numerous indications for not prescribing various inhalation therapies.
Preparation
Preparation for any of these treatments is normally not necessary; and in fact, these therapies may be administered as a result of an emergency situation. Some of the methods, particularly incentive spirometry, or at-home oxygen or ventilation, will require education and cooperation with a home health agency or respiratory therapist. Pretreatment testing of various indicators of respiratory function and oxygen saturation will be performed to determine exact needs of individual patients.
Aftercare
Pulmonary function tests and other tests will be performed to verify that treatments have been successful or to monitor and adjust treatments. Mechanical ventilation will require weaning from the equipment and may also require care for the area surrounding the intubation.
Risks
Inhalation therapies may carry risks, complications or side effects including:
Continuous positive airway pressure
Successful CPAP will result in reduction in apnea for those suffering from sleep apnea. A study completed in 1998 demonstrated that CPAP was effective in the majority of patients with sleep apnea, with the exception of significantly obese patients with blood gas values that were worse during waking hours at rest and at exercise. Hospitalized patients on CPAP therapy should show improvement in blood gas and other pulmonary measurements as expected by the treating physician.
ORGANIZATIONS
American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. (972) 243-2272., Fax (972) 484-2720.
American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. <http://www.lungusa.org>.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. <http://www.nhlbi.nih.gov>.
OTHER
Hyperbaric Research and Treatment Center Page. <http://www.hyperbaricrx.com>.
Teresa Norris, RN
KEY TERMS
Aspiration—Accidental suction of fluids or vomit into the respiratory system.
Cannula—A tube inserted into a cavity to serve as a channel for the transport of fluid.
Endotracheal—Placed within the trachea.
Hypoventilation—Reduced ventilation in the lungs' air sacs resulting in above normal carbon dioxide pressure.
Hypoxemia—A condition in which there is deficient oxygen supply in the blood.
Hypoxia—Low levels of oxygen in blood, tissue, or air.
Intubation—Placement of a tube into a hollow organ (such as the trachea).
Pneumothorax—Presence of gas or air in the hollow space around the lungs.
Trachea—The windpipe, or main by which air passes to and from the lungs.
