Table 1

Site of action of commonly nebulized drug aerosol therapies and the droplet size thought ideal for maximum clinical benefit

Drug	Target airway site	Special considerations
β₂-agonists acute	Central-peripheral	Use O₂ as driving gas unless there are concerns about CO₂ retention
Adults and children	Central-peripheral
β₂-agonists chronic	Central-peripheral	Reduce nebulization time for treatment compliance
Adults and Children	Central-peripheral	Reduce nebulization time for treatment compliance
Anti-cholinergic	Central	Mouth piece (preferable) or tight sealing face mask
Adults and Children	Central	(Mouth piece for glaucoma patients)
Corticosteroid	Central-peripheral	Minimize skin and eye exposure
Children and adults	Central-peripheral	Mouthpiece (preferably) (or tightly sealed face mask)
Amino-glycosides or Colomycin	Central-peripheral	Mouth piece
Adults		Filter or exhaust exhaled gases
Adults		Pre-treat with β-agonist when necessary
Pentamidine	Peripheral	Mouth piece
Adults		Pretreat with nebulized β-agonist
Adults		Filter or exhaust exhaled gases
Amphotericin	Central	Dilute with water not saline
Adults	Central	Filter or exhaust exhaled gases
RhDNase	Central	Mouthpiece