Table 1

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

DrugTarget airway siteSpecial considerations
β2-agonists acuteCentral-peripheralUse O2 as driving gas unless there are concerns about CO2 retention
Adults and children
β2-agonists chronicCentral-peripheralReduce nebulization time for treatment compliance
Adults and Children
Anti-cholinergicCentralMouth piece (preferable) or tight sealing face mask
Adults and Children(Mouth piece for glaucoma patients)
CorticosteroidCentral-peripheralMinimize skin and eye exposure
Children and adultsMouthpiece (preferably) (or tightly sealed face mask)
Amino-glycosides or ColomycinCentral-peripheralMouth piece
AdultsFilter or exhaust exhaled gases
Pre-treat with β-agonist when necessary
PentamidinePeripheralMouth piece
AdultsPretreat with nebulized β-agonist
Filter or exhaust exhaled gases
AmphotericinCentralDilute with water not saline
AdultsFilter or exhaust exhaled gases
RhDNaseCentralMouthpiece
  • O2: Oxygen

  • CO2: carbon dioxide

  • RhDNase: recombinant human deoxyribonuclease