Nebulisers in paeds...

Nor Azwany Yaacob

November 8

 

RCT on use of neb in bronchiolitis — with Mazlyn Mustapha.

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  You, Muhammad Hazwan Bin Nasarudin, Sheela Moorthy, Che' Wan Aminud-din Hashim and 2 others like this.
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  Fahisham Taib aik...I am doing on hypertonic saline

  November 8 at 2:46pm · Unlike · 1
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  Nor Azwany Yaacob sorry mr paediatrician, do not mean to cross your boundaries. mazlyn is asking on evidence of this so I just search and tag her..guna android version ter masuk dlm general post status..buleh la komen on mazlyn question on the use of neb in bronchiolitis

  November 8 at 6:25pm · Unlike · 1
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  Fahisham Taib Not much evidence but treatment clinically depends on the response of patients post nebs. We only give salbutamol here not racemic adrenaline

  November 8 at 10:01pm · Unlike · 1

 

Mazlyn Mustapha

November 8 · Edited

Can the paediatricans please clarify the role of nebulisers in bronchiolitis. Thank you.

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• Izny Hafiz Zainon, Miriam Byrne, Wong Ket Keong and 6 others like this.
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  Vasanthi Palani am no paeds but it helps to expand the airways and help expel the mucus as well...

  November 8 at 11:16am · Like · 1
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  DrFelix Chong It also helps to alleviate the anxiety from the parents.

  November 8 at 11:22am · Like · 3
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  Sheela Moorthy Mixed reviews on the use of bronchodilators and racemic epi for the treatment of bronchiolitis. They are not the standard of care here but will be used if clinically indicated or if there is a positive response. Racemic epi on the other hand works like magic for croup.

  November 8 at 11:25am via mobile · Like · 3
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  Shaktivel Palanivel mum and dad will feel better. if the little guy puts up a fight and screams, he will expand his lungs, clear mucus, expand energy and settle down later

  November 8 at 12:19pm via mobile · Unlike · 2
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  Mazlyn Mustapha Oh I see...so nothing really evidence-based huh. Well, I can give other cheaper placebos :D

  November 8 at 12:50pm · Edited · Like · 2
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  Mazlyn Mustapha When I was in paeds years ago we'd be killed for this (giving nebs for bronchiolitis), something to do with the size of drug particle not small enough to reach the intended airways. I thought perhaps there was some new research or new drug.

  November 8 at 12:51pm · Like · 2
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  Khoo Sin Dee my daughter were given once, she screamed and hubby said we got to stop. we turned to homeopathic treatment and never went for any steroid based medication since then. i think placebo is a better idea.

  November 8 at 3:03pm · Unlike · 1
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  WanLin Tan Khoo Sin Dee Given a choice, nebulised steroid to open up the airway is better than systemic steroid; unless placebo is a genuine magic placebo that works miraculously well.

  November 8 at 3:14pm · Unlike · 2
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  Khoo Sin Dee WanLin Tan, a magic placebo should come with dry spell --- most likely will start off with jampi-like or hypnotize kinda thing, is it? :P

  November 8 at 3:17pm · Unlike · 1
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  Nurul Aminudin there is no role for bronchodilating nebulisers in infants with bronchiolitis as it is however poorly understood that they have not developed the Beta2 receptors fully in their airways. however it is still given but creates more distress in an infant struggling to keep the noisy mask on. They more they cry the tired they get and they are at risk of 'getting too tired too breath' ie resp failure. the mainstay for treatment if bronchiolitus under one year particularly is oxygen minimal handling and supportive care. The nebulised treatment for above a year can differ from unit to unit.

  November 8 at 5:21pm via mobile · Unlike · 3
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  Mazlyn Mustapha Khoo Sin Dee: it depends, how old was your child and what was the diagnosis? As Prof Sheela mentioned we use steroid nebs for croup/laryngotracheobronchitis where the child has this characteristic 'barking' cough. Bronchiolitis is different.

  November 8 at 5:25pm · Like
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  Nurul Aminudin our unit would have a high threshold to start bronchodilating nebs. the last few years 3%NaCl nebs have been seen to clear up upper airway mucosal congestion.

  November 8 at 5:26pm via mobile · Unlike · 1
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  Mazlyn Mustapha Thanks Nurul Aminudin, I presume Prof Nurul by now ;)

  November 8 at 5:28pm · Like
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  Abdul Wahid Ns nebulise better

  November 8 at 5:30pm via mobile · Unlike · 1
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  Mazlyn Mustapha Since the parents insisted on nebs (baby was 6-8 months range) that's what I gave (Ns). They said some paediatrician insisted daily nebs but there was no letter or any written instruction.

  November 8 at 5:32pm · Edited · Like
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  Khoo Sin Dee Mazlyn Mustapha, my daughter was then about 2 yrs, mild wheezing, but was prescribed with nebulisers. is this necessary?

  November 8 at 5:36pm · Unlike · 1
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  Mazlyn Mustapha Khoo Sin Dee: normally I wouldn't comment unless I saw the patient and examined them myself :D

  November 8 at 5:54pm · Like · 1
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  Khoo Sin Dee understand that. :)

  November 8 at 5:57pm · Unlike · 1