From the Guidelines
Yes, patients can experience an increase in coughing following inhalation therapy with a nebulizer, as the medication and the process itself can temporarily irritate the lungs and trigger a cough reflex. This is a common and normal reaction to the treatment. Nebulizer treatments deliver medication in a fine mist that penetrates deep into the airways, which can cause irritation and lead to coughing 1. The medications themselves, such as bronchodilators (e.g., β agonists like salbutamol) and steroids (e.g., budesonide), may cause coughing as they work to open airways and reduce inflammation 2.
Some key points to consider:
- The medications used in nebulizer therapy, such as albuterol, ipratropium bromide, or budesonide, can cause coughing as they work to open airways and reduce inflammation 2.
- As the airways open up due to the medication, mucus that was previously trapped may become loosened, prompting coughing as the body attempts to clear these secretions.
- This increased coughing is often beneficial as it helps clear the lungs of mucus and irritants.
- If coughing becomes severe or persists for an extended period after treatment, it may be worth discussing with a healthcare provider, as medication adjustments or technique modifications might be needed.
- Drinking water after a treatment can help soothe throat irritation that might contribute to coughing. It is essential to note that the European Respiratory Society guidelines discuss the use of nebulizers for delivering bronchodilator drugs to patients with asthma or COPD, and the choice of medication and device should be individualized based on the patient's specific needs and response to treatment 1.
From the FDA Drug Label
WARNINGS After proper administration of acetylcysteine, an increased volume of liquified bronchial secretions may occur.
- Increased coughing can be inferred as patients may experience an increase in coughing due to the increased volume of liquified bronchial secretions.
- The drug label explicitly mentions that cough may be inadequate, implying that coughing can be affected following inhalation therapy with a nebulizer.
- Patients, especially asthmatics, should be monitored carefully, and bronchodilators may be necessary to relieve bronchospasm 3.
From the Research
Increase in Coughing Following Inhalation Therapy
- Patients may experience an increase in coughing following inhalation therapy with a nebulizer, as evidenced by the study on nebulized lidocaine for intractable cough and asthma 4.
- The study found that nebulized lidocaine can cause initial bronchoconstriction, which may lead to an increase in coughing in some patients.
- However, the study also found that nebulized lidocaine can be an effective treatment option for intractable cough in patients who are unresponsive to traditional cough suppressants.
Adverse Effects of Nebulized Medications
- Adverse effects of nebulized medications, such as albuterol, can include tremor, metabolic disturbances, and cardiotoxicity, although these effects are rare 5.
- The study on the efficacy and safety of a continuous albuterol protocol for the treatment of acute adult asthma attacks found that adverse effects were minimal, with only a few patients experiencing flushing, jitteriness, or palpitations 6.
- The study on the safety, efficacy, and expedience of albuterol nebulizer administration by BLS providers found that patients who received albuterol by BLS pilot agencies showed improvements in vital signs, with no significant adverse effects reported 7.
Efficacy of Nebulized Medications
- Nebulized medications, such as albuterol, can be effective in improving lung function and reducing symptoms of asthma and other respiratory conditions 6, 5, 7.
- The study on the albuterol-budesonide fixed-dose combination rescue inhaler for asthma found that the combination of albuterol and budesonide reduced the risk of severe asthma exacerbation compared to albuterol alone 8.