Aerosol Therapy during the Application of Non-Invasive Mechanical Ventilation or High-Flow Nasal Cannula in Patients with Asthma and COPD

Abstract

Noninvasive mechanical ventilation (NIV) and high-flow nasal cannula (HFNC) are increasingly used in patients with exacerbated acute and chronic respiratory failure. Some patients receiving these therapies may also benefit from inhaled drug delivery. It is therefore attractive to combine treatment with aerosols and noninvasive respiratory support (NIRS). Aerosol therapy devices that can be adapted in line with NIRS are pressurized metered-dose inhalers (pMDIs) and nebulizers. In the subgroup of nebulizers are three types: jet nebulizers (NJ), ultrasonic nebulizers (NUs) and vibrating mesh nebulizers (VMN). The administration of aerosol therapy in line with HFNC seems a novel combination and of great applicability in selected patients. Based on the available evidence, the combination of providing NIV and aerosol therapy in patients with airflow obstruction without interrupting respiratory treatment seems appropriate. The aim of this article is to review the available literature on aerosol therapy during NIRS. In addition, to provide recommendations based on the available evidence.