Aerosol Guide - AARC.org

Hazards of Aerosol Therapy
Hazards associated with aerosol drug therapy may occur as a result of inhaled medication,
an aerosol generator being used, the aerosol administration technique, and the environment.
Hazards of aerosol therapy can impact the patient receiving therapy, as well as care providers
and bystanders.
Hazards for Patients
Adverse Reaction: Most hazards associated with aerosol therapy are attributed to adverse
reactions to the drug being used. Therefore, inhaled medications should be administered
with caution. Types of adverse reactions include headache, insomnia, and nervousness with
adrenergic agents, local topical effects with anticholinergics, and systemic/local effects of
corticosteroids. 12,13 If any of these adverse reactions are seen during aerosol drug therapy, the
treatment should be ended and the physician should be notified.
Bronchospasm: Administering a cold and high-density aerosol may induce bronchospasm
in patients with asthma or other respiratory diseases. 13-15 If bronchospasm occurs during
aerosol therapy, the therapy should be immediately discontinued for 15-20 minutes. If it
persists, the physician should be notified.
Drug Concentration: In both jet and ultrasonic nebulizers, drug concentration may
increase significantly during aerosol therapy. 16-18 An increase in drug concentration may be
due to evaporation, heating, or the inability to efficiently nebulize suspensions. 13,16,18,19 As a
result of changes in drug concentration, the amount of the drug remaining in the nebulizer
at the end of aerosol therapy is increased and the patient is exposed to higher concentrations
of inhaled medications. This is a great problem with continuous-feed nebulization.
Infection: It has been well documented that aerosol generators can become contaminated
with bacteria and increase the risk of infection in patients with respiratory diseases. 20-25 The
risk of transmission of an infection is dependent upon duration of exposure of drugs with
pathogens and the procedures taken by respiratory therapists to avoid pathogen exposure.
Proper practices of medication handling, device cleaning, and sterilization can greatly reduce
this risk.
Eye Irritation: Inhaled medications delivered with a face mask may inadvertently deposit
in the eyes and result in eye irritation. Improving the interface between the face mask and
patient may eliminate this problem and increase the amount of drug delivered to the distal
airways. Therefore, caution should be exercised when using a face mask during aerosol drug
administration.
Hazards for Care Providers and Bystanders
Exposure to Secondhand Aerosol Drugs: Care providers and bystanders have the risk
of exposure to inhaled medications during routine monitoring and care of patients. While
workplace exposure to aerosol may be detectable in the plasma, 26 it may also increase the
risk of asthma-like symptoms and cause occupational asthma. 27-29 The development and
implementation of an occupational health and safety policy in respiratory therapy departments
can minimize exposure to secondhand aerosol drugs.
6 American Association for Respiratory Care A Guide to Aerosol Delivery Devices for Respiratory Therapists, 3rd Edition © 2013