Chymotrypsin aerosol inhalation - beware of adverse reactions

The prion protein is a mucus decomposing agent. Like the aerosol inhalation of ambroxol, chymotrypsin aerosol inhalation therapy is also an over-the-counter drug. The safety is not known due to the lack of corresponding systematic evaluation. What is worrying is that today, when the relationship between doctors and patients is so tight, some hospitals still use this product in the nebulized inhalation route. How much do you know about the sputum protease inhalation adverse reactions?

Chymotrypsin is a proteolytic enzyme. It is a proteolytic enzyme extracted from bovine or porcine pancreas. It has the function of endopeptidase and can cut the peptide chain of a protein macromolecule into a peptide with a smaller molecular weight. Decomposes denatured proteins, hydrolyzes fibrin and mucin in sputum into polypeptides or amino acids, liquefies viscous sputum, and facilitates coughing. It is effective against purulent or non-purulent sputum and plays a role in promoting liquefaction and purulent clearance of purulent secretions and necrotic tissue.

In addition, chymotrypsin also has a lipase action to hydrolyze certain lipids, so it can digest pus, blood, and necrotic tissue, and it can be used for purifying, anti-inflammatory, and swelling of wounds. It is widely used in surgical patients.

Regarding the administration method of chymotrypsin, after consulting relevant data, it was found that some scholars have proposed that the method of nebulization inhalation is worthy of clinical application in the treatment of acute and chronic bronchitis due to its better mucus release action. However, the report is more due to various adverse reactions caused by aerosol inhalation of chymotrypsin, so the administration of this method still needs to be discussed.

1.  allergic reactions, chymotrypsin is widely used in clinical practice, the drug specification indicates that intramuscular injection of chymotrypsin can cause allergic reactions, requiring allergic tests before injection, but most of the clinical inhalation route is not administered Skin test. Inhalation is the direct action of the drug solution on the respiratory mucosa after atomization. The lungs are often exposed to external allergens, and there are a large number of antigen-presenting cells that are sensitive to allergens. As a heterologous protein (allergen), chymotrypsin stimulates the body to produce lgE antibodies, binds to mast cells and basophils, activates adenylate-activating enzymes, causes mast cell degranulation, and releases histamine and other active substances to act on the target. Organs that cause bronchial smooth muscle spasm and induce asthma attacks.
2. it has been reported that chymotrypsin aerosol inhalation can cause hyperthermia, dyspnea, asthma, severe headache and other symptoms, although clinically rare, but can not be ignored.
3. long-term aerosol inhalation will lead to airway epithelial squamous metaplasia.
4. For younger babies, the humidity of the droplets may be large due to fogging, which may cause short-term hypoxia after continuous inhalation.

Clinical considerations

• For safety reasons, it is recommended to ask patients if they have a history of asthma and a history of allogeneic protein allergy before inhalation of chymotrypsin to prevent accidents. Patients with allergies are advised to have a skin allergy test when they are needed.
• No matter which method is used, the aqueous solution of this product is extremely unstable, and the liquid should be prepared temporarily, and the dilution should not be too much (2-5 ml).
• Chymotrypsin should not be administered by ultrasonic atomization. Due to the influence of ultrasonic on its activity, the chymotrypsin titer decreased significantly after ultrasonic atomization. It is recommended to use aerosol inhalation method or micro-atomizer to drive inhalation with air compression pump or oxygen, and the time should be controlled at 5 Within min.