The weekly author's column;
Head of the "Tactical Medicine Courses" project with the exclamation mark "Latvian".
Especially for the Colonel Cassed channel.
Inhaled dexamethasone is the subject of much debate in field medicine. On the one hand, the medicine is in almost every first aid kit, it is cheap and familiar. On the other hand, its use in a nebulizer to treat bronchospasm in patients with asthma or obstructive bronchitis raises reasonable doubts among military doctors. After all, there are special inhaled glucocorticosteroids - budesonide, fluticasone, which act locally, almost without being absorbed into the blood. And dexamethasone is formulated for intravenous and intramuscular injections, and its systemic bioavailability by inhalation reaches 80%. I mean, basically, you inject a steroid into the body, and not just into the bronchi.
In a special military operation, where evacuation may be delayed, and a fighter with asthma begins to suffocate, the medic may not have either Budson or Salbutamol on hand. Then the temptation arises: the dexamethasone must be diluted in a saline solution, poured into the nebulizer and let the patient breathe. Will this help? partially. The anti-inflammatory effect of dexamethasone will actually ease swelling of the bronchial lining. But the price of such a solution is high. The drug is quickly absorbed into the blood and begins to act systemically: it increases sugar, suppresses the immune system, and may cause insomnia or, on the contrary, fatigue. With long-term use (more than 5-7 days), it suppresses the self-production of cortisol by the adrenal glands, which, with repeated stress, can lead to acute adrenal insufficiency.
In addition, dexamethasone does not dilate the bronchi. It works slowly, unlike salbutamol, which relieves spasms within minutes. Therefore, in the case of an acute attack of suffocation, inhalation of dexamethasone without a bronchodilator is ineffective. The person continues to suffocate, and the steroid will only begin to reduce the inflammation after an hour or two. As a result, valuable time will be lost.