Inhaled medicines are medicines that people breathe in. Kids with cystic fibrosis (CF) need inhaled medicines to help prevent lung infections and make it easier to breathe. Inhaled medicines work best when you give them in the right order. Here's how to do it.

• Give your child inhaled medicines in this order:

1. Bronchodilator
2. Hypertonic saline
3. DNase
4. Inhaled antibiotic
5. Inhaled steroid

• If the care team did not prescribe one of the medicines listed above, skip that step and move to the next one.
• Follow the care team's instructions for when and how often to give each medicine and how much to give.
• Do airway clearance techniques (ACTs) as recommended by the care team. If your child is taking inhaled antibiotics, do ACTs before giving the antibiotic.
• Have your child rinse his or her mouth with water after taking inhaled steroids.
• Some medicines can only be used with certain types of nebulizers. Make sure you use the right nebulizer for each medicine.
• Follow your care team's instructions for cleaning and disinfecting the nebulizer parts.

Your child:

• has trouble taking the medicines
• gets white patches in the mouth
• has side effects that worry you or your child

What inhaled medicines do kids with CF need? Different types of medicines help kids with CF. Some kids don't need all of them.

Here's how the main types of inhaled medicines work:

• Bronchodilators relax and open the airways so air can move in and out of the lungs. Albuterol, Atrovent®, ProAir®, and Xopenex® all are bronchodilators.
• Hypertonic saline is a special type of saltwater. It helps thin mucus so a child can cough it up. HyperSal® is hypertonic saline.
• DNase (dornase alfa) breaks down a substance in mucus that makes it sticky. This helps loosen mucus so it moves out of the airways and a child can cough it up. Pulmozyme® is a DNase.
• Antibiotics kill bacteria (germs). It's important to clear out as much mucus as possible before inhaling an antibiotic. That way, the antibiotic gets deeper into the lungs to kill more germs. Brand names include Cayston®, TOBI®, and Coly-Mycin® M.
• Steroids (also called corticosteroids or glucocorticoids) reduce swelling in the airways.
  • Some steroids are given alone. Brand names include Flovent®, QVAR®, Asmanex®, and Pulmicort®.
  • Other steroids are combined with a bronchodilator. This is called a combined bronchodilator. Brand names include Advair® and Symbicort®.

How do ACTs help? "ACTs" stands for "airway clearance techniques." After inhaled medicines thin and break up mucus, ACTs help move it out of the lungs.

ACTs can include things like tilting the body, clapping on the back, wearing a special vest, or using a device that vibrates (shakes) the chest. Follow the care team's recommendations for what kind of ACT to do and when to do it.