What Is a Nebulizer?
A nebulizer is a way of converting medications into a fine spray or mist so they can be breathed in and act directly on the lungs. They use a flow of oxygen, compressed air, or occasionally ultrasonic energy, to nebulize a solution of medication (i.e. breaking up a solution into tiny airborne liquid particles that can be easily breathed in).
Nebulized medication can take different routes depending on the way you breathe; a simple mouthpiece can work well for people who are able to control breathing through their mouth, while a face mask which covers the nose and mouth might be more appropriate for those who cannot always remember how to use a mouthpiece, such as individuals with confusion or memory problems, or young children. Nebulisers can also be connected to tracheostomies or to mechanical ventilators.
What Is a Nebulizer Used For?
Nebulizers are used to manage the causes and symptoms of lung disease. They may be used only for short periods of acute illness or may be a longer-term solution to managing chronic lung disease. Nebulizers are commonly used for people with conditions like chronic obstructive pulmonary disease (COPD), cystic fibrosis, or bronchiectasis. Nebulizers may be offered to people with asthma who are unable to use inhalers, but usually, inhalers work just as well for people with asthma.
Some people have nebulizers only while they are in the hospital with an acute illness, whereas others go home with nebulizers either long-term or as required.
How Does a Nebulizer Work?
A nebulizer set-up has a small chamber which holds a small amount of liquid medication. Oxygen or compressed air is blown through this liquid through a small nozzle which is designed to break up the liquid into a fine mist of nebulized medication. This mist is then carried through a tubing or mask to be breathed in. This is an excellent way to deliver medications straight into the lungs to act directly on the surfaces of the air passages.
How Do I Use a Nebulizer?
Nebulizer solutions usually come as plastic ampoules of sterile, single-use liquid. Occasionally, medication may also come in powder form and will need to be mixed with a sterile solution for nebulization. The liquid is then poured into the nebulizer chamber, which is attached to a source of compressed air or oxygen to drive the solution.
Your doctor will advise you on whether you should use air or oxygen driven nebulizers. Air-driven nebulizers usually have a simple on/off switch, while those that are driven by medical oxygen can be adjusted to ensure the right amount of oxygen is being delivered. A respiratory nurse or doctor should advise you on the right flow of oxygen to use. Oxygen flow rate is measured in litres per minute (L/min). Anywhere between 4 and 8 L/min would be a fairly common flow rate for an oxygen-driven nebulizer.
The nebulizer chamber should be kept fairly upright for the medication to be properly nebulized. If the chamber is directly attached to a face or tracheostomy mask, being in a good, upright sitting position is important to ensure the right amount of solution is nebulized. If it’s working properly you’ll see a mist around the mask or mouthpiece as you breathe in and out, and you’ll know when it’s finished because there won’t be any more visible mist.
The way you hold or fit the nebulizer will depend on the model and type, and you should be able to get advice from your doctor or specialist nurse who can watch you and make sure you’re using it correctly.
A nebulizer will usually take anywhere from around 5 to 20 minutes to deliver the medication, depending on the flow rate and the medication being given.
There is usually a little bit of residue in the chamber after the nebulizer is finished which should be cleaned out properly to avoid getting the wrong dose of medication next time.
Medications Given by a Nebulizer
There are a few types of medication commonly given by nebulizer. Any medications designed to be given by nebulizer come in sterile, single-dose ampoules. Once opened, if the full contents of the ampoule aren’t used, the rest should be thrown away.
Nebulizers can be used to give ‘normal saline’ – 0.9% salt (sodium chloride, or NaCl) in sterile water, which does not count as a medication, but can help to loosen up secretions. This makes it easier to cough up any phlegm and mucus in your lungs. Normal saline may also be used to dilute or reconstitute other medications for inhalation. Stronger solutions of saline – ‘hypertonic saline’ can also be used to make any mucus in your lungs looser and easier to cough up.
Corticosteroids act to reduce inflammation of the walls of the fine passageways in the lungs. They may be used as a long-term treatment for lung disease, or in stronger doses for acute flare-ups or exacerbation of the condition.
These work by opening the airways, reducing wheeze and improving airflow. Ventolin – the ‘reliever’ inhaler is a common example of an inhaled bronchodilator.
Occasionally, people who are prone to having frequent chest infections caused by certain bacteria can benefit from long-term courses of inhaled antibiotics by nebulizer. Antibiotics given by nebulizers act directly on any bacteria that are colonising or infecting the lung tissue, making serious chest infections much less frequent.
Cleaning and Caring for a Nebulizer
It’s important to keep your nebulizer equipment clean, especially the parts which have immediate contact with your mouth and breath. Any particles or microbes sitting in the mouthpiece or tubes may breed in the moist, warm environment inside nebulizer parts and can be breathed into your lungs the next time you use the nebulizer.
Nebulizers should be washed at least once a day. They can be taken apart and washed with clean soapy water, rinsed thoroughly and left to dry. If they are visibly dirty, or if you’ve been coughing lots of phlegm up while using your nebulizer, they should be washed after every use.
Each disposable part of the nebulizer set-up should be changed regularly – your respiratory nurse or doctor can advise you, or there may be manufacturer’s instructions on regularly replacing parts. It’s a good idea to have spares in case any parts break or fail.
The manufacturer of each nebulizer machine may have individual recommendations for cleaning and disinfecting the machine, so it’s important to read any instructions provided. In general, the nebulizer machine should be wiped down every day; remember to unplug mains powered nebulizer machines before cleaning around them.
Nebulizers or Inhalers?
Both nebulizers and inhalers deliver medication directly into our lungs. However, there are some key differences between the two.
Inhalers are generally smaller and more portable than nebulizers, as a nebuliser requires a mouthpiece or mask, tubing, and a medical air pump, oxygen canister or oxygen concentrator. The medical air pump or oxygen concentrator will usually also need to be plugged into a mains socket, so nebulizers may not be the best option for travelling.
There are two types of inhalers. A metered-dose inhaler delivers a dose of sprayed medication when you press a pump. Spacers can be fitted in to help you to get the right dose by holding the medication in a chamber for a short time before it’s breathed in. A dry-powder inhaler, on the other hand, punctures dry powder in capsules. To pull the powder into your lungs, you will have to take a deep, sharp breath. Those who are unable to breathe in hard enough to inhale the powdered medication may have to use a different sort of medication or delivery system.
Inhalers can be harder to use as you have to get the technique right. This can be tricky for people with memory problems or confusion, as they may not always remember the technique and find it hard to inhale at the right time with inhalers. Other individuals with dexterity problems in their hands may also find it hard to use inhalers, but there are various aids available to help.
Nebulizers, on the other hand, are good for delivering the right amount of medicine and are generally easier to use. It may be more suitable for babies and young children to use a nebulizer rather than an inhaler. Individuals with poor diaphragm control – those who have limited control over their ability to breathe and cough independently, such as those with high spinal cord injuries – may be best suited to a nebulizer as well.
Nebulizers at Home
Living with chronic respiratory conditions can be difficult and often means complying with strict regimes of medication. Life can feel restricted by breathlessness and the fatigue of a serious illness.
Some people find that having a caregiver around for medication reminders and to take care of other tasks around the house such as meal preparation can make it easier to live with chronic conditions. Having that support in place can help you adapt and stay independent within the restrictions of long-term or short-term respiratory illnesses.
Living with a long-term health condition can sometimes feel like a strain, but most importantly, always remember that you’re not alone and help is always available.
- Smith, C., & Goldman, R. D. (2012). Nebulizers versus pressurized metered-dose inhalers in preschool children with wheezing. Canadian family physician Medecin de famille canadien, . https://www.ncbi.nlm.nih.gov/pubmed/22734168
- Bardsley, G., Pilcher, J., McKinstry, S. et al. (2018) Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial. BMC Pulm Med https://doi.org/10.1186/s12890-018-0720-7
- Kellett, F., Redfern, J., & Niven, R. M. (2005). Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis. Respiratory medicine, https://doi.org/10.1016/j.rmed.2004.05.006
- Yaxley J. P. (2016). Prescribing patterns of nebulized bronchodilators: A prospective chart review. Journal of family medicine and primary care https://doi.org/10.4103/2249-4863.192330
- Cole PJ. (2001) The role of nebulized antibiotics in treating serious respiratory infections. J Chemother. https://doi.org/10.1179/joc.2001.13.4.354
- American Lung Association (2020) How to Use a Nebulizer (video) https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/treating/medication-management-tips/how-to-use-a-nebulizer