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Tuesday, November 24, 2015

The impact of pets on asthma

The following was originally published at on April 23, 2015

The impact of pets on asthma

The impact of pets on asthma is an interesting subject. On the one hand, evidence suggests exposure to pets may cause and trigger asthma. Yet on the other hand, evidence suggests exposure to pets may actually prevent asthma. So what gives?

Statistics. Of the 235 million people with asthma worldwide, about 75 percent have allergies, and about 10 percent are allergic to household pets. Cats and dogs are the most common pets that cause allergies, although cat allergies are about 50 percent more common than dog allergies. However, along with cats and dogs, any warm-blooded animal has the potential to cause pet allergies.

What are pet allergies? All warm-blooded animals produce dander (flakes of skin), urine, feces, and saliva. Exposure to proteins (allergens) in these substances causes the immune systems of susceptible subjects (the unfortunate 10 percent) to release proteins (called IgE antigens). These attach to mast cells lining the respiratory tract, eyes, and skin. Future exposure to that allergen will cause it to bind with an Ige antigen. This causes a series of chemical reactions that lead to inflammation of cells lining the eyes, nose, throat, and airways. This is what causes allergy symptoms: itchy and watery eyes, nasal congestion, itchy throat, coughing, sneezing, wheezing, difficulty breathing, and irritability. To learn more, read my post “Why Do Allergies Trigger Asthma? What Can You Do?

What’s the pet allergy-asthma link? A common theory suggests that repeated or chronic exposure to any substance -- such as pet allergens -- that causes airway inflammation may lead to chronic airway inflammation, or asthma. Airways are now said to be oversensitive, or hyper-reactive. Subsequent exposure to the allergen will cause this chronic inflammation to worsen, causing the asthma response as well as the allergic response. To learn more, read my post “Do Allergies Cause Asthma?

How are pet allergies detected? One way is to be vigilant to what you were exposed to just prior to having an allergy or asthma attack. If you have a reaction after exposure to a pet, then chances are it’s the culprit. Still, the best method is to be tested for allergies. Allergy testing is the only sure way of knowing if you have pet allergies.

What can you do? The ideal treatment for pet allergies is removal of the pet from the home, and avoiding it in the future. For pet lovers who simply cannot avoid their loving pets, the next best option is to:
  • Keep pets out of the bedroom and keep the door closed
  • Remove upholstered furniture and carpets, or keep pets off of these
  • Wash pets weekly to wash off potential allergens
  • Use High Efficiency Particulate Air (HEPA) filters to reduce airborne allergens
If allergies persist despite these efforts, the next best option is to work with your physician, who may recommend medicines such as antihistamines (like Claritin and Benadryl) or leukotriene antagonists like Singulair. Plus, it’s always a good idea to work with your physician to obtain and maintain good asthma control.

Do pets prevent allergies? It’s a possibility. One study showed that exposure to cats prior to the age of 18 resulted in a 50 percent less chance of developing a cat allergy. Likewise, boys exposed to dogs in the first year of life had a 50 percent less chance of developing a dog allergy. There are some theories, and research is ongoing to better understand this. Learn more by reading my post “Having a Dog or a Cat May Prevent Asthma.”

Bottom line. It’s clear that pets may cause and trigger allergies and asthma, and that pet allergies may be prevented and controlled. What’s not so clear is how pets might prevent allergies and asthma. So the full impact of pets on asthma has yet to be determined.

Further reading:

Monday, November 23, 2015

11 Advancements COPDers can be thankful for

The following was originally published on November 23, 2014, at

11  COPD Advancements to be Thankful for this Thanksgiving

It’s never easy coming to grips with a diagnosis like chronic obstructive pulmonary disease (COPD). Sure, it’s caused some hardships along the way, yet COPD patients have a lot to be thankful for this Thanksgiving holiday.  

1. Better financing. For most of history, money dedicated to health care was focused on finding a cure for deadly diseases like tuberculosis.  Now that those diseases are better controlled, money is now being dedicated to diseases like asthma and COPD.  

2. Better research. Thanks to the gift of more money, researchers are now able to dedicate their time learning as much as they can about this disease. It is by this research that we have learned of the dangers of smoking, and the advantages of quitting.  

3. Scientific breakthroughs.  Better financing and research has helped the science community focus on finding a cure for this disease.  They have already learned that chemicals inside cigarette smoke cause chronic inflammation that causes the gradual loss of lung tissue (emphysema). While there is no cure for emphysema right now, researchers have learned that stem cells may helpregenerate lung tissue.  

4.  Better education.  Improved research and scientific breakthroughs have provided physicians and nurses and respiratory therapists better knowledge regarding this disease.  This has resulted in improved treatment options for physicians.  It also means patients will be better capable of taking care of their lungs.  

5.  Fewer smokers.  Cigarette sales started to spike at the turn of the 20th century, yet this escalated during WWI as cigarette companies encouraged smoking to improve morale of troops.  Not knowing they were actually poisoning their bodies, nearly every soldier came home addicted.  Today, thanks to better finances, research, and education, the word has gotten out, and smoking rates are on the decline.  So it should be expected that COPD-related deaths should hopefrully also start to decline.  It also means cleaner air for easier breathing.  

6. Better medicine. Pharmaceuticals are risking millions, if not billions, of dollars on finding better treatment options for people with this disease.  They have already given us great  medicines -- Advair, Symbicort, Dulera, Spiriva, Pulmicort, Serevent, Atrovent, Duoneb, Ventolin, Xopenex -- to treat and control this disease.  In the future we have hope for even better treatment options, and maybe even an eventual cure. 

7. Improved technology.  Some patients with COPD are required to wear non-invasive ventilation devices, such as BiPAP and CPAP.  These machines used to be large, bulky, and loud, and the masks were uncomfortable.  Today, the machines are compact and relatively quiet, and the masks are quite comfortable.  This has greatly improved life for many.

8. Great resources. For most of history only the select few had access to wisdom. Now, due to many books, magazines, and websites like, everyone has easy access to the latest COPD wisdom.  

9.  Gallant health care professionals. Another advantage to access to so many resources is the ease of which physicians, nurses, and respiratory therapists are able to learn new wisdom that will benefit patients with COPD. Whenever a need arises, these good folks are trained to offer help, and usually with a smile.

10. Payment options. For most of history if you didn’t work you probably couldn’t afford good health care.  This all changed with the creation of programs such as Medicare and Medicaid.  There are also a variety of other programs aimed at helping patients afford pricey COPD medicine.

11. Better breathing.  Medical professionals have gathered together to createCOPD protocols and guidelines to help regional physicians better help their patients.  COPD action plans help COPDers decide what action to take in order to prevent and treat flare-ups.  Combined, these have helped COPD patients breathe easier and live normal lives. 

So there’s a lot to be thankful for this year if you have COPD.  So many people have worked so hard to help people with COPD.  Thank you for hanging out with us.  Have a wonderful Thanksgiving.

Tuesday, November 17, 2015

What is Exercised-Induced-Bronchospasm?

The following was originally published on April 9, 2015, at

What is Exercised-Induced-Bronchospasm? 

Exercise-Induced Asthma (EIA) is a sub-type of asthma where prolonged and vigorous exercise triggers asthma attacks. Like allergies, it affects about 75 percent of asthmatics, so it’s quite common. The good news is that it can also be prevented.

Modern evidence suggests that a better term for this is Exercise-Induced Bronchospasm (EIB). This is because exercise is just one of many asthma triggers that may induce an asthma flare-up. It’s also because you do not have to have asthma for exercise to cause bronchospasm.

What is it?

Exercise, particularly the aerobic kind, like running, may induce a narrowing of the airways called bronchoconstriction or bronchospasm. It occurs when the bronchial muscles wrapped around the airways spasm and squeeze the airways, thus causing them to become narrow. This causes airways to become obstructed, thus making you feel symptoms.

What are symptoms?

Common symptoms include:
  • Burning, itchy feeling of chest and neck
  • Shortness of breath
  • Increased mucus production
  • Coughing
  • Chest tightness
  • Fatigue during exercise
  • Inability to exercise
  • Avoidance of activity (common in children)
  • Why does it happen? 
First, keep in mind that during normal breathing air is inhaled through the nose, which warms it to body temperature and humidifies it. While exercising, air is inhaled in rapid, large volumes through the mouth, and may not be adequately warmed and humidified.

Keeping that in mind, experts have theorized that heat and moisture are transferred from airway cells to heat and humidify this air. In susceptible people, this stimulation causes airway cells to release inflammatory mediators, such as histamine and leukotrines. This ultimately leads to bronchospasm and increased mucus production.

Many people with asthma find that this problem is exacerbated when exercising in cold air, such as during the winter time. This is because cold air tends to hold less humidity than warm air.

How might it set you back?

In order to avoid symptoms, some people use EIB as an excuse not to participate in aerobic activity. Yet avoidance of aerobic activity causes one to miss out on all the benefits of staying active.

What are the benefits of exercising?

The Mayo Clinic lists seven benefits of exercise, and I add a couple more. These are ten reasons why it is essential for EIB to be recognized and prevented.
  • Makes your heart and lungs stronger
  • Increases your energy level
  • Increases your stamina and decreases fatigue
  • Helps you sleep better and improve your concentration
  • Helps you combat chronic disease
  • Improves your mood, confidence and self esteem
  • Reduces stress and anxiety
  • Improves your immune system, which improves your ability to stave off nasty viruses (the most common asthma trigger) and the flu
  • Helps you control weight (Obesity may lead to worsening asthma)
  • Makes asthma attacks, when they do occur, less severe
How is it prevented?

The good news is that EIB can be treated and prevented. Generally, there are two methods used.

EIA. For those who have EIB with asthma, pretreatment with albuterol (usually 2 puffs of the inhaler about 10 minutes prior to exercising) is the most common treatment. However, daily treatment with corticosteroids to reduce and control chronic underlying airway inflammation is also proven to help.

EIB. For those who do not have typical asthma and only have symptoms with exercise, the best treatment appears to be a pretreatment with albuterol about 10 minutes prior to exercising. Since they are less likely to have chronic airway inflammation, daily treatment with inhaled corticosteroids does not appear to be as helpful.

Another thing that might help is exercising indoors when the air is cold outside. This is because warm air holds more humidity. So the risks of EIB acting up may be less when the air is warmer, such as greater than 50 degrees.

Exercise is essential. Most asthma experts recommend that all people with asthma, regardless of severity, get some form of exercise, including aerobic activity. This is why it is especially important to both recognize and treat EIB.

Further reading

Monday, November 16, 2015

Summer COPD Triggers

The following was originally published at on June 11, 2015

10 Summer COPD Triggers

Oh, there are so many things you can do in the summer. You can sit on your front porch while enjoying a cool drink and a refreshing breeze. You can bask in the sun while watching kids playing in cool, refreshing water. You can camp with your family and cook on the grill. Still, while summer can be the greatest season of the year, it also brings about COPD triggers that we must be leary of.

Campfire & Cooking Smoke. So you love to spend time with your friends and family while enjoying all the pleasures of camping. You love to cook hotdogs and hamburgers (or steaks) on the grill. Evidence suggests, and studies have shown, that both the smell and particles inside heating and cooking smoke may trigger a flare-up of COPD. It may be best to cook on a traditional stove, and to avoid camping.

Heat and Humidity. Hot summer days may be ideal for lounging around a beach or outdoor pool. However, temperatures greater than 90 degrees, and humidity greater than 50 percent, may also make breathing difficult. Humid air tends to be thick with moisture and hard to breathe. A better idea may be to sit inside an air conditioned room watching a movie.

Indoor Mold. According to the CDC, mold can grow anywhere where moisture exists. Weather conditions may contribute to moisture inside your home. This may result from high humidity or water leaks after large rainfalls. Mold itself is harmless, although mold spores may be inhaled and irritate sensitive airways. Air conditioners and dehumidifiers work great for controlling indoor humidity. Be sure to prevent leaks into your home, and clean up any leaks immediately when they do occur.

Mowing lawns. The smell of grass, especially freshly mowed grass, may trigger a flare-up. Riding over grassless areas may cause a cloud of dust that may be inhaled, also triggering flare-ups. The best solution is to avoid mowing the lawn yourself, and to stay inside when your grass is being cut. It may also be a good idea to stay inside while your neighbor’s grass is being mowed.

. Many people with COPD also have allergies to pollen. Tree pollen may still be in the air in early June, although June is usually considered grass pollen month. July may provide some relief from pollen, but once ragweed season begins in August, pollen counts start to increase again. The best way to prevent pollen from irritating airways is to monitor pollen counts in your area, and stay indoors with the windows shut when levels are high.

Dehydration. Another thing to pay attention to, especially when you have a lung disease, is how hydrated you are on hot summer days. Dehydrated lungs make airways increasingly irritable and prone to spasm. The best way to prevent a flare-up due to dehydration is to drink plenty of water, especially on hot days.

Ozone. This is a form of air pollution caused by emissions from factories, outdoor grills, and car exhaust. Ozone levels may be higher during hot, sunny days. Inhaling ozone may worsen airway inflammation. You can’t see ozone, but you can monitor it by learning the Air Quality Index in your area. The American Lung Association recommends you limit outdoor exposure when levels are high.

Particulate Matter. It’s another form of air pollution caused by particles in the air due to smoke, dust, haze, emissions from factories, sea spray, and volcanoes. Inhaling these particles may irritate sensitive airways. Stay inside when you suspect smoke or dust to be in the outdoor air. Monitor the Air Quality Index and stay indoors when the levels are high.

Thunderstorms. Studies showed an increase in emergency room visits among asthmatics following thunderstorms. Experts think this may be because rain causes pollen to rupture, causing minute particles that can be inhaled. It may also be due to rising humidity, or simply the pressure changes. Due to limited studies in this regard, and similarities between asthma and COPD, we can probably assume that thunderstorms may also be a COPD trigger.

Even your own ambition may pose as a COPD trigger. A simple walk in the park may go too long, a canoe trip may expose you to too much environment, a 4th of July picnic may expose you to smoke from a cooking grill. It’s important to have fun, just be sure to plan the day so you aren’t exposed to your COPD triggers. Also be sure to follow your COPD Action Plan and pace yourself so you can enjoy all the summer fun.

Further reading:

Thursday, November 12, 2015

Fake Diagnosis: Is any diagnosis accurate?

Fresh out of respiratory therapy school 20 years ago the medical profession seemed so right.  Doctors always properly diagnosed patients and everything they ordered was always necessary. Then, after studying charts and assessing patients before and after every procedure I did, unexpected revelations occurred.

  1. Most of what we do is a waste of time or delays time
  2. No diagnosis can be trusted
Look, what I am about to say does not reflect, in any way, my respect for physicians and the institutions they work for.  In fact, I in no way expect any person to be perfect, and therefore it's not possible for every thing they order to be necessary, nor every diagnosis to be accurate.  

What is my evidence?  Why is this true? Yes, I will get to the answers. 

I've written enough about useless breathing treatments on this blog to choke a cow, so I don't want to get into that too much here.  But any respiratory therapist is taught to assess a patient before and after every treatment. When three treatments are ordered 20 minutes apart, and the patient is breathing normal after the first and still breathing normal before the second is due, that the second one is not needed. 

But the Quality Assurance people will cry on your shoulder if you did not do the second two treatments, because the patient required three failed breathing treatments to qualify for admission.  

So, while doctors sometimes order breathing treatments because they "think" they will help, or because they will make the patient "feel like we are doing something" or because "it can't hurt."  Many more now appear to be ordered just so the hospital gets paid.  

Now I don't know if it started with ICD-10 or DRGs, but most diagnosis' now appear to be incorrect as well.  Long ago a coworker of mine showed me a diagnosis of pneumonia.  He went over the patient's chart with me and said there is no evidence here that the patient has pneumonia at all.  

"Look," he said, "the x-ray is normal, there is no elevated white blood cell count, and the patient is not having trouble breathing. The only reason this patient was diagnosed with pneumonia is because the patient was too sick to go home and needed a reimbursable diagnosis."

From then on I paid attention every time a diagnosis of pneumonia was written, and, on many occasions, there was no evidence of pneumonia.  

Recently a doctor came to me and asked me a logical question.  He said, "How do you, as a respiratory therapist, define hypoxemic respiratory failure? Or, worded another way, what do they teach about it in respiratory therapy school?" 

I said, "Well, the easiest way to diagnose it is a CO2 greater than 50 and a PO2 less than 60. Why?

He said, "I just find that hypoxemic respiratory failure is often written as the diagnosis and there is no evidence of it.  Most of these patients do not even have a blood gas." 

I said, "Keep in mind that a patient can be in acute respiratory failure and have an SpO2 of less than 90 and still be diagnosed with it.  During some such episodes there is not time for a blood gas."  

He said, "True.  But in most cases, that is not the case, and yet patients are still getting diagnosed improperly. I'm getting tired of it." 

I said, "I see your frustration.  I think most doctors have no clue what a bronchodilator is and when they are needed.  I think that most doctors order albuterol because they think it will do something for pneumonia, and there is no reason why it would. And this has gotten so out of hand that CMS requires albuterol for the patient to meet admission and reimbursement criteria."

He said, "I agree. If I don't order albuterol I have QA people knocking on the back of my head saying, "Hello.  Hello. We need albuterol ordered on this patient. We need a diagnosis of pneumonia.  We need a diagnosis of asthma.  We need a diagnosis of COPD.  Those are much more reimbursable than what you wrote.  We need a diagnosis of hypoxemic respiratory failure."

I said, "It's sad."  

He continued to show me examples.  He opened the chart of a cancer patient.  Her charting showed the following:
  • Respiratory Assessment: Dyspnea noted
  • Breath sounds; rhonchi
  • SpO2: 98% on 2lpm
  • Temperature: 98.5
  • White Blood Cell Count: normal
  • ABG: pH 7.4, PO2 95% on 2l, CO2 35
  • Diagnosis: hypoxemic respiratory failure; also pneumonia, lung cancer
He said, "An accurate diagnosis is exacerbation of COPD secondary to pneumonia or lung cancer.  You see how this is not a good diagnosis.  It throws off statistics, and it also causes the doctor to seek medical solutions that are not best for the patient. It causes the doctor to treat what doesn't need to be treated, wasting money and resources."

I said, "I agree."

He gave me another example.
  • Respiratory Assessment; no respiratory distress, coughing spasm
  • Breath sounds; rhonchi
  • SpO2: 98% on room air
  • Temperature: 100.5
  • White blood cell count: normal
  • ABG: none ordered
  • Other: patient has peg tube
  • Diagnosis: hypoxemic respiratory failure, aspiration pneumonia, sepsis
He said, "First, there was no ABG done. Second, the physician charted that the patient was in no respiratory distress. So how could he diagnose hypoxemic respiratory failure?"  It's simply wrong. 

I said, "Agreed."

He said, "So I charted that I disagreed with the above diagnosis, and entered that the patient had probable aspiration pneumonia. The next day the QA officials was all over me.  She said, 'That's a difference of $20,000 in reimbursement.' I said, "It's also fraud, and why healthcare costs are so high.'  So she was mad at me. The other doctor was mad at me, and I proceeded to explain to her why I was right and she was wrong. It was a learning experience for her.  But the next day I worked I saw that she had written, 'I respectfully disagree with the other doctor's diagnosis.'  Fine.  And you wonder why the healthcare profession is so screwed up.  QA officials are so concerned with making money for the hospital that they are trained, encouraged to falsify, or exaggerate, diagnosis. It has caused doctors to become lazy. Rather than think, they just chose a diagnosis from a list of ten most reimbursable."

I said, "The same happened with asthma.  Since DRG law was passed in 1978 or 1979 or 1980, asthma rates have skyrocketed.  Did asthma rates really skyrocket, or was it because asthma is a reimbursable diagnosis?"

He said, "Agreed.  It sucks."

It does suck.  

Tuesday, November 10, 2015

Links between asthma and genetics

The following was originally published at on March 25, 2015.

The Link Between Asthma and Genetics

The discovery of asthma genes has lead to better wisdom about asthma. The hope is that this will some day lead to better treatment, and ideally a cure. In the meantime, here is what is now known about the link between asthma and genetics.

1. A brief history. Around 400 B.C. Hippocrates suspected asthma was hereditary. Since then, asthma has been treated as a single disease, with the treatment being the same for all asthmatics. Since the 1980s most cases of asthma are treated with corticosteroids. While this strategy usually works, it fails to work for some. Genetic research may help explain this.

2. What is genetics? It’s the science of how genes control the characteristics of a person. Think of it this way. The human body is composed of 37.2 trillion cells. Every cell has a nucleus, inside of which is a DNA molecule consisting of genes. Each gene contains a recipe for creating a protein, and each protein carries out some bodily function. Researchers have been studying genetics to determine its role in asthma for many years now.

3. Asthma is hereditary. Genetic researchers have learned that most genes are the same in all people, although about one percent are unique, making every person unique. Some of these unique genes are asthma genes, and they are handed down from parent to child, proving Hippocrates was right all along. So they now believe all cases of asthma are caused by genetics.

4. Asthma is heterogeneous. Every asthmatic presents with unique asthma signs, symptoms and triggers. What medicine works for one asthmatic may not work for another. Researchers now suspect the reason for this is due to the fact that every asthmatic has a unique combination of asthma genes.

5. Asthma genes? That’s right! Researchers have now discovered over 100 genes responsible for causing asthma, and are on the hunt to find more. They think this explains why every asthmatic is unique.

6. Some genes cause asthma. The proteins released by these genes may cause an abnormal increase in the chemicals responsible for the asthma and allergic responses. Some cause asthma by themselves, and this may explain childhood onset asthma. Others cause asthma after exposure to certain environmental triggers, and this may explain adult onset asthma. It also may explain why there are so many things that may cause asthma.

7. Some genes impact severity. Most asthmatics develop chronically inflamed air passages that are responsive to corticosteroids. However, some develop airway remodelling, such as abnormally thick airway walls, and are not responsive to corticosteroids. This might be because some asthma genes cause the inflammatory response, some cause airway remodelling, and some cause both. This might also explain why some asthmatics have mild asthma, while others have mild or severe asthma. This might also explain why some cases are easy to control with corticosteroids, and others are difficult to control regardless of the treatment.

8. Some genes cause both asthma and allergies. Some people have just asthma, but about 75 percent of asthmatics also have allergies. This might be because some genes or gene combinations cause both. Taking this a step further, some people have a perfect trifecta of asthma, allergies and eczema, causing some researchers to suspect that some genes may cause all three diseases.

9. Genetics may impact what medicine works. A common cliche among the asthma community goes something like this: “Finding what medicine works for you is often a matter of trial and error.” The theory that every asthmatic has a unique combination of genes should help explain this. Advair works great for some asthmatics, while others respond better to Symbicort. Some asthmatics respond poorly to both. As researchers learn more about how genes impact what medicine works, perhaps the day will come when a simple blood test will determine what medicine works best for you. And, of course, this may also help researchers discover better treatment options too.

10. It may lead to better categorization. As researchers learn more about human genetics, they may be able to use this information to determine what sets of genes cause what symptoms in what populations. They may be able to use this information to create more precise asthma subgroups. Perhaps a simple blood test will allow a physician to put you in one subgroup or another, and guidelines catered to that subgroup will guide your physician toward treatment options tailored just for you.

Further Reading:

Monday, November 9, 2015

Nebulizers -vs- Inhalers for COPDers

The follow
ing was originally published at on May 20, 2015

Inhaler -vs- nebulizer: which one is best for COPD

One of the best ways of controlling COPD is by inhaling COPD medicine. To do this, some use an inhaler with a spacer, some use a nebulizer, and some use both. So which one is the best way to deliver COPD medicine to your lungs?

To learn about inhalers, check out my post “What is an inhaler?” To learn about nebulizers, check out my post “What is a nebulizer?”

Both inhalers and nebulizers allow patients to inhale a low dose of a medicine to receive a more rapid response (sometimes immediate), with fewer side effects than taking the medicine systemically. So they both work great for people with lung disease.

That said, let’s delve into this subject a little deeper and compare the two.

Medicine Distribution. Many studies have been done comparing inhalers with nebulizers. Most suggest that, when used properly, inhalers used with a spacer work equally well as nebulizers. So, it would appear at first that there’s no difference between the two, as far as getting the most medicine.

Cost. Your first nebulizer will cost anywhere from $50 on up. It includes the nebulizer and the air compressor used to power it. You’ll need to purchase supplies a few times a year, plus the medicine each month. Albuterol inhalers cost about $50, although other inhalers (such as Advair), may cost upwards to $200 plus each month. However, any cost for COPD medicines can usually be picked up by co-pays and Medicare.

Medicinal Waste. Most people who use inhalers don’t realize this, but most of the medicine is wasted. Furthermore, it does not matter whether you are using an inhaler or a nebulizer. Studies suggest that when an inhaler with a spacer is used, only 15 percent of the medicine gets to the airways. When a nebulizer is used, only 12 percent of the medicine gets to the airways. However, this fact is accommodated for by the dosing.

. Nebulizers require an air compressor and a power source and about 10-20 minutes of your time. Inhalers with spacers are small, compact devices, are convenient for travel, can be used anywhere, and require no power source.

Coordination. Studies show most people don’t use inhalers correctly. This has been confirmed by many studies. Age, and disease severity, may also impact your ability to use inhalers correctly. Poor technique means less medicine gets to your lungs, resulting in less benefit from the medicine. Inhalers often require training and practice to get it right. Nebulizers require less training. They simply require breathing normal through a mouthpiece. This assures an ideal dose and ideal benefit.

Airflow Limitation. Some people cannot generate enough flow to operate inhalers. This may occur during asthma attacks, COPD flare-ups, and during the end stages of COPD. Nebulizer treatments allow you to inhale the medicine over a period of time regardless of flare-ups or disease severity. Nebulizers, therefore, appear to work better during flare-ups, and for severe COPD.

Decision. There really is no winner or loser here. The convenience of inhalers makes them ideal for most people. However, if you have severe COPD, or frequent flare-ups, nebulizers may work better. Still, the best way of learning which one is better for you is by talking to your physician.

Further reading: