Some respiratory therapists, and many patients, tap the nebulizer until they presume all the medicine in the cup is gone, while others simply end it once the medicine in the nebulizer cup starts to sputter. So who is right and who is wrong? Is tapping necessary?
According to the experts a breathing treatment ends when the medicine starts to sputter, and by this time most of the medicine is gone. This was discussed by Dr. Bruce Rubin and James Fink, RRT, in their 2003 article, "The delivery of inhaled medication to the young child," in Pediatric Clinical of North America (50, pages 717-731). They write:
Most of the available medication in the nebulizer cup is nebulized in the firstAccordingly, the the study showed that (2, page 316):
few minutes . All nebulizer cups have some amount of medication remaining
near the end of therapy, when aerosol generation becomes intermittent. This
intermittent nebulization is referred to as sputtering; it has been documented that
aerosol delivery to the patient declines by half within 20 seconds of the onset of
sputtering . At this time it is appropriate to discontinue therapy.
Albuterol delivery from the nebulizer stopped with the onset of inconsistent nebulization (sputtering). Continuation past the past the point of jet nebulizer sputter is ineffective and should indicate an end of the treatment.So there you have it. Now you know when is the best time to end a treatment.
- Rubin, Bruce K, M.D., James B. Fink, RRT, "The delivery of inhaled medication to the young child," Pediatr Clin N Am 50 (2003) 717– 731. Note: James Fink is one of the foremost experts on aerosol delivery and has been involved in many tests and written many articles on the subject. You should Google him to see what else he has written. You might be impressed.
- Hess, Dean, Neil MacIntyre, Shelley Mishoe, William Galvin, editors, "Respiratory Care Principles and practice," 2nd edition, 2012, Jones and Bartlett, page 316