The infamous nebulizer

Sometimes we neglect the basics here at the RT Cave.  One of the cornerstones of treating lung diseases is with aerosolized therapy with a nebulizer.  So what exactly is a nebulizer anyway?  I explain in my most recent post from MyAsthmaCentral.com.

"What is a Nebulizer?" from MyAsthmaCentral.com on March 31, 2011

Ancient Egyptians inhaled fumes of herbs heated on bricks. In the 19th century cigarettes were used. Finally, after about a hundred years of experimenting, the first mass produced nebulizer was invented in 1969. The nebulizer has since become a lifesaver for many asthmatics.

The concept here is quite simple:  inhaled asthma medicines go directly to the lungs and may instantly relieve asthma symptoms.

Ancient techniques did this, but they were slow and inefficient. The modern nebulizer solved these problems.The nebulizer is simply a cup with a mouthpiece on the top (or a mask) and oxygen tubing on the bottom.  The tubing is connected to an air compressor.  When turned on, the  air compressor provides a flow of air through a tiny hole in the cup so that liquid inside the cup is drawn into the flow, causing a fine, white mist.

In this way, the nebulizer turns liquid into aerosols that are the perfect size for deposition into the lungs once inhaled. This process is called atomization, and this is why nebulizers used to be called atomizers.

Other names for nebulizers are nebs, updraft therapy, aerosol therapy, nebulizer therapy, breathing treatment, or simply a treatment. Most air compressors are compact and connect to a power source. Newer ones are actually quite convenient and even  portable, as they either come with a battery or can be plugged into an outlet in your car.

For most asthmatics a simple inhaler is all they need. Most asthma experts recommend every asthmatic carry an Albuterol inhaler for quick relief of asthma symptoms. Unlike nebulizers, inhalers can be held in your hand, and even stuffed into a purse or your pocket.

What works better, nebulizer or inhaler?
Even though you put more medicine into the nebulizer cup than what is expelled from an inhaler, most studies show (as you can see here) that when an inhaler is used properly with a spacer it is just as effective as nebulized medicine.

To learn which one works best for you or your child, click here.

So, what asthmatics should have nebulizers?

• Asthmatics with severe, persistent asthma (It allows them to treat asthma symptoms at home instead of going to the hospital all the time)
• Elderly or other adults who are unable to coordinate an inhaler
• Young children and infants who lack coordination with inhalers
• If the medicine you need is only available in solution form (Pulmicort)
• Your personal preference (you think nebulizers work better than inhalers)
• If you require the use of an emergency room for acute asthma symptoms
• If you require an unscheduled doctor's visit for acute asthma symptoms

How do I get one?

If you or your doctor believes you should have a nebulizer at home, your doctor will have to write a prescription for the air compressor and the medicine used with it. The air compressor you will get from a home health care company, and the medicine from your local pharmacy.

How do you use a nebulizer?

How often and when to use your nebulizer should be determined by you and your doctor. Some people take it at regular intervals, such as every four hours if their asthma is severe enough. Although most asthmatics only need to use it when their asthma is acting up and/ or their inhaler is not working well enough.

Unless regularly scheduled, you and your doctor should add to your asthma action plan when you are to use your nebulizer.

What medicine can you take with a nebulizer?

• Albuterol: Relaxes lung muscles and can make breathing instantly easy. Also available as inhaler.  Most common asthma medicine.
• Xopenex: Relaxes lung muscles and can make breathing instantly easy. Also available as inhaler.
• Atrovent: Mild bronchodilator and is generally used as an asthma controller medicine. It's no longer a top line asthma medicine.
• Duoneb: A combination of Albuterol and Atrovent. It's not used often for asthma, yet it's still available if necessary.
• Pulmicort:  A corticosteroid only available in solution form, and is only recommended for kids or adults unable to use an inhaler.

So, how do you use it? 

The medicine used in nebulizers are premixed with water and inserted into tiny plastic ampules. All you have to do is twist open the top and pour the contents into the cup.

You can either place a mask or a mouthpiece on top of the nebulizer, whichever you prefer. Most older kids and adults can use a mouthpiece just fine. Younger kids and some adults may prefer or require the mask.

Then you simply turn on the flow source (air compressor), and a fine, white mist will be seen coming out the mouthpiece or inside the mask.

If you use a mask it should be securely placed on your face with the strap. You should breathe normal through your mouth or nose.

If you use a mouthpiece, it should be clipped between your teeth with your mouth closed. You should breathe normal through your mouth. 

The duration of the treatment is usually 4-10 minutes, and depends on the flow generated from your flow source. 

(To learn more on how to take a treatment click here.)

So nebs provide another option for inhaling asthma medicines.  Along with modern inhalers, this is a vast improvement from inhaling fumes from a brick.

What do you think?

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