Nebulizers break down liquid medicine into an aerosol mist that patients inhale through a facemask or mouthpiece. Like inhalers, nebulizers deliver medication directly to the lungs.

Nebulizer delivery requires two components:

• Compressor. Breaks down the medication into tiny particles and powers the nebulizer.
  
  
• Nebulizer. This contains the medication cup which houses the medication, tubing and a mask or mouthpiece through which the medication travels before reaching the patient’s mouth and traveling into the patient’s lungs.

Patients inhale the medicine mist with regular breaths. A single treatment takes between five and 30 minutes to complete. Sympathomimetics (drugs that stimulate the sympathetic nervous system), anticholinergics, bronchodilators and corticosteroids are medications delivered by nebulizers.

Nebulizers are available only by prescription. Most patients will find the use of a nebulizer to be unnecessary. Studies have shown that inhalers are as effective as, or more effective than, nebulizers in delivering medicines.

However, some patients find nebulizers easier to use than inhalers, especially infants, children, the elderly and those in the midst of an asthma attack. Nebulizers do not require the hand-breath coordination necessary when using an inhaler. A physician will work with the patient or parent to decide if nebulizer use is an appropriate option. Some people use both nebulizers and inhalers.

Nebulizers convert a liquid medicine or a mixture of medicines from a medication cup into an aerosol mist that can be inhaled through a facemask or mouthpiece. Nebulizers are beneficial because breathing medication directly into the lungs tends to relieve symptoms faster than taking the medication orally.

There are two parts to every nebulizer setup:

• Compressor. This is a machine that uses air pressure to convert the medicine to a mist.
  
  
• Nebulizer kit. This contains a medication cup, medication, the connecting tubing and mask or mouthpiece.

Before using a nebulizer, premeasured vials of liquid medications (or prescribed doses measured in a measuring cup) are emptied into a chamber between the mask (or mouthpiece) and the tubing that connects to the nebulizer. The compressor pumps compressed air through the liquid medicine, which turns it into a fine mist.

Nebulizers are available only by prescription. A physician will work with the patient or parent to decide if nebulizer use is an appropriate option. Sympathomimetics (drugs that stimulate the sympathetic nervous system), anticholinergics and corticosteroids are all available for use in nebulizers.

Nebulizers are used to treat asthma, as well as other conditions. Nebulizer medications are often used as a short-acting bronchodilator during an acute asthma attack because they can deliver large doses of medication directly to the lungs. They are recommended for high-dose beta2 agonists and anticholinergics when asthma symptoms become severe.

Young children, the elderly and those who are seriously ill often find nebulizers easier to use than inhalers. Unlike inhalers, nebulizers do not require deep breathing or coordination between taking a breath and pressing the pump to deliver the drug.

Most patients, however, will find the use of a nebulizer to be unnecessary. Studies have shown that inhalers are as effective as, or more effective than, nebulizers in delivering medicines. The droplets of medication sprayed from an inhaler are smaller than those that come from a nebulizer. The smaller the drop, the easier it is for the medication particles to reach the tiniest air tubes in the farthest reaches of the lungs. However, some patients prefer nebulizers because the device allows them to see and feel the mist coming from the machine.

It also takes longer to deliver a single dosage of medication with a nebulizer (between five and 30 minutes) than it does to deliver a similar dosage with an inhaler. Another major difference is that inhalers are smaller and require no power source. Nebulizers, on the other hand, need to be plugged into an electrical socket or powered by batteries.

Patients inhale the mist with regular breaths. This brings the medicine directly into the lungs in the same manner as an inhaler. Some physicians recommend that patients hold their breath for one or two seconds after inhaling to give the medicine more time to be absorbed into the lungs. Parents of young children should monitor their child throughout the treatment.

A treatment session usually lasts between five and 30 minutes. Once a full dose has been delivered, the misting should stop automatically and the compressor will make a sputtering noise. The machine can then be turned off. 

It is important to clean the nebulizer after each use according to the machine’s directions. Patients who use a nebulizer several times a day should rinse the tubing with soap and water after each treatment and let it air dry. After the last treatment of the day, patients should take the following steps:

• Disconnect the nebulizer kit from the compressor.
  
  
• Remove the tubing that connects the kit to the compressor. Clean the outside of the tubing with a damp cloth. The inside of the tube generally does not need to be cleaned, as only air passes through it.
  
  
• Take apart the individual pieces of the nebulizer kit according to the manufacturer’s instructions.
  
  
• Submerge the components in a solution that is one part vinegar to three parts water for 30 minutes. The solution will remove medication residue and kill any accumulated bacteria.
  
  
• Rinse the kit under running water and let it air dry overnight. Do not towel dry, as lint may be left behind.
  
  
• Reassemble the nebulizer and store in a cool, dry place.

Patients who use a valved nebulizer that is reusable can clean the nebulizer by washing it in a dishwasher.

Patients should also check the filter on their nebulizer machine on a weekly basis. Filters that appear discolored should be removed and replaced with a new filter

Nebulizer kits and compressors are either nonportable or portable:

• Nonportable models are plugged into an electrical socket. Nonportable versions work well for those who use a nebulizer at home but switch to an inhaler away from home. 
  
  
• Portable versions tend to be battery-powered or can be run electrically with a 12-volt adapter. They can typically provide several treatments before recharging is necessary.

Nebulizers are either nonvalved or valved:

• Nonvalved. The most common type of kit, these can be found in many hospitals. This type of nebulizer is called nonvalved because it does not contain a valve to hold the medication in place until a patient is ready to inhale. Nonvalved kits must be hand washed and replaced every month.
  
  
• Valved. These reusable kits are highly efficient because they use a valve to hold most of the medication inside the nebulizer kit until the patient takes a breath. The kits also keep particle size uniform, ensuring that more medication gets deeper into the patient’s lungs. This added efficiency may mean a patient needs fewer treatments to achieve lasting relief. Valved nebulizer kits need to be replaced every six months. Most can be washed in a dishwasher.  

Nebulizers also differ in the method used to break down medicine:

• Jet nebulizers. These use a pressurized jet stream of air forced through a narrow opening to create a vacuum effect. This forces the liquid medicine in the reservoir to rise in particle form. The jet stream then forces the particles out of the nebulizer and toward the patient.
  
  
• Ultrasonic nebulizers. These use vibrations of a crystal at high frequencies to turn the liquid medicine into an aerosol. Inhalation then brings the medicine toward the patient. Ultrasonic nebulizers are designed to break down medicine into very fine particles that can reach deep into the lungs. Though some patients may find this to be an improvement over the jet nebulizer, others find the high-density aerosol irritating to the lungs. Also, some medicines cannot be used with ultrasonic nebulizers, as the high-frequency vibration may alter the medication’s structure.

Finally, nebulizers use different means to deliver the medication. These include:

• Mask. This can be used by very young children who may lack the sophistication to use a mouthpiece.
  
  
• Mouthpiece. A plastic device that is inserted into the mouth. Older children and adults usually prefer this delivery method over the mask. 

Because the machines are so efficient at delivering the medication, a larger dose tends to reach the patient. Though this is an overall plus, it also tends to increase the risk of side effects of medications.

Patients who breathe in too deeply or too fast while using a nebulizer may experience dizziness or jitteriness. Patients who experience these symptoms should stop the treatment and rest for a few minutes before resuming. If symptoms continue, the patient should alert a physician.

In addition, recent research has suggested that nebulizers can become contaminated with indoor allergens, such as cockroach debris. This contamination could lead to life-threatening asthma attacks in sensitive patients. More research is needed to confirm this link and to develop methods to prevent contamination.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding nebulizers:

1. Am I candidate for a nebulizer or are inhalers a better option for me?
   
   
2. What type of nebulizer do you recommend for me?
   
   
Should I use a mask or a mouthpiece with my nebulizer?


Can you show me the proper way to use my nebulizer?


3. How often will I need to use the device? Will I need it for the rest of my life?
   
   
4. How long does the device take to deliver medication?
   
   
5. How often should I replace the nebulizer?
   
   
6. How often should I clean the nebulizer? How should I clean it?
   
   
7. Are there any risks associated with use of a nebulizer?
   
   
8. Will I have to change the medications I am on if I start using a nebulizer?