Nebulizer – types, indications, use. Which nebulizer should I choose?

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A nebulizer is a medical device that people with asthma or other respiratory disease can use to deliver drugs directly and quickly to the lungs. The nebuliser turns the liquid medicine into a very fine mist that the patient can inhale through a face mask or mouthpiece. Taking the drug in this way allows it to go directly to your lungs and respiratory system.

What is a nebulizer?

The nebuliser is a small device that turns liquid medication into a mist, allowing the medication to be absorbed into the lungs more quickly and more easily. Typically, nebulizers come in both electric and battery powered versions and are either portable (so you can carry them with you) or designed to sit at a table and plug into the wall.

Both versions of nebulizers consist of:

1. bases for an air compressor;
2. a small container for liquid drugs;
3. a tube connecting the air compressor to the medication cup.

Above the medication cup there is a mouthpiece or mask that is used to inhale the mist.

The nebuliser is helpful in a variety of conditions, including:

1. chronic obstructive pulmonary disease (COPD);
2. asthma;
3. bronchiectasis;
4. cystic fibrosis (cystic fibrosis);
5. pulmonary fibrosis.

Nebulizers are also a helpful means of administering medication in palliative care and for very young children.

See also: How to take medications effectively?

Nebulizer – types

There are three main types of nebulizers available.

1. Pneumatic nebulizer – is the most popular nebulizer. It works with the use of a compressor that produces compressed air. Air flows through the drug solution and atomizes it into tiny droplets. It is quite noisy, but can be used for virtually any type of drug.
2. Ultrasonic nebulizer – it is distinguished by quiet operation, as well as small dimensions. Their operation is based on the use of a piezoelectric vibrator, which generates high-frequency vibrations (2-3 million / s). The vibrations are transferred to the water and medicine tank (water serves as a coolant). Strong vibration generates a column of liquid drug and small particles are formed. Their advantage is that they are portable devices. However, they are quite expensive and they cannot be used to administer certain medications (ultrasonic waves can have a destructive effect on the structure of proteins present in steroids, antibiotics and some medications administered to people suffering from cystic fibrosis), but they can moisturize the respiratory tract with saline.
3. Membrane (mesh) nebulizer – consist of a thin membrane with microscopic holes. The vibrating element forces the drug through the fine holes in the membrane, creating aerosol droplets. These nebulizers are also very quiet and lightweight, making them suitable for travel and children’s use. They are characterized by high efficiency, and thanks to them, it is possible to administer almost the entire drug without leaving any residues in the chamber (and the latest models allow the drug to be administered also in a lying position, e.g. during sleep). However, it should be realized that such nebulizers are expensive and require periodic replacement of the membrane.

Also check: How to choose the right inhaler? Characteristics, types, advantages and disadvantages of inhalation

Nebulizer – how to use it?

Before you start taking your medicine with a nebuliser, your doctor or nurse will explain how the nebuliser works and answer any questions you have. If a person receives a nebulizer from a pharmacy or a medical equipment company, someone there will also explain how to use it.

Keep in mind that each nebulizer works slightly differently. It is very important to read the instructions for the specific device we have.

Overall, the nebuliser is very easy to use and only requires a few basic steps.

1. Wash your hands. To keep the nebuliser – and the lungs – free from germs, always wash your hands before handling the medicine and the device itself.
2. Check your medications. Before we begin, it is better to take a close look at your medication. Check the expiration date, if the vial is crushed or damaged, if the medicine accidentally looks discolored, or if it has been exposed to extremely high or low temperatures. If we suspect anything about the condition of our drug, it is better to replace the drug or contact a doctor or pharmacist.
3. Prepare your nebulizer. In most configurations we have a compressor (basic nebulizer), tubing, medication container and mouthpiece. In some models you can also find a special mask. The compressor forces air into the drug canister, breaking the liquid into an aerosol. The design of the container determines how well the device can produce droplets of the correct size to travel deep into the respiratory tract. Functional nebulizers allow less medication to be released into the air. Very young children and disabled or elderly patients who are unable to use the mouthpiece effectively should always use a mask. Choose one that is soft and flexible enough to fit snugly against your face and large enough to cover your mouth and nose.
4. Pour the medication into the nebulizer container. Unit dose vials are simple to use; just unscrew the top and pour in. Choose a nebulizer container that will lie flat to facilitate pouring. It is recommended not to refill the container as this may prevent aerosolization of the medicine.
5. Sit back and relax. Put on the mask or place the mouthpiece on your tongue and clench your teeth and lips, then turn on the nebulizer. Let’s breathe normally. If we start coughing, turn the device off until we can breathe freely. Continue breathing therapy until the medication cup is empty. During the procedure, it is best to assume a sitting or half-sitting position (in such a way that the head is slightly tilted). Side lying is not recommended. However, it is worth knowing that some models allow the drug to be administered to a patient in a lying position, even during sleep. If the medicine is foaming or bubbling, treatment should be stopped (this could be due to a defective or contaminated medicine or nebuliser). Do not “blow in” or spray the medicine in front of your child’s face; this will release the medicine into the air, not your lungs. A mask must be used when using the device.
6. Rinse the nebulizer. Follow the manufacturer’s instructions to keep the nebulizer medication cup, mouthpiece, and tubing clean; whatever gets into the container – from your hands, medicine or house dust – will enter your lungs. When the nebuliser is clean and dry, store it in a dust-free place. After the treatment, it is very important to wash your face thoroughly to remove any drug residues from the skin, as they may be irritating. You also need to brush your teeth as some nebuliser medications can discolor and promote cavities.

The medication cups / nebulizer mouthpieces and tubing are not indestructible. The plastic will disintegrate over time. Replace them as recommended – and don’t forget to clean or replace the air filter, if one is used in your model.

If you have any questions or concerns about the device, please contact your doctor.

Nebulizer – Do I need a prescription?

Typically, the nebulizer and the drug we use require a prescription from a doctor or other healthcare provider.

It is of course possible to buy a nebulizer online without a prescription, although your doctor will likely still need to prescribe the drug. However, some drug manufacturers require the use of a specific type of nebulizer, so it’s always a good idea to check with your pharmacist or doctor before making a purchase.

There are several types of medication that a person can use with a nebulizer.

1. Bronchodilators: these are drugs that help to open the airways and make it easier to breathe. Doctors often prescribe bronchodilators for people with asthma, COPD, or other respiratory disorders.
2. Sterile saline solution: the nebulizer can deliver a sterile saline solution, which helps to open the airways and thin out secretions. This can relax it and make it easier for you to cough up mucus in your lungs.
3. Antibiotics: A nebuliser can deliver certain types of antibiotics directly to the lungs or airways when someone has a severe respiratory infection.

Also check: 11 signs your lungs are in terrible condition It must not be taken lightly

Nebulizer – what to consider when choosing?

Choosing a nebulizer is a difficult task, because you need to pay attention to the technical parameters of the device, because it affects the effectiveness of the treatment. When choosing a nebulizer, it is worth paying attention to:

1. MMAD (Mass Median Aerodynamic Diameter) indicator – it defines the particle size into which the nebulizer sprays the drug. The smaller the index is, the better, because only the smallest form of sprayed drugs is able to reach the lower respiratory tract.
2. respirable fraction FPF% – is the percentage of particles smaller than 5 µm. The FPF% fraction of not less than 80% is optimal.
3. compressor capacity – the optimal flow for nebulizers is 8 l / min. Those with a capacity of 10 l / min and higher are recommended.
4. residual volume (dead) – determines the amount of medication that remains in the nebulizer reservoir after the end of the treatment. The lower the value, the better, as this indicates that the nebuliser drug is used almost completely (the optimal volume is 0,5 ml and less).
5. treatment time – the shorter the time of the procedure, the better, especially in the case of children and chronically ill people.
6. device functions – e.g. whether, apart from nebulization, inhalation is also possible, e.g. with physiological saline.

In addition, it is also worth paying attention to such things as the ease of cleaning and maintenance of the nebulizer, or whether it is equipped with additional elements, e.g. an additional set of masks, various tips, a travel bag.

See also: Nebulizer for children – types, selection of the best. Nebulizer and inhaler [EXPLAIN]

Differences between nebulizers and inhalers

Nebulizers and inhalers have some similarities, for example, they both deliver medication directly to the lungs to make breathing easier. However, there are some important differences between them.

There are two types of inhalers: metered dose inhalers (MDI) and dry powder inhalers (DPI).

The most popular type of inhaler is the MDI. To use it, you inhale a measured amount of medicine through the mouthpiece. Some inhalers have a spacer that makes it easier to inhale the medicine. The powder inhaler is similar, but the medicine is in powder form inside the inhaler. This device requires the user to take a deep, rapid inhalation which draws the powdered drug deep into the lungs.

Both types require you to be able to inhale the drug deep into your lungs. Some children and people with severe respiratory illnesses may have a problem with this.

Nebulizers tend to be slightly easier to use when it comes to drug delivery. However, it can take up to 10 minutes for the medication to be delivered through a nebuliser and the user must sit still until it has fully absorbed, which can be difficult for a young child.

Moreover, nebulizers are not as portable; can be difficult to carry around while inhalers are usually smaller and more suitable for travel.

Also check: Home inhaler – how to choose the best model?

How do I clean the nebulizer?

A nurse or pharmacist will show you how to clean and maintain the device. The general guidelines are as follows.

1. Before cleaning and maintaining the nebuliser, wash your hands and work on a clean surface.
2. Remove the tube, medication chamber, mask, or mouthpiece and wash them thoroughly in warm, soapy water after each use.
3. Allow the components to dry on a clean towel.
4. Disinfect the machine according to the manufacturer’s instructions.

The user of the nebuliser will need to replace some components three to four times a year. Please refer to the user manual for how and how often to do this. You should also make sure that you never share the nebuliser components with other people.

It is imperative to follow the cleaning, disinfecting and replacement instructions. If a person does not care for the nebuliser, bacteria and other germs can develop in them and can cause an infection. Infections can be very dangerous, especially for someone with lung disease.

After cleaning and drying the parts, store the nebuliser in an airtight plastic container or bag in a cool and dry place. Also, make sure the nebuliser is free of dust.

Nebulizer for children

In the case of children under 3 years of age, specialists recommend the use of classic pneumatic nebulizers and the use of a mask during nebulization (older children should use a mouthpiece). For children over 5 years of age, the use of inhalation-operated pneumatic nebulizers is recommended. As for other types of nebulizers, there are no age restrictions in the case of mesh nebulizers, however, ultrasonic nebulizers should not be used by children under 1 year of age.

For older children and adults, specialists recommend using a mouthpiece to reduce drug wastage. It is also important that nebulization for children is carried out in the presence of adults. The child should also be calm during the procedure, as crying may reduce its effectiveness.