12% of deaths are due to respiratory diseases, and the leading cause of absenteeism among young people today is due to respiratory infections. ENT and pulmonary care are therefore very worrying health issues. The treatment of certain respiratory conditions involves the use of a nebulizer. This relatively recent medical device makes it possible to distribute drugs in aerosol form directly into the respiratory system.

A nebulizer, or nebulizer, makes it possible to transform a liquid drug into an aerosol, that is to say into very fine droplets which will be quickly and easily absorbed by the respiratory route and without any intervention by the patient being necessary. Nebulized aerosol therapy is a very effective, painless, local treatment method with minimal side effects compared to systemic treatment.

Composition

Depending on how the aerosol is produced, there are three types of nebulizer:

• pneumatic nebulizers, which produce the aerosol thanks to a gas sent under pressure (air or oxygen);
• ultrasonic nebulizers, which use ultrasound to deform a crystal which will then transmit vibrations to the liquid to be nebulized;
• membrane nebulizers, which use a sieve perforated with thousands of holes a few microns in diameter through which the liquid to be nebulized is projected by the action of an electric current.

The pneumatic nebulizer

It is the oldest and most commonly used nebulizer model, both in hospitals and at home. It is made up of three parts:

• a compressor that sends air or oxygen under pressure;
• a nebulizer, connected to the compressor by a tubing, into which is introduced the medicinal liquid to be nebulized. The nebulizer itself consists of a tank receiving the liquid (2ml to 8ml), a nozzle through which the pressurized gas passes, a device for sucking the liquid by the venturi effect, and a deflector on which the droplets break into fine, breathable particles;
• a patient interface attached to the nebulizer which may be a face mask, a mouthpiece or a nosepiece.

The term nebulization comes from the Latin nebula (mist) to mean that the medicine that is in solution is administered in the form of a mist, called an aerosol. The droplets in suspension in this mist are of modular composition and size depending on the pathology to be treated.

Different particle sizes

The size of the particles will be chosen according to the respiratory site to be reached

Particle composition

The main drugs dispensed by aerosol are suitable for each type of pathology:

• bronchodilators (ß2 mimics, anticholinergics), which work by causing the bronchi to dilate rapidly, are used for the treatment of severe asthma attacks or flare-ups of chronic obstructive pulmonary disease (COPD);
• corticosteroids (budesonide, beclomethasone) are anti-inflammatory drugs associated with a bronchodilator for the treatment of asthma;
• mucolytics and viscolytics help thin the mucus that accumulates in the bronchi in cystic fibrosis;
• antibiotics (tobramycin, colistin) are given locally for maintenance treatment in cases of cystic fibrosis;
• laryngitis, bronchitis, sinusitis, otitis media can also be treated by nebulization.

Public concerned or at risk

Pathologies treated by nebulization are chronic diseases which require non-intrusive local treatments and devoid as much as possible of deleterious side effects.

Nebulization aerosol therapy does not require any effort or movement on the part of the patient, so this therapy is particularly suitable for infants, young children, the elderly and people with reduced mobility.

Nebulization is frequently used in hospital, pediatric, pulmonary, emergency or intensive care units. It can also be done at home.

Using a nebulizer at home requires prior “training” for nebulization to be truly effective. This task is the responsibility of healthcare staff (doctors, nurses, physiotherapists, etc.) or pharmacists.

When to use it?

Nebulization at home should only be performed under medical prescription. The order must specify several points :

• the drug to be nebulized, its packaging (for example: single dose of 2 ml), possibly its dilution or its mixture with other drugs;
• the number of sessions to be performed per day and when they should be performed if other types of care are prescribed (for example, before physiotherapy sessions);
• the duration of each session (5 to 10 minutes maximum);
• the total duration of treatment;
• the model of nebulizer and compressor to be used;
• the type of mask or mouthpiece recommended.

The stages of operation

• The sessions must be carried out away from meals to avoid vomiting;
• the nose and throat must be clear (use a baby nose device for infants);
• you have to sit with your back straight, or in a semi-sitting position for babies;
• you have to be very relaxed;
• the nebulizer is held vertically and the mouthpiece, or the mask, is kept well applied by a light pressure;
• you have to breathe in through your mouth and then breathe out calmly;
• a “gurgling” in the nebulizer indicates that the tank is empty, and that the session is therefore over.

Precautions to take

Before the session :

• wash your hands well;
• open the nebulizer and pour the medicine into it;
• connect the mouthpiece or mask;
• connect to the compressor via the tubing;
• plug in and turn on the compressor.

After the session:

Except in the case of a single-use nebulizer, the equipment must be cleaned and disinfected with care:

• at the end of each session, the nebulizer must be disassembled, the rest of the preparation discarded, and all the components must be washed in hot soapy water;
• every day, the elements should be disinfected 15 minutes in boiling water;
• the material must be left to dry in the open air and then stored away from dust.

The choice of a nebulizer must be adapted to each case and each type of treatment. It must meet certain criteria.

The constraints for the choice of its nebulizer

• The type of drug to be nebulized: some preparations are not suitable for all types of nebulizer (eg corticosteroids are better diffused by ultrasonic nebulizers);
• patient profile: for infants, the elderly or disabled, the mask should be chosen as the patient interface;
• autonomy of operation and transport;
• value for money (rental systems exist at distributors of medical equipment);
• the nebulizer must meet the requirements of standard NF EN 13544-1 and must be supplied with instructions detailing its operation, performance and the necessary maintenance operations.