Frequently Asked Questions on Nebulizers

What is a Nebulizer?

A nebulizer is a device that administers medication in the form of a liquid mist to the airways. It is primarily used in the treatment of chronic asthma, cystic fibrosis and other respiratory diseases.

What are the various types of Nebulizers?

There are two nebulizer models available in market.

1. A jet nebulizer converts a pool of liquid medicine into an aerosol mist. It consists of an electric or battery-powered compressor attached hollow tubing. The tubing connects to a cup which holds the liquid medication. Air then flows through the tube to the medicine, creating a medicated mist is which is inhaled through a mask.
2. An ultrasonic nebulizer uses high-frequency electrical vibrations, rather than compressed air, to convert the medication to a mist.

Why may I need a nebulizer?

Inhaled medicines from a nebulizer act faster on your airways and lungs compared to medicines taken by mouth. They may also have fewer side effects. You may need a nebulizer in any of the following conditions:

• Asthma: This is a long-term disease of the lungs caused by inflammation (swelling) and narrowing of the airways. You may have shortness of breath, chest pain, cough and wheezing. The medicines used to relieve the narrowing work well when they are inhaled.
• Other lung diseases: You may have other diseases of the airways that may make it hard for you to breathe. These may include bronchiectasis, bronchopulmonary dysplasia (BPD), chronic obstructive pulmonary dysplasia (COPD), and cystic fibrosis. Ask your caregiver for more information about these diseases.

How does a nebulizer works?

A nebulizer consists of parts that make the mist, and a machine to power the nebulizer. The parts include tubing to connect the machine to the medicine container. The other parts are the medicine container where the mist is made, and the delivery piece. The machine may be mechanical or ultrasonic.

A mechanical nebulizer is a compressor machine that makes high air pressure. The air moves very fast through a small opening where the liquid medicine is to make the mist. A mechanical nebulizer is also called a jet nebulizer, or a small volume nebulizer or SVN. An ultrasonic nebulizer uses high speed vibrations to make a mist.

The mist is made in a container (chamber) that may be cleaned and used again. The machine or container may have a valve that controls the flow of air to increase the amount of mist you receive. A mouthpiece or mask connected to the nebulizer container brings the mist to you. The mist is then breathed in through the mouth or nose, and travels down to your airways.

What types of medicines are given with a nebulizer?

• Antibiotics: These medicines fight lung infections caused by bacteria. They may be for diseases such as cystic fibrosis and bronchiectasis. These medicines improve lung function and decrease symptoms.
  
• Bronchodilators: These medicines stop body reflexes that make your airways smaller, to help you to breathe easier. Their effects may last for 4 to 6 hours (short acting) or for 12 hours (long acting). You may feel that your heart is beating faster or that your hands are shaking after using them. They may blur your vision for a short time or worsen glaucoma if they go into your eyes. Close your mouth when inhaling these medicines to prevent this. Dry mouth, another side effect, can be avoided by rinsing your mouth and spitting out the rinse water.
  
• Corticosteroids: These drugs decrease the inflammation in your airways. They may help if you often have trouble breathing from a long-term lung disease. You may be instructed to inhale a bronchodilator first before using this medicine to prevent spasm (fast tightening) in your airways. You may get a fungal infection in your mouth when you use this medicine often. Rinse your mouth every time after you use this medicine.
  
• Prostanoids: These drugs relax blood vessels and increase blood flow and oxygen to damaged areas of the lungs. They are used in those with severe (very bad) lung infection or sudden airway problems.

How do I use a nebulizer?

• Wash your hands.
• Prepare the compressor machine. Place the machine on a hard surface. Look to see if the air filter is clean. If you see that it is dirty, rinse it using cold water and let it air dry. Plug in the machine to an electrical outlet.
• Prepare the medicine. If your medicine is in a pre-mixed, single dose vial, open and place it in the nebulizer medicine container. If you have to mix medicines, place the right amounts into the container using a dropper or syringe. Call your caregiver if you have questions or concerns about mixing medicines.
• Add saline if needed. Some medicines may need to have saline (special salt water) added. If saline needs to be added, buy sterile normal saline. Never use homemade saline solution into a nebulizer.
• Connect the medicine container to the machine. Attach the nebulizer medicine container to the tubing that is connected to the compressor machine.
• Attach the delivery piece to the container. Attach the mouth piece or mask to the medicine container.

Adults and older children: Place the mouth piece in your mouth. Breathe in and out slowly through your mouth until all the medicine is gone.

Infants and younger children: For your child, place the mask on his face. You may need to distract your child during the treatment to keep him from removing the mask. Let your child watch a video he likes or play with toys during the treatment.

Give the treatment. Turn on the machine. Keep the medicine container in a straight-up position. Towards the end of the treatment, you may need to tap the sides of the container. This will move the last of the medicine down to the air jet to be misted. The whole treatment may take 8 to 10 minutes.

The treatment is over when all the medicine is gone or there is no more mist coming out. The machine may also make a sputtering noise when treatment is done.

What are the advantages of using a nebulizer?

Nebulizers can be used at any age. You can mix more than one medicine, and they can all be given at the same time. Very high doses of drugs can be used. The delivery of medicine is done during normal breathing. No special breathing techniques are needed to use a nebulizer.

What are "smart nebulizers"?

These are mechanical nebulizers that have been changed to improve the shortcomings of the traditional compressor machine. These newer machines may use your breathing pattern for better drug delivery. They may reduce other problems such as the size and weight of the machine or device. They may also not need to be plugged in for electrical power.

How do I take care of my nebulizer?

The parts that get wet during the treatment must be cleaned to keep germs from growing on them. You do not need to rinse the tubing that connects the machine to the medicine container.

• Wash after every use: Wash the container and mouthpiece or mask with dishwashing detergent under hot, running water. Shake off the excess water and let the parts air dry. Remove any mucus or medicine stuck to the machine or tubing.
• Disinfect at least three times a week: Even with washing after every use, germs can still grow on the nebulizer parts. These germs can cause lung infection. Soak the nebulizer parts in diluted white vinegar or the disinfecting solution that your caregiver recommends. Do this for the amount of time he tells you to do it. Rinse the parts after soaking, according to his instructions, and let them air dry. This should kill most or all of the germs on the nebulizer parts.

What should I know about having my child use a nebulizer?

There should be a tight fit between your child's face and mask for the medicine to reach his lungs. If your child is crying, little of the inhaled medicine may reach his lungs. If your child is fighting the treatment, the seal around his face and mask may loosen.

Do not hold the mouthpiece or tubing near your child's nose or mouth. This will not deliver the drug to the lungs. Quiet inhalation is the best way for the drug to reach the airways. Encourage your child's interest in quiet play activities while giving the treatment to prevent struggling.

Make sure that you follow your caregiver's instructions on how to use the machine properly. Not following treatment and machine instructions is a problem in all age groups, but more so in children.

Struggling to give the inhaled medicine to your child also decreases your willingness to give the treatment. You may want to use a reward system to encourage your child to not resist the treatment.