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How to use a nebulizer

Nebulizer - how to use; Asthma - how to use a nebulizer; COPD - how to use a nebulizer; Wheezing - nebulizer; Reactive airway disease - nebulizer; COPD - nebulizer; Chronic bronchitis - nebulizer; Emphysema - nebulizer; Chronic obstructive pulmonary disease - nebulizer; Cystic fibrosis - nebulizer

A nebulizer is a small machine that turns liquid medicine into a mist that can be easily inhaled. You sit with the machine and breathe in the medicine through a connected mouthpiece or facemask. This allows the medicine to enter the lungs directly.

Nebulizers may be used for people with lung disease, including:

  • Asthma
  • COPD
  • Cystic fibrosis
  • Bronchiectasis

Types of Nebulizers

Most nebulizers work by using air compressors to create the mist containing the medicine. A different kind, called an ultrasonic nebulizer, uses sound vibrations. Nebulizers come in three main types:

  • Jet - Compressed air turns the medicine into a mist (tiny particles of medicine that float in the air).
  • Mesh - Medicine is passed through a tiny mesh to create a fine mist.
  • Ultrasonic - High frequency vibrations turn medicine into a mist. The droplets tend to be a bit larger. This kind of nebulizer is quieter, but costs more.

A nebulizer can be a smaller portable device or a plug-in tabletop machine you use at home. You will need a prescription from your health care provider to get a nebulizer. Check with your health plan to see if it will cover the cost of the device. Most plans will cover it.

Setting Up and Using a Nebulizer

Use your nebulizer according to the manufacturer's instructions.

The basic steps to set up and use your nebulizer are as follows:

  • Wash your hands.
  • Connect the hose to an air compressor.
  • Fill the medicine cup with your medicine. To avoid spills, close the medicine cup tightly and always hold the mouthpiece straight up and down.
  • Attach the other end of the hose to the mouthpiece and medicine cup.
  • Turn on the nebulizer machine.
  • Place the mouthpiece in your mouth. Keep your lips firmly around the mouthpiece so that all of the medicine goes into your lungs. If using a facemask, place it over the mouth and nose. Small children usually do better if they wear a mask.
  • Breathe through your mouth until all the medicine is used. This takes 5 to 20 minutes, depending on the device and medicine used. If needed, use a nose clip so that you breathe only through your mouth.
  • Turn off the machine when done.
  • Wash the medicine cup and mouthpiece with water and air dry until your next treatment.

Taking Care of Your Nebulizer

You will need to clean your nebulizer to prevent bacteria from growing in it, since bacteria can cause a lung infection. It takes some time to clean your nebulizer and keep it working properly. Be sure to unplug the machine before cleaning it.

After each use:

  • Wash the medicine cup and mouthpiece with warm running water.
  • Let them air dry on clean paper towels.
  • Later, hook up the nebulizer and run air through the machine for 20 seconds to make sure all of the parts are dry.
  • Take apart and store the machine in a covered area until the next use.

Once per day, you may add a mild dish soap to the cleaning routine above.

Once or twice each week:

  • You may add a soaking step to the cleaning routine above.
  • Soak the cup and mouthpiece in 1 part distilled white vinegar, 2 parts warm water solution.

You may clean the outside of your machine with a warm, damp cloth as necessary. Never wash the hose or tubing.

You will also need to change the filter. The instructions that come with your nebulizer will tell you when you should change the filter.

Nebulizers vs. Inhalers

Like nebulizers, inhalers are also used to send medicine into your lungs. But there are differences.

Inhalers:

  • Quickly deliver an exact dose of medicine
  • Take a little practice to use properly
  • Are smaller and more portable
  • Cost less and tend to have fewer side effects than nebulizers, such as rapid heartbeat and jitteriness

Nebulizers:

  • Allow you to see and feel the medicine as you breathe it in.
  • Can be easier to use because all you have to do is breathe normally. This makes them a good choice for young children and for people with severe lung disease.
  • Take at least 5 to 10 minutes or more to deliver the medicine.
  • May be larger and more bulky, making it harder to use for travel or work.

If you have asthma, you may not need to use a nebulizer. You may use an inhaler instead, which is usually just as effective if used properly. But a nebulizer can deliver medicine with less effort and greater predictability than an inhaler. You and your provider can decide if a nebulizer is the best way to get the medicine you need.

The choice of device you use may be based on whether you find a nebulizer easier to use and what type of medicine you take.

Below are examples of medicines that may be used with a nebulizer:

Bronchodilators work by relaxing the muscles of your airways, and this lets you breathe better during an attack or flare-up. Examples include:

  • Albuterol
  • Ipratropium
  • Levalbuterol

Corticosteroids help prevent airways from becoming inflamed and help prevent symptoms. These include:

  • Budesonide
  • Flunisolide
  • Fluticasone
  • Triamcinolone

Nebulizers also may be used with:

  • Certain inhaled antibiotics to treat lung infections
  • Sterile saline solution or medicines to help loosen up mucus in the lungs

Note: This is not a comprehensive list of medicines.

When to Call the Doctor

Contact your provider or medical device supplier if you are having trouble using your nebulizer. You should also call your provider if you have any of these problems while using your nebulizer:

  • Anxiety
  • Feeling that your heart is racing or pounding (palpitations)
  • Shortness of breath
  • Feeling very excited

These may be signs that you are getting too much medicine.

References

Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society guideline. Chest. 2015;147(4):894-942. PMID: 25321320 pubmed.ncbi.nlm.nih.gov/25321320/.

Fonceca AM, Ditcham WGF, Everard ML, Devadason S. Drug administration by inhalation in children. In: Wilmott RW, Deterding R, Ratjen E, et al, eds. Kendig's Disorders of the Respiratory Tract in Children. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 16.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2020 report. goldcopd.org/gold-reports/. Accessed December 9, 2022.

Han MK, Lazarus SC. COPD: diagnosis and management. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 64.

Laube BL, Dolovich MB. Aerosols and aerosol drug delivery systems. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

National Heart, Lung, and Blood Institute website. National Asthma Education and Prevention Program. How to use a metered-dose inhaler. www.nhlbi.nih.gov/files/docs/public/lung/asthma_tipsheets.pdf. Updated March 2013. Accessed December 9, 2022.

Rochester CL, Nici L. Pulmonary rehabilitation. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 139.


Review Date: 12/9/2022

Reviewed By: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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