What is a nebuliser?

A nebuliser works by turning liquid medicine into a fine mist which you can breathe easily into the lungs. A nebuliser can be useful for people with asthma or COPD (chronic obstructive pulmonary disease); however, many clinical trials have found spacers to be equally as effective as a medicine-delivery method, in most instances. Spacers are also cheaper, not dependent on a power supply, and they are less frightening, especially for children.

Who should use a nebuliser?

Only a small number of people need a nebuliser, and then usually only for short-term use during an acute episode of asthma or for some people with COPD, under the directions of their doctor.

Those who might benefit from a nebuliser are usually:

• some older adults with chronic respiratory disease who get better relief of symptoms with a nebuliser
• people with disabilities or people who are unable to use hand-held inhalers and spacers
• people using medication that needs to be nebulised, eg, those with cystic fibrosis requiring nebulised antibiotics
• people who are recommended a nebuliser by their doctor.

What does a nebuliser look like?

A nebuliser consists of:

• an electrical air pump (or compressor) to pump the air at a high pressure
• the nebuliser bowl where the medicine is placed
• a length of plastic tubing connecting the pump (or compressor) and the nebuliser bowl
• a mouthpiece or facemask used to breathe in the medicine.

Note: Oxygen from a cylinder or hospital wall supply can be used instead of a compressor and air.

What medicines can be used in a nebuliser?

Many different medicines used to treat asthma can be delivered using an nebuliser. These include: preventers, relievers, antibiotics and other drugs such as pain relievers. Drugs used for cystic fibrosis and anaesthetics can also be delivered via an nebuliser.

Some of the medicines can be mixed together instead of being given separately. Your doctor or pharmacist can tell you about this.

How should I use a nebuliser?

Whoever supplies you with a nebuliser should tell you how to use it and show you:

• how to attach the tubing, nebuliser bowl, facemask or mouthpiece
• how and where to put the medication
• how to fit the mask on or use the mouthpiece
• how to maintain and clean the equipment.

People who are purchasing on their doctor's recommendation need to know:

• where replacement tubing, nebuliser bowls, facemasks/mouthpieces can be obtained from
• where and how often the nebuliser should be serviced.

A yearly service is usually recommended. If it takes your nebuliser longer than 10 minutes to deliver one 2.5ml dose, a service is advised. A service agent can check that the compressor is producing the correct flow and pressure, and check on the electrical safety of the nebuliser. If the nebuliser is used every day you will need more frequent flow and pressure checks. Contact your local Asthma Society for the names of service agents.

How should I care for my nebuliser?

Nebuliser (compressor)

• keep the nebuliser covered in a dust-free place when not in use
• wipe over with a damp cloth when necessary
• if a filter is fitted, it will need replacing or cleaning, depending on the manufacturer's instructions.

Tubing

• this does not require washing. If you do notice some condensation in the tubing, take off the nebuliser bowl, turn on the nebuliser and remove the condensation by shaking the tubing
• replace the tubing if any dirt is seen in it, or cracks appear
• do not keep tubing and bowl in direct sunlight.

Nebuliser bowl

• Needs to be rinsed in warm water after every use. This is because the medicine comes in a salt solution and some may get left in the bowl. This can crystallise and block up the outlets.
• After rinsing the bowl, drip dry or connect up tubing to it, switch on nebuliser, blow air through for a few seconds. Don't wipe the bowl dry.
• Once a week, wash the bowl with dishwashing liquid and water.
• Disposable nebuliser bowls need replacing every one to two months if used regularly. Durable bowls are more expensive to buy but last 12 months. As the bowl gets worn the medication is less effective, since larger particles of medicine are produced that cannot enter the small breathing tubes.

Facemask or mouthpiece

• These need to be washed daily with dishwashing liquid and water. They need replacing if they crack, or the facemask doesn't fit snugly. The elastic on the face mask is easy to replace yourself.

Would I benefit from using a nebuliser?

Your doctor may suggest it is worth using a loaned/hired nebuliser for several weeks to see if it is of benefit to you. In each area hire/loan pools are operated by different agencies. Your doctor or the local Asthma Society will know where you can find one near you.

Only a doctor can prescribe the nebuliser medication and give approval for you to hire a nebuliser. Specialists at the hospital may arrange for some of their patients to have a nebuliser on loan from the hospital. You may be asked to keep taking peak flow recordings during your nebuliser trial.

Often an inhaler with a spacer is as effective for most people, provided adequate doses of medication are given. Because a nebuliser is a machine and costs a lot more money than an inhaler and spacer, it does not necessarily mean it is the best choice for you.

Where do I purchase a nebuliser?

If it is recommended by your doctor that you buy your own nebuliser, you can buy one directly from the manufacturer, from a pharmacy or from some Asthma Societies. Your own local Society will be able to tell you the purchasing sources in your area.

Getting help to understand the management of your breathing condition is recommended before a nebuliser is considered.

What should I look for in a nebuliser?

There are many different makes of nebulisers. The Asthma Foundation has a policy of not endorsing a particular brand. All have advantages and disadvantages. You have to look at how you are going to use a nebuliser then pick the most suitable model.

Aspects you should consider are:

• DURABILITY. If you are using the nebuliser three to four times a day you require a sturdy model, while for occasional use in attacks durability is not so vital. Check the details of the guarantee.
• POWER SUPPLY. Some people may require the nebuliser for travel in the car as well as at the home; a model that runs on electrical supply (240v) as well as the car battery (12v) would be suitable. Some models have a battery that can be recharged.
• PORTABILITY. If the nebuliser needs to be moved from room to room check the weight as some are heavy. This may cause difficulties for older adults and people with disabilities. Ultrasonic nebulisers are the most portable but are expensive.
• SERVICE AVAILABILITY. The nebuliser should be serviced yearly. Check if your model can be serviced in your area and if a loan machine will be given to you while yours is being checked.
• PRICE. This varies greatly from approximately $200-$700. Being more expensive does not mean they are better, they may just have features that you don't need.

How do I use a nebuliser?

Drug delivery is increased if you are able to use a mouthpiece with the nebuliser, because it avoids the natural filtering system of the nose. A mask may be needed for children under three or during a bad attack. It must fit closely.

• use slow "normal" breathing - rapid breathing is not as effective
• if a steroid preventer is used with a mask, you should wash your face afterwards
• do not leave medicine in the nebuliser bowl between uses. 

Related topics

Also see: COPD medicines and Puffers and other devices

Original material provided by the Asthma Foundation of New Zealand. Reviewed by everybody, November 2010.