How to look after your Nebuliser
The National Asthma Council highlights the latest
Cochrane Review of the published studies on spacers
versus nebulisers.
Holding chambers versus nebulisers
for beta-agonist treatment of acute
asthma
Cates CJ, Bara A, Crilly JA, Rowe BH
Cochrane Database Syst Rev.
2003;(3):CD000052
Spacers (holding chambers) can be as
effective as nebulisers for delivering
beta-2-agonist drugs to relieve acute
asthma. In acute asthma attacks higher
doses of inhaled beta-2-agonists
(reliever inhalers) are used to overcome
the narrowing of the passages in the
lungs. The medication can be given by
wet nebulisation or from an inhaler with
a spacer device (holding chamber). This
review now includes in-patient studies,
as well as those in casualty and
community setting, comparing these two
delivery methods in acute asthma
attacks.
In adults, no important differences
were found between the two methods,
whilst in children those randomised to
wet nebulisation spent longer in
casualty.
Metered-dose inhalers with a spacer
can perform at least as well as wet
nebulisation in delivering
beta-2-agonists in acute asthma
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Some people may use a nebuliser for their
asthma medication.
Most people will be able to use a
puffer alone or a puffer and a spacer. Your doctor will
prescribe what is best for you. Your pharmacist will
also be able to help you learn how to use and maintain
your nebuliser.
A nebuliser is used to change liquid medication into
a vapour form for your use. Pressurised air is pumped
through the liquid to form a fine mist which can be
inhaled through a mask or mouthpiece. If you have been
prescribed a nebuliser, it is important to choose the
type most appropriate to your needs.
- Low-flow pumps are best for occasional use, for
delivering one type of medication.
- High-flow pumps are heavy duty and are best when
more than one person is using the pump, where more
than one medication is being used, or for inhaled
corticosteroids or antibiotics.
- Also consider where the nebuliser will be used.
There are battery operated pumps and 12-volt pumps
that plug into a car cigarette lighter.
- Place your pump on a firm surface when in use.
This allows smooth running and stops particles of
lint and other materials entering the pump. A pump
should nebulise 80% of the medication in the first 8
minutes, and it is common to have some liquid left
in the nebuliser bowl - this is the saline solution
used to dilute the medication. If using a low-flow
pump, watch that it doesn't overheat.
- Pumps should be serviced and filters changed
regularly, every 6-12 months depending on the amount
of use. This will ensure they deliver the 6-8 litres
of air needed for effective medication delivery.
Your nebuliser will work best when well maintained.
Correct cleaning will also reduce the risk of chest
infections.
- Nebuliser bowls, which contain the medication
solution, are often for short-term use only and it
is important to know when to replace them as their
performance often deteriorates with repeated use.
Make sure you check for cracks in the plastic.
Multi-use nebuliser bowls are available and are most
suited to home asthma care. Types most commonly used
are jet nebuliser bowl, venturi nebuliser bowl, and
ultrasonic nebuliser bowl.
- Nebuliser bowls should be rinsed after each use.
It is best to wash the bowl and face mask daily in
hot water with dishwashing liquid, which will remove
any grease from your hands or from the medication
solutions. Allow the components to air dry.
- Check the tubing regularly for cracks - you can
blow air through the tubing with the pump's air
compressor.
- Store nebuliser bowls, masks and mouthpieces in
airtight containers and keep a spare bowl handy.
Useful tips: Masks are recommended for children under
the age of five. Mouthpieces are normally suitable for all
other users. It is wise to use eye protection when
nebulising Atrovent or corticosteroid preventer
medications such as Pulmicort.
For more information on nebuliser therapy, contact
your local Asthma Foundation: on 1800 645 130
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