Using 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, however many clinical trials have found spacers (used with a reliever) to be equally as effective. 

Spacers are also cheaper, not dependent on a power supply, and they are less frightening, especially for children.

Only a small number of people need a nebuliser, and should be used 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 e.g. those with cystic fibrosis requiring nebulised antibiotics; or
  • people who are recommended a nebuliser by their doctor.

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?

  • Preventers
  • Relievers
  • Antibiotics

Other drugs such as

  • Morphine
  • Pulmozyme
  • Lignocaine

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

How to use a nebuliser

Delivery is increased if you are able to use a mouthpiece, as 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 (Pulmicort) is used with a mask you should wash your face afterwards.
  • Do not leave medicine in the nebuliser bowl between uses.

Whoever supplies you with a nebuliser should tell you 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 to care for the nebuliser

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. The tubing 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. 

The 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 bowl with dishwashing liquid and water. 

Disposable nebuliser bowls need replacing every 1-2 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. 

Facemasks or mouthpieces 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.

Trialling 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.

What to look for in a nebuliser

There are many different makes of nebulisers. 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.

When asthma is worsening

The medicines that you take daily through a nebuliser should give relief for three to four hours. If this is not happening tell your doctor. The best way to tell if your asthma is getting worse is by using a peak flow meter to check. Follow your Self-Management Plan. This will guide you and tell you what to look for when your asthma is getting worse and when to seek help.

After having a dose wait 15 minutes – if your peak flow hasn’t risen a lot and/or you still feel wheezy, have another nebuliser and let the doctor know. If no improvement (i.e. your peak flow readings are still low and/or you’re still breathless) after the second nebuliser treatment, get someone to ring immediately for an ambulance – dial 111.

Is your asthma under control?

Take the asthma control test to find out