Are Nebulizers Better Than Inhalers for COPD and Asthma?

Inhalers and nebulizers work to open the airways for medicine delivery directly into the lungs, which is essential for treating lung-specific diseases like COPD and asthma. Both are equally effective, though there are advantages and disadvantages to using each type of device. Some may be fast-acting, while others are long-acting, but the most important aspect is that you know how to use an inhaler or a nebulizer properly. The device you choose ultimately depends on your personal preference, your doctor's recommendation, and your insurance coverage.

Nebulizers differ from inhalers in that they create a cloud of mist that's breathed through a face mask, and the dosage process takes slightly longer—anywhere from five to 20 minutes. Inhalers, in contrast, send short bursts of aerosolized medication directly into the mouth and can work in seconds, but some medication may be lost if an attachment known as a spacer is not used. Nebulizers may be easier for children, as they can be more accurate in terms of dosage delivery.

There are two types of nebulizers: atomizer and ultrasonic. Options for each range from $50 to $200 and both are available as a tabletop or portable models. Both fast-acting and long-term medications are able to be used with a nebulizer, including albuterol, corticosteroids, and mast-cell inhibitors.

Atomizer Nebulizers

The most common type of nebulizer, an atomizer or compressor nebulizer uses an atomizer to create vaporized droplets of medicine. The vapor is then inhaled through a mouthpiece or facemask.

Examples include:

• PARI Vios PRO Nebulizer System with LC Sprint
• PARI Trek S Portable Nebulizer System with LC Sprint
• Philips Respironics Sami the Seal Pediatric Compressor Nebulizer

Ultrasonic Nebulizers

This type of nebulizer, also known as a mesh nebulizer, utilizes high-frequency ultrasonic waves to vaporize medication. It is usually quieter than an atomizer and can deliver medication more quickly.

Examples include:

• Philips Innospire Go Portable Mesh Nebulizer
• Lumiscope Portable Ultrasonic Nebulizer
• Omron Mesh Nebulizer
• Flyp HypersoniQ Portable Nebulizer

There are three types of inhalers that may be employed in the treatment of those with COPD, asthma, or other lung conditions. Because inhalers can be expensive, costing around $350 each, it's important to find a format that works best for you, so as to minimize wasted dosages and keep up with your treatment plan.

Hydrofluoroalkane inhalers (HFA)

Formerly known as metered-dose inhalers (MDIs), HFAs contain aerosolized liquid medication in a pressurized canister that is attached to a metered valve. As you inhale, you'll need to press down on the canister and breathe in the medication, which is sprayed into the mouth via a mouthpiece from one to two inches away. Using HFAs requires some manual dexterity and may be difficult for those with grip issues or arthritis.

As HFA delivery results in some medication loss, a spacer may be useful. A spacer is an attachment connected to an inhaler that catches the mist as it leaves the device and allows you to take in more medication. With a spacer attachment, you don't have to worry about coordinating your breath with each puff, and there is far less irritating residue left in the mouth.

Examples include:

• Proair HFA (albuterol)
• Xopenex HFA (levalbuterol)

Dry Powder Inhalers (DPIs)

Dry powder inhalers send out a puff of dry, powdered medication rather than a sprayed liquid, and don't contain any propellants—just the medicine. DPIs are breath-activated, and will only release medication when you take a deep inhale. For this reason, they may not be effective among elderly COPD patients, as a fairly forceful inhale is necessary. To use a DPI, you'll need to close your mouth around the mouthpiece and inhale deeply–no spacer necessary. Hold your breath for up to 10 seconds, then remove the device from your mouth before exhaling—so that any moist air from your mouth doesn't contaminate the device and clump up the powder. Because the dry powder is so fine, be aware that you may not feel or taste it, which differs from other types of inhalers.

Examples include:

• Advair Diskus (fluticasone)
• Spiriva HandiHaler (tiotropium bromide)
• ProAir Respiclick (albuterol)

Soft Mist Inhalers (SMIs)

The newest form of inhalers, SMIs utilize a lower dosage and release a gentle mist of pre-measured medication that is slowly inhaled. Unlike other forms of inhalers, SMIs don't require you to sync your breaths with the medication delivery. SMIs are highly effective at delivering the medication down into the lungs.

Examples include:

• Spiriva Respimat (tiotropium)
• Merxin MRX004 (tiotropium/olodaterol)
• Striverdi Respimat (olodaterol)
• Combivent Respimat (ipratropium bromide and albuterol sulfate)

Precautions and Contraindications

While most people with COPD tend to use inhalers thanks to their fast-acting abilities and small size, nebulizers often seem to be the device of choice in hospitals, as they're easy to use, can be quickly adapted (to accommodate a mouthpiece, mask, tracheostomy collar, or endotracheal tube), and can deliver a host of different medications simply by pouring the drug into the device.

While the proper technique is important for both inhalers and nebulizers, the general consensus is that there is more room for error when it comes to using an inhaler, which requires more coordination and manipulation than a nebulizer. In fact, one study showed that only five percent of patients used an MDI inhaler correctly.

While the medications used in these devices are generally responsible for the side effects and not the machines themselves, there are a few problems that may stem from device usage. It's super important to properly and routinely clean your device so as to minimize the risk of infection and skin irritation.

Potential side effects from using both inhalers and nebulizers include:

• Dizziness
• Agitation
• Damaged optic nerve
• Recurring infections
• Skin or eye irritation from leaking mist

Both nebulizers and inhalers have their advantages and shortcomings. If one device has been working for you just fine and you have mastered the proper technique, there is really no need for change other than cost.

And even if the price is an issue, it is often better to explore ways to trim the cost of nebulizer treatment (for example through mail-order prescription plans and drug assistance programs) than to change to a device that may not work as well for you as an individual.

However, if you aren't getting the benefit you think you should from your current device, don't assume that it's solely the product at fault. Speak with your doctor and see if there are things you can do to improve how you use the device. This is especially true for inhalers, which are more prone to user error.