COPD Treatment Are Nebulizers Better Than Inhalers for COPD and Asthma? By Deborah Leader, RN Deborah Leader, RN Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD. Learn about our editorial process Updated on January 27, 2023 Medically reviewed by Reza Samad, MD Medically reviewed by Reza Samad, MD Reza Samad, MD, is a board-certified pulmonologist and assistant professor of medicine. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Inhalers vs. Nebulizers Nebulizers Inhalers Side Effects Inhalers and nebulizers are devices that deliver medicine directly into the lungs. The difference between the two devices is in the way they deliver the medication. An inhaler relies on pressure, while a nebulizer releases the medicine as a fine mist. When you use an inhaler, you inhale the medication through a mouthpiece. With a nebulizer, you breathe in the medication via a mask that fits over your mouth and nose. These devices are essential for treating lung-specific diseases like chronic obstructive pulmonary disease (COPD) and asthma. Which device you choose ultimately depends on your personal preference, your healthcare provider's recommendation, and your insurance coverage. This article looks at the basic differences between nebulizers and inhalers, and offers some suggestions on how to choose the device that's right for you. Roy Morsch / Getty Images Inhalers vs. Nebulizers Inhalers send short bursts of aerosolized medication directly into the mouth and can work in seconds. With a metered-dose inhaler, the mouthpiece has to be tightly sealed with the lips and inhaled while maintaining the seal. Nebulizers, in contrast, create a cloud of mist that's breathed through a face mask. The dosage process takes slightly longer (anywhere from 5 to 20 minutes). Nebulizers may be easier for children to use since they can be more accurate in terms of dosage delivery. While most people with COPD tend to use inhalers thanks to their fast-acting abilities and small size, nebulizers are often the device of choice in hospitals. This is because 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 10% of patients use a metered-dose inhaler correctly. Inhalers More room for error in terms of medicine delivery, though spacers can help Can only use until medication dosage runs out Easier to transport Medication delivered quickly Medication may be pre-measured per puff Nebulizers More accurate medicine delivery thanks to the face mask Can use for longer periods of time Less portable Medication delivery takes longer User needs to measure medication before use Medication doses are higher to account for loss in the aerosol How Do Inhalers Work? Types of Nebulizers There are two types of nebulizers: atomizer and ultrasonic. Prices for each range from $50 to $200, and both are available as tabletop or portable models. Both fast-acting and long-term medications can be used with a nebulizer, including bronchodilators and corticosteroids. Atomizer Nebulizers The most common type of nebulizer is an atomizer or compressor nebulizer. This type creates vaporized droplets of medicine. The vapor is inhaled through a mouthpiece or face mask. Examples include: PARI Vios PRO Nebulizer System with LC SprintPARI Trek S Portable Nebulizer System with LC SprintPhilips Respironics Sami the Seal Pediatric Compressor Nebulizer Ultrasonic Nebulizers This type of nebulizer is also known as a mesh nebulizer. It 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 NebulizerLumiscope Portable Ultrasonic NebulizerOmron Mesh NebulizerFlyp HypersoniQ Portable Nebulizer If the cost of using a nebulizer is prohibitive, but the device works best for you, explore savings options such as mail-order prescription plans and drug assistance programs. How to Use a Nebulizer Types of Inhalers There are three types of inhalers used to treat people with COPD, asthma, or other lung conditions. Because inhalers can be expensive, costing around $350 each, it's important to find the one that works best for you. Using your inhaler confidently helps you minimize wasted dosages and keep up with your treatment plan. Hydrofluoroalkane Inhalers (HFA) HFAs contain aerosolized liquid medication in a pressurized canister attached to a metered valve. As you inhale, you'll need to press down on the canister and breathe in the medication. 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 the medication. Examples include: Proair HFA (albuterol)Xopenex HFA (levalbuterol) Using HFAs requires some manual dexterity and may be difficult for those with grip issues or arthritis. 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 is required. 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) SMIs deliver 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 medication into the lungs. Examples include: Spiriva Respimat (tiotropium)Merxin MRX004 (tiotropium/olodaterol)Striverdi Respimat (olodaterol)Combivent Respimat (ipratropium bromide and albuterol sulfate) 13 Common COPD Inhalers Side Effects Side effects usually happen because of the medications, not the delivery systems. Still, there are a few problems that may stem from device usage. It's essential to properly and routinely clean your device in order to minimize the risk of infection and skin irritation. Potential side effects from both inhalers and nebulizers include: DizzinessAgitationDamaged optic nerveRecurring infectionsSkin or eye irritation from leaking mist Summary Nebulizers and inhalers are two types of devices that deliver medication directly into the lungs. An inhaler uses pressure to deliver medication through a mouthpiece, while a nebulizer delivers a fine mist of medication through a mask worn over the nose and mouth. Nebulizers may be easier to use than inhalers, especially for children. Because it's easier to take in the medication, they can deliver a more accurate dose. Inhalers, on the other hand, require coordination and correct technique in order to deliver the right amount of medication. With practice, inhalers can be just as effective as nebulizers. A Word From Verywell There is really no medical reason to change your device if the one you have has been working well for you and you have mastered the proper technique to use it. If you aren't getting the benefit you think you should from your current device, speak with your healthcare provider to see if there are things you can do to improve its ease of use. 3 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2585-2596. doi:10.2147/COPD.S114034 Ahmed M, Munir M, Sufyan A, et al. Metered dose inhaler technique: A priority catch for physicians. Cureus. 2020. doi:10.7759/cureus.10857 Alhaider S, Alshehri H, Al-Eid K. Replacing nebulizers by MDI-spacers for bronchodilator and inhaled corticosteroid administration: impact on the utilization of hospital resources. Int J Pediatr Adolesc Med. 2014;1(1):236-240. doi:10.1016/j.ijpam.2014.09.002 By Deborah Leader, RN Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit