Are Nebulizers Better Than Inhalers for COPD and Asthma?

Man with Asthma
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Inhalers and nebulizers work to open the airways for medicine delivery directly into the lungs, which is essential for treating lung-specific diseases like chronic obstructive pulmonary disease (COPD) and asthma. Both devices are equally effective, though there are advantages and disadvantages to each.

For example, inhalers leave more room for user error, but they allow you to act quickly. Nebulizers can't be easily accessed on the go, but can be used for longer durations.

The device you choose ultimately depends on your personal preference, your doctor's recommendation, and your insurance coverage.

Key Comparisons

Inhalers send short bursts of aerosolized medication directly into the mouth and can work in seconds. Some medications may be lost if an attachment known as a spacer is not used.

Nebulizers, in contrast, 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). They may be easier for children, as 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 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 5% of patients used a metered-dosed inhaler (MDI) correctly.

Inhalers

  • More room for error in terms of medicine delivery, though spacers can help

  • Can only use until medication dosages run 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

Types of Nebulizers

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 creates 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

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.

Types of Inhalers

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 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)

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.

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)

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 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:

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)

Side Effects

While the medications used in these devices are generally responsible for any side effects, not the delivery systems themselves, there are a few problems that may stem from device usage. It's essential that you 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

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 doctor and see if there are things you can do to improve how you use it.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Smith C, Goldman RD. Nebulizers versus pressurized metered-dose inhalers in preschool children with wheezing. Can Fam Physician. 2012;58(5):528-30. pmid:22734168

  2. Alhaider, S.; Alshehri, H.; and Al-Eid, K. Replacing nebulizers by MDI-spacers for bronchodilator and inhaled corticosteroid administration: Impact on the utilization of hospital resources. International Journal of Pediatrics and Adolescent Medicine. 2014; 1(1):236-240. doi:10.1016/j.ijpam.2014.09.002

  3. 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

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