What to Know About a Portable Nebulizer for Your Asthma

Little boy and nebulizer
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Nebulizers are small machines that convert liquid asthma medication into an aerosolized mist which is inhaled directly into the lungs. They can be used as a maintenance treatment to keep asthma under control or during an asthma attack to halt symptoms such as wheezing. Nebulizers may also be used to treat other lung conditions such as COPD.

Nebulizers are one option for asthma treatment, sometimes used instead of metered dose inhalers (MDIs) or dry powdered inhalers (DPIs). They offer several advantages, especially for small children or older adults. Several types of asthma nebulizer, known as "breathing machines," are available to choose from. Before deciding whether using a nebulizer is right for you or which type to choose, you should discuss your specific asthma condition and medical needs with your doctor and consider factors such as cost and convenience.

Uses

Vaporized medication is dispensed by the nebulizer through a tube so that you can inhale it. Depending on which medication your doctor has prescribed, the nebulizer treatment will serve one of two goals:

  • Provide quick-relief of asthma symptoms: This is usually accomplished with short-acting beta-agonists (SABAs), called "rescue" medications because they stop an attack of asthma.
  • Prevent asthma attacks: Long-term controller medications may be inhaled daily to keep airways healthy and reduce the frequency of attacks.

Nebulizers may be chosen over MDIs or DPIs as the means for delivering these medications because they are easy to use. This is especially true if the medication is being administered to infants and young children or adults who have difficulty using the small inhalers.

When used incorrectly, those inhalers can leave medication in the back of your mouth instead of delivering it into your lungs. This can lead to side effects like hoarseness and thrush. It's also possible to push down multiple times on an inhaler, which would deliver more than the required dosage.

With a nebulizer, medication can be pre-measured by a parent, aide, or medical professional. You then breathe normally through a mask or mouthpiece and the correct dose enters your lungs.

Before Using a Nebulizer

In addition to supporting children and older adults with treatment, nebulizers are sometimes preferred for other reasons, but there are disadvantages to a nebulizer compared to an inhaler.

Pros of Nebulizer
  • Less room for error: Only measured medication can be inhaled versus MDIs and PDIs.

  • Best for those with poor coordination: Infants and disabled adults can be assisted.

  • Long-term use: Medication needs to be replenished, but a nebulizer can be used for several years.

Cons of Nebulizer
  • Takes longer: Time for prepping and inhaling can be 15+ minutes versus ~1 minute for inhalers.

  • Less convenient: Bulky machine may need to be plugged in versus handheld inhaler.

  • More expensive: In most instances, using a nebulizer can be more costly than an inhaler.

Precautions

Studies of MDIs versus nebulizers show that nebulizers may significantly increase your heart rate and the possibility of tremors compared to MDIs. There may also be a greater need for hospitalization with nebulizers. If you are at risk for tachycardia and arrhythmias, discuss these risks with your doctor.

How They Work

A nebulizer machine takes medication in a liquid form and turns it into a fine mist that can be breathed into the lungs through a mask or mouthpiece. You just breathe in and out, and the medicine goes into your lungs. The medicines and moisture ease breathing problems and help loosen lung secretions.

How to Operate a Nebulizer

Follow these specific steps:

  1. Set up your machine in a spot where you can comfortably sit for up to 15 minutes and where there is a power source if needed.
  2. Wash your hands before using the nebulizer.
  3. Pour measured medication into the nebulizer cup and attach the mask or mouthpiece to the cup.
  4. Connect the tubing from the cup to the machine's body, and switch the nebulizer on.
  5. Place the mouthpiece between your teeth and seal your lips over it, or put the mask over your face. Within seconds, a light mist will emit from the openings.
  6. Breathe normally through your mouth. Around every fifth breath, take a slow, deep inhale and hold for two or three seconds.
  7. Continue until the mist dissipates and all the medication is gone from the cup.

After Use

It's very important to disinfect the nebulizer equipment after a treatment. Wash the mouthpiece or mask with soap daily; rinse and dry thoroughly before the next use. Rinse the nebulizer cup and let it air dry. You should not wash the tubing.

Side Effects

For some people, the medication delivered via a nebulizer can produce immediate side effects:

  • Dizziness: If you become dizzy, slow your breathing or rest briefly.
  • Jitteriness: Feeling the jitters or "shaky" after treatment is common, but the sensation should pass soon.

If these side effects continue, contact your health care provider.

Types of Nebulizers

While different nebulizers will have certain properties that may make one nebulizer more appropriate or desirable, no specific nebulizer has been shown to be better than another for asthma. However, people do often prefer one of these versions over another.

Jet nebulizers

Jet nebulizers have a small plastic cup with an attached mouthpiece where the liquid medicine is placed. The mouthpiece is connected by plastic tubing to a motorized machine that provides a stream of compressed air. The air flows into the tubes, and as it passes through the small plastic cup containing the liquid medication, the medication is converted to a fine mist, which can then be breathed into the lungs.

Jet nebulizers are the most commonly prescribed because they are easy to use and inexpensive.

Jet nebulizers are bulky and require an electrical source, which can be a problem when you are traveling. Medication must be mixed with saline, which takes some extra time. Finally, compared to other types of nebulizers, jet nebulizers are significantly noisier.

There are different types of jet nebulizers. The most effective are breath‐enhanced, open‐vent nebulizers, which better ensure that the complete dosage of a medication is inhaled, compared to open‐vent nebulizers. In fact, research has shown that less than half of the dose of common inhaled steroids makes it into your lungs when an open-vent nebulizer is used. With breath‐enhanced, open‐vent nebulizers there is less likelihood of medicinal vapor escaping and failing to make it into the lungs. However, these types of nebulizers require you to be able to inhale powerfully. They may not be as effective, therefore, with infants or very young children.

Ultrasonic Nebulizers

Ultrasonic nebulizers use ultrasonic waves to aerosolize asthma medication. They deliver treatments significantly faster than jet nebulizers and do not require mixing saline with your asthma medication. Since they do not require a compressor, ultrasonic nebulizers are much more compact. They can be operated by battery as well, which makes them more portable.

Mesh Nebulizers

Mesh nebulizers vibrate a small mesh membrane at very high speeds. As liquid medication is forced through tiny holes in the mesh, an aerosol is produced. Mesh nebulizers are the fastest and most expensive of the nebulizers. Like ultrasonic nebulizers, battery-operated models are available, making these portable nebulizers very convenient. Because of the vibrating mesh, however, mesh nebulizers need to be cleaned frequently to avoid clogging of the small openings used to create the mist.

Doctors often recommend that you have a backup nebulizer since mesh nebulizer can fail more often than other types of machines. This creates added expense.

A Word From Verywell

While physicians may not necessarily think about prescribing or recommending a particular type of nebulizer, it is worthwhile to discuss the differences between devices with your doctor. Nebulizers that are more convenient for your lifestyle or better meet your child's needs are going to provide a better overall outcome than other types. It's also helpful to work with your doctor to develop a successful routine for using the nebulizer. This is especially important if you are using the nebulizer with small children or older adults who may be intimidated by the noise or the need to use a mask. Medical supply companies now offer attachments that make the nebulizers fun to use for children and will allow you to ensure that a treatment session results in a full dosage being properly inhaled.

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Article Sources
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  4. The Cleveland Clinic. Home nebulizer instructions. Updated November 20, 2019.

  5. Murayama N, Murayama K. Comparison of the Clinical Efficacy of Salbutamol with Jet and Mesh Nebulizers in Asthmatic Children. Pulm Med. 2018;2018:1648652. doi:10.1155/2018/1648652

  6. Usmani OS, Lavorini F, Marshall J, et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res. 2018;19(1):10. doi:10.1186/s12931-017-0710-y

Additional Reading
  • American Academy of Allergy Asthma & Immunology. Tips to Remember: Inhaled Asthma Medications.
  • NHLBI Guidelines for the Diagnosis and Treatment of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
  • Tashkin DP.  The Role Of Nebulizers In Airways Disease Management.