2. TABLE OF CONTENT
•Definitions
•Devices
•Indications and Contraindications
•Types of nebulizer
•Procedure
•Advantages and Disadvantages of nebulizer
•Inhalers and Nebulizers
•Care of a nebulizer
•Cautions in it use
4. What is a nebulizer?
A nebulizer is a device that turns liquid medicine into a mist. As you breathe, the
mist of medicine moves into your lungs. The medicine may be an antibiotic or
other medicine for your lungs. The nebulizer is usually connected to a machine
that pushes air through the nebulizer. The air helps turn the medicine into a mist.
When a nebulizer is used it is called a breathing treatment or nebulizer treatment.
5. Definition conts,.
A nebulizer changes medication from a liquid to a mist so you can
inhale it into your lungs.
Nebulizers come in home (tabletop) and portable models. Home
nebulizers are larger, and you have to plug them into an electrical
outlet. Portable nebulizers run on batteries, or you can plug them
into a car outlet. Some are only a bit bigger than a deck of cards, so
you can carry them in a bag or briefcase.
6. Inhalations with nebulizer
Nebulized therapy is a modern effective method
of treatment for respiratory diseases. By turning a
pharmaceutical substance into a kind of fog, a
nebulizer ensures delivery of the drug product to
the focus of disease and enhances its
effectiveness. Possibility to adjust the particles
size makes it possible to utilize another advantage
of a nebulizer – its ability to localize delivery of
the drug product in the affected section of the
respiratory tract: nose, larynx, nasopharynx,
bronchi, and alveoli.
7. Why a Nebulizer?
• Nebulizers are especially good for infants’ or small children’s asthma
medications. They’re are also helpful when you have trouble using an
asthma inhaler or need a large dose of an inhaled medication.
• Nebulized therapy is often called a breathing treatment. You can use
nebulizers with a variety of medications, both for controlling asthma
symptoms and for relief right away. These include:
• Corticosteroids to fight inflammation (such as budesonide, flunisolide,
fluticasone, and triamcinolone) beclometasone.
• Anticholinergics (for example, ipratropium bromide)
• Bronchodilators to open your airways (such as albuterol, formoterol,
levalbuterol, and salmeterol, salbutamol)
8. Indications and contraindications
for inhalations with nebulizer
In most cases, the drug is administered via a nebulizer in
coughing, common cold, and other respiratory diseases.
Besides, the nebulized therapy is prescribed for the following
diagnoses:
bronchial asthma, obstruction;
infectious lesions of the lower respiratory tract;
chronic obstructive pulmonary disease in adults;
pneumonia;
tuberculosis and other diseases.
Contraindications to the use of nebulizers include heart rhythm
disorder, internal bleeding, individual intolerance to the aerosol
form of drug products.
9. Types of Nebulizers
• There are three main types of nebulizers:
• Jet. This uses compressed gas to make an aerosol (tiny particles of
medication in the air).
10. Ultrasonic.
This makes an aerosol through high-frequency
vibrations. The particles are larger than with a jet
nebulizer.
11. Mesh
• . Liquid passes through a very fine mesh to form the aerosol. This kind of
nebulizer puts out the smallest particles. It’s also the most expensive.
• Talk to your doctor about whether a mouthpiece or a mask is right for you or
your child. Face masks, which fit over the nose and mouth, are often better for
children under 5 because they breathe through their nose more than older
children and adults do.
12. PROCEDURE
• - Explain the procedure to the patient and obtain informed consent.
• - Prepare the equipment.
• - Check the prescription chart to ensure that the nebulised drug has
been prescribed and is due to be administered (Fig 2).
• - Check the expiry date of the solution to be nebulised.
• - Ensure the patient is in a comfortable position, as upright as possible.
• - If a nebulised bronchodilator is being administered, it is standard
practice to obtain a pre and post-administration peak expiratory flow
(PEF) reading (Jevon, 2007).
• - Place the compressor near the patient and plug it into the mains.
Clean following local infection control policy and ensure the filter is in
place.
13. Procedure conts,.
• - Assemble the nebuliser.
• - Connect the tubing between the nebuliser and the compressor.
• - Unscrew the top and pour the prescribed solution into the nebuliser chamber (F
• - Ensure the top is firmly reapplied.
• - Turn on the compressor: the solution to be nebulised should begin to ‘mist’.
• - Assist the patient to apply the mask or mouthpiece
• - Remind the patient that it is important to breath through the mouth and not to
talk during the procedure (Porter-Jones, 2000).
• - Ask the patient to tap on the nebuliser chamber every few minutes - this will
help to prevent condensation developing.
• - Once ‘misting’ has stopped, switch off the compressor and remove the mask or
mouthpiece. There is usually a small volume of solution at the bottom of the
chamber.
14. Procedure conts,.
• - Wash and dry the nebuliser chamber and place the pack in its package for
storage.
• - Offer the patient a drink.
• - Document that the nebuliser has been administered following local protocols.
• - In some hospitals it is usual practice to repeat the measurement of PEF (Fig 5).
• - Wash and dry hands.
• - If acutely ill patients need to receive their nebuliser using an oxygen supply,
connect the nebuliser tubing from the oxygen flow meter to the nebuliser
chamber and set the oxygen flow rate to 6-8l/min unless told otherwise (Porter-
Jones, 2000)
15. What are the advantages and disadvantages of a nebulizer?
• Advantages
• Nebulizers can be used by anyone of any age. You can mix more
than 1 medicine, and they can all be given at the same time. High
doses of medicines can be used. No special breathing techniques
are needed to use a nebulizer.
• fast delivery of a drug product to the focus of the disease;
• reduced risk of adverse effects;
• accelerated exposure to the drug product;
• precise dosage;
• a wide range of indications for use;
• possibility to use for treatment of children and patients with any
physical condition.
16. Disadvantages of nebulizer
The machine is noisy and needs an electrical power source for it to function.
Compared to other inhalation devices, it is larger, less portable, and has a
longer treatment time.
Nebulizers are usually not as easy to transport as an inhaler.
They often require a stationary power source.
Delivery of medications takes longer through a nebulizer than through an
inhaler
17. Nebulizer vs. Inhaler
• Inhalers and nebulizers both send medication into your lungs, and both
have pros and cons.
• A nebulizer is often easier for young children to use because all they
have to do is breathe normally. It takes longer to deliver medicine: at
least 5 or 10 minutes. And even portable nebulizers can be bulky and
hard to carry around. But some people prefer nebulizers because they
can see and feel the mist of medication.
• Inhalers are often cheaper and tend to have fewer side effects than
nebulizers. You can carry one in your pocket or bag. An inhaler can be
tricky to use at first, but most people quickly get the hang of it. It
delivers an exact dose of medication.
18.
19. Inhalers and Nebulizers, similarities
• There are two main ways inhaled medicine is used: with an inhaler and with a
nebulizer.
• Inhalers and nebulizers have the same purpose: to get the medicine into your
lungs. Both deliver the same type of medicine, and they work equally well when
you use them the way you should.
• Inhalers and nebulizers are available only by prescription. You might see some
bronchodilator inhalers sold over the counter, but don't use them unless your
doctor recommends it. They could be dangerous for people with certain health
conditions, such as heart problems.
20. Inhalers
Easier to use
Requires practice to use properly
• Don’t require aerosol additive
• Don’t require a power source
• The most common issue with inhalers is the incorrect use. A recent study found
that 84% of people incorrectly use their inhaler.
• Inhalers require some practice to administer medicine properly, which may be
difficult for small children or elderly patients with a respiratory illness. Misuse can
lead to ineffective treatment and an increase in respiratory illness episodes such
as asthma attacks.
21. How Do I Care for My Nebulizer?
• It’s important to clean and disinfect your asthma nebulizer equipment to prevent
infection. Clean it in an area away from smoke, dust, and open windows.
• Follow these instructions for cleaning your nebulizer:
• After each treatment, rinse the nebulizer cup thoroughly with warm water, shake
off excess water, and let it air-dry. At the end of each day, wash the cup and mask
or mouthpiece in warm water with a mild detergent. Rinse it thoroughly and let it
air-dry. You don’t need to clean the compressor tubing.
• Every third day, after washing your equipment, disinfect it with either a
vinegar/water solution or a disinfectant solution. To make the vinegar solution,
mix ½ cup of white vinegar with 1½ cups of water. Soak the equipment for 20
minutes and rinse it well under a steady stream of water. Shake off the excess
water and let it air-dry on a paper towel. Be sure it’s totally dry before storing it in
a zippered plastic bag.
22. Storing
• Cover the compressor with a clean cloth when you’re not using it. Wipe it
with a clean, damp cloth if necessary.
• Don’t put the air compressor on the floor, either for treatments or for
storage.
• Store medications in a cool, dry place. Some need to be kept in a
refrigerator, and others should be kept out of the light. Check them often. If
they’ve changed color or formed crystals, throw them out and replace
them.
• Other tips
• Always have an extra nebulizer cup and mask or mouthpiece on hand. If you
get a breathing treatment in your doctor’s office, ask for the tubing, cup,
and mask.
• Follow the equipment directions on checking, cleaning, and replacing the
filter on the air compressor.
23. Disinfecting
• Take off the detachable parts (mouthpiece and medicine container).
• Soak them in the solution provided by your doctor or one part white vinegar
and three parts hot water.
• Let these parts soak for one hour, or as long as listed on the instructions.
• Remove the parts and either let them air dry or reconnect the machine to dry
them.
• Check with your doctor or pharmacist to make sure you have the correct
instructions for daily cleaning and disinfecting your nebulizer.
24. Cautions
• Patients with COPD should have nebulisers driven by air.
• - Patients with acute asthma should have nebulisers driven by oxygen (usually 6-
8l/min)
• - If a patient with glaucoma is to receive an anticholinergic drug such as
ipratropium bromide, a mouthpiece is preferred as this reduces the leakage of
nebulised solution into the eyes (Porter-Jones, 2000).
• - Compressors should be serviced on a regular basis according to local policy.
• - Local infection control procedures should be followed to minimise the risk of
cross infection.
