Nebulizer Or Inhaler: Which Is Better?

Each person's asthma is different, meaning that treatment methods generally vary, too. Many asthmatics use an inhaler or a nebulizer at some point in their treatment regimen. One of our community members asked, "I am confused about what is better for my asthma: a nebulizer or an inhaler?" We asked our team of respiratory therapists and asthma educators for their thoughts, and this is what they said.

Editor’s Note: The information in this article cannot be substituted for medical advice. Always consult your doctor before beginning, ending, or changing treatments.

They're different but equal

Response from Lyn Harper, MPA, BSRT, RRT:

Actually, one is not necessarily better than another. They both have their advantages and disadvantages.

The inhaler or MDI (metered-dose inhaler) is portable and thus more convenient. But, that also makes it easy to misplace, especially for children. However, when used properly with a spacer, the MDI provides the needed medication dose just as well as the nebulizer.

I must stress the “when used properly” statement. For many, this is the downfall of the MDI – when not used with a spacer it requires considerable coordination. If a person doesn’t coordinate their breaths with the pump, much of the medication is wasted. Thus, some mistakenly believe the MDI doesn’t work as well, when in fact it’s not actually the fault of the device.

The MDI is also quicker to use if needed. You can pull it out, place it in the spacer and take the needed breaths, achieving the needed relief.

The nebulizer uses liquid medication that it turns into an aerosol and you breathe it in through a face mask or mouthpiece. They are easy to use and relatively quick – it usually takes about 10 minutes to finish a treatment. The nebulizer is known to cause more side effects from the medication – more shakiness, tremor, and increased heart rate. For this reason, many people prefer their MDI. The nebulizer can also be more costly, which is certainly a consideration.

It depends on the patient

Response from Leon C. Lebowitz, BA, RRT:

There is no need for confusion. The answer is dependent on the patient’s capability to use the device, the setting, the medication and, in some cases the individual patient's preference.

A nebulizer is a device that takes a liquid solution and turns it into a fine mist that can be inhaled. The most common nebulized medication for asthma is albuterol, which is used to treat wheezing in asthma and other illnesses (e.g. emphysema). The main advantage to using an aerosol nebulizer is that they are easy to use.

The main alternative to nebulizers is the metered dose inhaler (MDI). MDIs are harder to coordinate than a nebulizer, but when they are used with a spacer device, coordination is much easier and the delivered dose is more consistent. Learning to use a spacer device is quite easy for the majority of patients. A common misconception is that the nebulizer method provides a stronger dose than the MDI system. This is simply not true. Many studies and reference materials have shown that patients utilizing the MDI/spacer system do as well, if not better, than those receiving nebulized medication.

MDIs offer several advantages. First, they are much quicker to use. Two puffs from an MDI/spacer takes 30 seconds or so, if done properly, versus 10 minutes or so for a nebulizer treatment. Second, MDIs cause fewer side effects. Nebulizer (albuterol) causes much more heart rate increase and tremor than albuterol from an MDI/spacer. Third, MDIs are considerably less expensive to use than a nebulizer system. Remember, however, that some medications for asthmatics cannot be aerosolized and only come as a metered dose or dry powder inhaler. In those cases there is no choice.

Since there is no distinct clinical advantage of one method over another, the choice of which method of medication delivery system to use is best left to you in concert with your physician.

Depends on your preference

Response from Lorene Alba, AE-C:

There are many reasons to choose either a nebulizer or an inhaler. Asthma symptoms can pop-up without warning, so having your quick-relief medication with you at all times is recommended. Inhalers are small, portable and easy to carry with you wherever you go, so that’s definitely a plus. However, they are technique dependent. Remembering to shake, prime if needed, press the inhaler, and breathe-in correctly all at the same time can be difficult, especially if you are in distress. Work with your healthcare provider to ensure you have the correct inhalation technique.

Nebulizers are not technique dependent, which makes them easier to use when you are experiencing symptoms. When using the nebulizer, you get to sit still and breathe deeply for several minutes, providing the opportunity relax and concentrate on your breathing. This often helps the user stay calm while waiting for the medication to work. Even though nebulizers are becoming smaller, more portable and quieter, using them takes much longer than taking a few puffs of albuterol from an inhaler and is not as convenient.

A strongly debated topic

Response from Theresa Cannizzarro, Respiratory Therapist:

This is a hotly debated topic amongst asthmatics. Ideally, with proper technique, an inhaler can be equally as effective as a nebulizer. I will be referring to the inhaler/nebulizer as being used with a rescue medication, such as Albuterol or Xopenex. Using a spacer is important. It helps the medication get deeper into your lungs rather than most of it in the back of the throat. There are techniques to master using an inhaler without a spacer but are difficult for most people.

I will say, that many asthmatics will swear that a nebulizer is more effective. Like I previously stated, inhalers are just as effective if used properly-- the key word there is *if*. If an asthmatic is in the middle of a really bad attack, having the coordination and timing the hard fast breath in can be almost impossible. In this case, a nebulizer would be the better option. Also, using passive breathing with a nebulizer when having a flare-up can be calming. Nebulizers have both a mouthpiece as well as a mask which can give an asthmatic options for which they are more comfortable or able to use.

Editor’s Note: The information in this article cannot be substituted for medical advice. Always consult your doctor before beginning, ending, or changing treatments.

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