Nebulizer Systems: Everything You Need To Know

I have had my own nebulizer since 1985, and have doled them out to patients since 1995. So, I guess that makes me sort of a nebulizer expert. Here I will anticipate any questions you might have, along with the answers.

What is a nebulizer? It’s a small, handheld cup attached to a mouthpiece or mask that converts solutions of respiratory medicine into a mist to be inhaled. Other names include small volume nebulizer, updraft nebulizer, or neb.

What is a nebulizer compressor? It’s a small air compressor that creates a flow of about 6-8 liters per minute. It’s sometimes incorrectly referred to as a nebulizer.

What is a nebulizer system? It is the combination of a nebulizer and air compressor. The most common system consists of a nebulizer and an air compressor that sits on a table and is powered by a wall outlet. These are the most common units mainly because they are the most affordable. One end of oxygen tubing connects to the air outlet port on the air compressor and the other end connects to the air inlet port at the bottom of the nebulizer cup.

What is a breathing treatment? Medicine solutions are inserted into the cup. The air compressor is turned on. The nebulizer then creates a mist to be inhaled. Other names include nebulizer treatment, updraft treatment, aerosol therapy, aerosol or treatment.

How is the mist created? It’s based on the Bernoulli Principle that states that as the stream of water through a narrow opening increases a negative pressure is created alongside the stream. In our case, as the flow of air goes through the narrow opening in the bottom of the nebulizer cup, this creates a stream of air through the water. A negative pressure alongside the stream sucks water into the stream, thereby creating the mist to be inhaled.

How does the medicine come? Today, most respiratory medicines to be used in a nebulizer come in small plastic ampoules (amps) with easy to twist off tops. Once the top is twisted off, the contents are then squirted into the nebulizer cup.

Is all the solution in the amp medicine? No. A small amount of medicine is mixed with normal saline. For instance, one amp of albuterol contains 0.5cc albuterol mixed with 0.3cc normal saline.

What is normal saline and why is it used? It is sterile salt water. It contains the same amount of salt as normal body fluids such as saliva and mucus. It is used because it causes no harm to your airways1. It is needed because it makes the treatment last long enough to be effective.

Should I use a mask or mouthpiece? Studies show that both the mouthpiece and mask are equally effective at delivering inhaled medicine to the lower airways. For this reason, which one used is up to you. Usually, small kids use a mask, and adults use a mouthpiece. What do you prefer?2

What’s the best way to take a treatment? The best way is to sit tall on the edge of your bed or to sit up tall in a chair. This makes sure your airways are in the best position to receive the medicine for ideal distribution to your lung fields. Clip the mouthpiece between your teeth, or place the mask over your mouth and nose.

How should I breathe during a treatment? The ideal method is to breathe normally. This creates a nice smooth, laminar flow for creating an easy path for the medicine to your lower airways. Some experts recommend an occasional slow deep inhalation to reach the deeper airways.

Should I breathe through my mouth or nose? When you use a mouthpiece you should breathe normally in and out of your mouth. When you use a mask you should breathe normally either through your mouth or nose.

How long does a treatment last? Most treatments last about ten minutes, although it depends on how many amps of medicine you include in the treatment. Just a simple albuterol breathing treatment lasts about ten minutes.

How do I know a treatment is done?One study showed that the medicine inside the solution is cut in half about 20 seconds after sputtering starts, and this is a good time to end the treatment3. Otherwise, once the mist is gone the treatment is done.

Should you tap the sides of the nebulizer cup? Droplets of solution often impact the sides of the nebulizer cup and can be knocked free by tapping the sides. This is usually done when sputtering begins to make the treatment last a little longer.

There are different kinds of nebulizers, so which ones work best? Many companies make nebulizers. While some may advertise that they offer some unique feature, they all do the same thing.

Are there portable nebulizer systems? Yes. They are battery operated, and some are small enough to fit in a bag or purse. They are charged the same way other electronic devices are charged, either at home or in your car.

How do I get my own nebulizer system?  You must have a discussion with your doctor, and together you can decide whether you would benefit from having one. Your doctor’s staff will then set you up with a home health care office that supplies the nebulizer systems and whatever supplies you need to operate and maintain them.

How much do nebulizers cost? Nebulizer systems cost anywhere from $50 to $200, with the least expensive being the table units and the most expensive being the portable units.  Individual nebulizer replacement cups and oxygen tubing usually cost anywhere from $2-5.

Will Medicare or my insurance pay for them?  Your insurance or Medicare will usually only cover the cost of the most basic units. Other options are available, including portable nebs, if you are willing to cover the cost.
What’s better, nebulizers or inhalers? Most scientific studies show that inhalers and nebulizers, when used properly, are equally effective. The scientific data, in this case, does not necessarily support the analytical data, where most asthmatics say nebulizers work better than inhalers, especially during asthma episodes. This may be due to the inability to generate enough flow to actuate inhalers, or it may be due to the soothing effect of inhaling medicine over a period of time. Which one works best for you is basically up to you and your doctor to decide.

Covered here are some of the most common questions I receive as a respiratory therapist. Let me know in the comments below if you have any further questions.

view references
  1. Normal Saline: How to Prepare at Home. AboutKidsHealth. Accessed November 5, 2016.
  2. Facemask or mouthpiece for delivery of nebulized bronchodilator aerosols? National Center for Biotechnology Information. Accessed November 5, 2016.
  3. The delivery of inhaled medication to the young child. Accessed November 5, 2016.
  4. American Journal of Respiratory and Critical Care Medicine. Comparable Efficacy of Administration with Face Mask or Mouthpiece of Nebulized Budesonide Inhalation Suspension for Infants and Young Children with Persistent Asthma: : Vol 162, No 2. Accessed November 5, 2016.
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