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Nebulizer Systems: Asthma Treatment

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Normal Saline: How to Prepare at Home. AboutKidsHealth. http://www.aboutkidshealth.ca/en/healthaz/testsandtreatments/homehealthcare/pages/normal-saline-solution-how-prepare-home.aspx. Accessed November 5, 2016.
  2. Facemask or mouthpiece for delivery of nebulized bronchodilator aerosols? National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pubmed/7259970. Accessed November 5, 2016.
  3. The delivery of inhaled medication to the young child. http://calgaryem.com/files/s003139550300049x.pdf. 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. http://www.atsjournals.org/doi/full/10.1164/ajrccm.162.2.9909030. Accessed November 5, 2016.

Comments

  • Debbiekayj55
    2 months ago

    I purchased a portable nebulizer that delivers a fine mist similar to the cold mist humidifier

    Punasi Portable Mini Nebulizer Machine Rechargeable

    I like using it because I do not wake the dead/ my family when I do a treatment. I also like it because I can use a treatment from my desk.

    The ER dr didn’t like this system. Aren’t they the same?

  • John Bottrell, RRT moderator author
    1 month ago

    Debbiekayj55. It’s so neat all the nice nebulizer options currently on the market. Some of them are so new not even us health experts (me, Leon, your ER DR.) are not even aware of them. Such is the case in today’s fast growing asthma product market. As Leon said, if it works for you that is what matters. And, all of these new products must be studied extensively on asthma patients before they hit the market. So, that’s another thing to consider. If you do talk to that doctor, do share with us why he holds the view he does. John. Site Moderator.

  • Leon Lebowitz, RRT moderator
    2 months ago

    Hi Debbiekayj55 and thanks for joining in the conversation here. Although I have no personal experience with this particular brand nebulizer, from what I read about it, it certainly seems capable of providing you with your medication treatments. And, that is what matters – if you have success with it, it’s a good machine. To determine why the ER doctor ‘doesn’t like’ the machine, you would have to ask him/her directly.
    What does your prescribing physician think of the nebulizer?
    Leon (site moderator)

  • Sarah-artist
    2 months ago

    Is there a nebulizer machine, errr Compressor that doesn’t sound like a Lawn mower? I have often needed to use mine at night and am self conscious of waking people in another room because it is so loud, but my room is the only accessible wall plug.

  • Leon Lebowitz, RRT moderator
    2 months ago

    Hi Sarah and thanks for your question. We all understand how noisy the compressors can be. It (obviously) is the compressor that generates the (offending) noise. The only way I am familiar with that permits a ‘quiet’ treatment is to power the nebulizer from a ‘gas source’. That would be an oxygen or a compressed air cylinder. Under those circumstances, the only sound/noise that can be heard is the nebulization process. I do realize this typically is not practical in the home setting. However, some folks may have an oxygen cylinder in the house. This would facilitate a ‘quiet treatment’, assuming the physician approves the use of oxygen for the patient.
    Wishing you well, Leon (site moderator)

  • John Bottrell, RRT moderator author
    2 months ago

    I hear you. So many times I suffered in bed because I didn’t want to wake people. Or gathered my nebulizer stuff and used it in the living room. So, is there a quiet nebulizer? I do not know. I have not found one. It would be neat to hear what other’s in this community have to say. John. Author/ Site Moderator.

  • warriorTN
    6 months ago

    I have had asthma for many years and at one point had to call 911 because it was so bad we were afraid I wouldn’t make it by car. Doctors only give drugs to mask the symptoms and don’t look for the root cause. I have found several: 1: low stomach acid. 2: acid reflux. 3: chronic dehydration.

  • Sarah-artist
    2 months ago

    WarriorTN

    I wonder about your list of probable causes.
    1: Low Stomach acid, and 2. Acid Reflux –

    Both can be helped with a few things to include Apple Cider Vinegar, or Betaine HCL, or a good Digestive enzyme with Betaine HCL as almost always Acid Reflux is caused by low stomach acid.

    I was diagnosed with Acid reflux, amended later to IBS in college, found watching processed, and oily foods and taking digestive enzymes cured 90% of my digestive issues.
    3. Chronic dehydration-
    a rule of thumb we would tell customers is that it is good to drink ‘Half your body weight in ounces of water each day’ so someone weighing 180 lbs. would be drinking 90 oz. of water/juice. Not including caffeinated drinks. Of course for me a upper limit is a gallon, regardless of my weight.

    Not to pretend to be a medical professional, because I am not. I however did work in Health food retail for 14 yrs and loved to help people.

  • John Bottrell, RRT moderator author
    2 months ago

    Sarah-artist. Thank you for the post and advice. Yes, it is true that those conditions are treatable. Although, we are unaware of all of the circumstances surrounding WarriorTN. Thanks. John. Site Moderator.

  • Lyn Harper, RRT moderator
    6 months ago

    Hi warriorTN – I see your point, but keep in mind that when a person is having a severe asthma exacerbation, the physician wants only to give you the ability to breath. At that point, not much else matters.

    Once the flare has been dealt with, often there are other problems that should be considered, a few of which you have mentioned.

    It’s great that you’ve educated yourself and can be a good advocate for yourself as well.

    Regards,
    Lyn (site moderator)

  • Leon Lebowitz, RRT moderator
    6 months ago

    Hi warriorTN and thanks for your post. Have you had an opportunity to read the response from Lyn as yet. I think she made an excellent point – treat the asthma emergency first. Then, once the condition has returned to normal, might be the time to assess the other causes that you’re considering. How does that sound to you? Leon (site moderator)

  • Weezer
    8 months ago

    Hi

    I just wanted to say thank you for writing this article. I have had severe asthma pretty much my whole life and I have to admit I didn’t resort to my nebuliser fast enough and ended up on prednisone and also on one occasion gasping for air as I was walking to a doctors appointment about the asthma (I never got to say much but wheezed while trying to think of an excuse to not need steroids…just yet!) it was the gp who helped me to not be to shy to use it I ended up using the steroids and then they retrained me to understand the point at which I should be using my nebuliser to regain control from an attack. Not just leaving it to 8 puffs of an MDI Ventolin inhaler!

  • John Bottrell, RRT moderator author
    8 months ago

    You are welcome, Weezer. Interesting how even those of us living with this a long time still need to be reminded of the do’s and don’ts of asthma. That’s why it’s so important to have a good GP as it seems you have. Hope all is going well. John. Site Moderator.

  • Leon Lebowitz, RRT moderator
    8 months ago

    Hi Weezer and thanks for your post and comment. I’m sure John Bottrell, the author, will be gratified when he reads what you have to say. It sounds like the (gp) physician was largely responsible for assisting you in understanding how to manage this condition, and your medications, to gain more control over your breathing. It’s good to hear you feel more confident in handling your asthma. Wishing you the best, Leon (site moderator)

  • cooper71
    9 months ago

    I think inhalers are okay for normal everyday use and I use mine everyday but nebulizer work better for controlling a severe asthma attack. In 2017 I started a new job in a factory and we were required to wear a dust mask because strong smelling dust particles coming from the product would get into the air. Soon I was having trouble with my breathing and I used my inhaler and went home for the day. I kept waiting and waiting for my breathing to get better and nothing happened and my breathing got even worse overnight. I used the inhaler about 5 or 6 times that night and it had no effect. This was one of the worse nights of my life and the only way I could sleep was to put my knees on the floor and place by elbows on the bed and try to keep my chest elevated. If I tried to lay down it would feel like somebody was standing on top of my chest. I was trying to make it through the night and go to the urgent care center in the morning so that I would avoid a big hospital bill. I explained to the doctor that I use an inhaler but I breathed some fumes and dust particles at work and the inhaler is not helping my breathing. The doctor let me use a nebulizer and this was the first time i had seen one. Twenty to thirty minutes later my breathing was back to normal and I was impressed. I suffered all night waiting for the inhaler to work and this nebulizer made me feel better in just a 20 to 30 minutes. There is no comparison. Nebulizer are superior to inhalers when it comes to controlling a severe asthma attack.

  • John Bottrell, RRT moderator author
    9 months ago

    Picturing you kneeling beside your bed reminded me of my own similar experiences when I was a kid. In my case, I didn’t want to bother my mom and my inhaler was empty from overuse. And, yes, many of us asthmatics note that nebulizers work better when you’re having a bad asthma attack. This is true even though studies show otherwise. But, what happens in a lab is not always reproduced in real life. I personally think nebs work better when you’re sick. Glad you found something that works for you. So, you’re set up with all your own equipment now? John. Site Moderator.

  • Wiley7205
    11 months ago

    I always replace my neb cup and tubing if I have to go into hospital as soon as I get home. Same with my regular oxygen tubing. I go with brand new each time. Medicare/ Medicaid at least with my plans allow me to do so.

  • John Bottrell, RRT moderator author
    11 months ago

    That’s a great idea! And we can certainly understand why Medicare/Medicaid would support this, as it assures you have equipment that is in it’s cleanest and best working conditions. Do you also wash your equipment from time to time? John. Site Moderator. https://asthma.net/living/asthma-chores-cleaning-supplies/

  • Leon Lebowitz, RRT moderator
    11 months ago

    Hi Wiley and thanks for your post. I agree with John – practicing good ‘hygiene’ for your equipment goes a long way towards preventing infection. Once again, keep up the good work! Leon (site moderator)

  • ruthieq
    1 year ago

    I was able to get a portable nebulizer system online for $35. It works well. Don’t forget to clean the cup as the saline can leave residue..

  • John Bottrell, RRT moderator author
    1 year ago

    That’s a good deal. I think I just paid $50 for my new one. John. Site Moderator.

  • Christine.Fitzpatrick moderator
    1 year ago

    Hi @ruthieq,I am glad you found a portable nebulizer that works well for you. Thanks for sharing the cleaning tip with the community! Best, Christine, Asthma.net Team Member

  • Leon Lebowitz, RRT moderator
    1 year ago

    Hi again ruthieq and thanks for the tip on remembering to clean out the nebulizer cup – that’s very important following each treatment. All the best, Leon (site moderator)

  • RockinRita03
    1 year ago

    I have a big box tabletop nebulizer system from when I was a child. It still works but with the way technology has advanced over the years I wonder, should I upgrade it? How long should I keep the supplies (tubing/nebulizer container/mask/mouthpiece)? Can I wash them out with vinegar to help preserve their lifespans?

  • John Bottrell, RRT moderator author
    1 year ago

    Hi. RockinRita03. I have to say I agree with Leon. If it continues to work, there’s probably no reason to get a new one. Some older machines might even work better than the newer ones. But, you may also find the opposite to be true. I have an old nebulizer from 1985 and that thing just keeps on a going. However, be sure to change the air filter every once in a while. If it gets clogged, the mist will pitter out. And while you can definitely clean nebulizers (and should at least once per weak), it’s also a good idea to get new ones every so often. I’m not sure what the recommendation is. Here’s a link to an article on this subject if you’re interested. John. Site Moderator. https://asthma.net/living/4-nebulizer-tips-worth-sharing/

  • Leon Lebowitz, RRT moderator
    1 year ago

    Hi (again) RockinRita03 and thanks for this post and question. I see that you posted this concern a bit earlier to which there is now a reply.
    For your convenience, i will post the reply here for your consideration:

    “Hi Rockinrit03 and thanks for your post. Although we cannot provide medical advice or diagnostics over the internet (for your own safety), your concerns certainly warrant a reply.

    If your table top nebulizer system works well, and you derive the benefit you expect (and have experienced over the years) from your therapy, it may not be necessary to ‘upgrade’ it. However, you may want to investigate further by discussing this with your physician as to what (s)he recommends. The supplies you have that you’ve mentioned, should be changed on a regular basis and/or if they’ve become worn. Most of the parts can, in fact, be cleaned using a diluted vinegar solution for disinfection. You may want to discuss this with the respiratory therapist who is affiliated with your equipment supplier. Please do check back and let us know how you’re doing.
    All the best,
    Leon (site moderator)”

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