Nebulisers for Asthma

The breathing difficulties that we know as asthma arises because of narrowing of the air passages of the lungs. It seems sensible therefore to treat asthma by breathing medicines directly into the narrowed air passages. Many of these medicines will open up ("dilate") the air passages (or "bronchi") and so are known as bronchodilators.

 

What is Nebuliser?

A Nebuliser is a device which makes a mist out of a liquid by blowing air or oxygen through it.

  1. The Nebuliser unit itself - a small container into which the liquid medicine is put and through which air or oxygen can be blown, to make the mist and a source of compressed gas. This is likely to be the oxygen supply in hospital or health centers but for home use will be a small electrical air pump. A pump rather like the foot pump which is used to inflate car tyres is marketed as an alternative.
  2. A mouthpiece or mask which can be attached to the outlet from the Nebuliser so that the mist can be breathed in.
  3. The medicine which is to be nebulised made up in a suitable solution to be put into the Nebuliser unit.

 

An alternative design is the ultrasonic Nebuliser. This creates a mist by sending vibrations through the liquid medicine.

There is no "best buy". It is often easiest for all the patients from one clinic or area to have the same make since this simplifies servicing and maintenance.

 

Which Drugs May be Used in Nebuliser?

Nebulisers are used for bronchodilators, medicines which give quick relief from asthmatic wheezing, though they can also be used for certain protective medicines.

Some of these medicines come in a single dose ampule or plastic capsule ready for use. With others, you have to measure out a set amount of medicine from a bottle, either using a syringe or a dropper. This then needs to be mixed with a dilute salt solution. This solution MUST be what is called normal saline. You must not use tap, distilled or sterile water.

 

When is Nebuliser Treatment Used?

For the Emergency Treatment of Acute Asthma
Acute severe attacks of asthma respond so well to nebulised bronchodilators that injections of these medicines are rarely needed now. Nebulisers have become part of routine treatment for patients admitted to hospital with acute asthma. Quite a number of GPs now have Nebulisers in their health centres and may take them out to patient's homes. In a few areas’ ambulance personnel can use Nebulisers. Finally, some patients have their own Nebuliser to treat acute attacks under the guidance of their GP’s.

 

For Regular Treatment of Chronic Asthmatics with Bronchodilators
A small number of patients with persistent and chronic asthma do not respond adequately to the doses of bronchodilator available in pressurised inhalers or Rotacaps. They need larger doses that can be delivered using a Nebuliser. So, they are given a Nebuliser for regular bronchodilator treatment every day.

 

Some Guidelines for Using Nebuliser At Home

  • Learn all you can about your nebuliser from your doctor, nurse or physiotherapist. You must know how to set up the Nebuliser and air pump, how to keep it clean and understand in simple terms how it works.
  • Be sure you know
    • What medicine you are to use
    • How much you need
    • How to put it in the Nebuliser
    • When to take it
  • If you have been advised to use your Nebuliser for acute attacks learn what warning signals you should look for that indicate the Nebuliser should be used. It may be
    • Failure of your usual medicine to work
    • Drop in your peak flow reading
    • Rise in your pulse rate.
  • Work out with your doctor what you should do after using the Nebuliser for an acute attack. It may be
    • That you should contact your doctor
    • That you should repeat the Nebuliser a certain number of times
    • That you should start steroid tablets.
  • If you have been advised to use your Nebuliser regularly, make sure you keep to the scheme advised. The regular use of Nebulisers does not mean that you can stop protective medicines such as steroid aerosols. On the contrary, the aim should be to use protective medicines continually so that the use of nebulised bronchodilators can be kept to a minimum.
  • It is important to be aware of possible side-effects of nebulised medicines
    • With most bronchodilators, this may be trembling of the hands or excessive thumping of the heart. Less often there may be giddiness or headaches.
    • With ipratropium, you may notice a dry mouth.