Nebulisers

Nebulisers are used for the treatment of COPD (including alpha-1 emphysema), asthma, cystic fibrosis and other respiratory diseases.

The aim is to get a medication, such as a bronchodilator, directly into the lungs where it can have an immediate medical beneficial effect. The most effective way of doing this is to create an aerosol which a mixture of gas and particles and breath this aerosol or mist into the lungs.  The particles are droplets of liquid containing the medication and the smaller they are the faster they reach the parts of the lung where they have their effect.

Though not called a nebuliser the Metered Dose Inhaler, generally called a puffer, works in the same way. The MDI contains a small canister of harmless and eco-friendly gas that propels a fixed amount of the drug for each puff.  Each dose is released by pressing the top of the canister.  The inhaler is quick to use, small, and convenient to carry.  To be effective it needs good co-ordination to press the canister, and breathe in at the same time.  Read more about Inhalers.

Hospital nebulisers, and until recently, most home-use nebulisers, use compressed air or oxygen passing through a fine jet which breaks up the liquid medicine and creates the aerosol. When oxygen is not available or not needed for therapeutic reasons the compressed air comes from a pump driven by an electric motor.

The large white nebuliser is a typical mains-powered machine for home use – an Omron CX.  These machines are simple to operate and the only maintenance other than the regular cleaning of the drug container and the mouthpiece or mask is the replacement of the air filter.

A more portable nebuliser is the Freeway Lite II – in the centre of the picture.  This machine may be operated from the mains, a car 12 volt connector or its own internal rechargeable battery.

The problems with compressed air nebulisers are (i) noise from the jet (ii) noise from the electric motor and, in the case of a portable machine, (iii) the weight of the motor, pump and battery.

Recently, small, dry cell operated nebulisers have become available and these use a different principle .  An electronically controlled element is made to vibrate at ultrasonic frequencies. The element is in contact with the liquid medication and the vibration is sufficient to create a mist of air and very fine droplets.  The latest machines have a vibrating element which is a mesh perforated with thousands of laser-drilled holes.  These Vibrating Mesh Technology nebulisers produce a very small particle size in the aerosol which makes it more effective and can reduce the treatment time.  This is an Omron NE-U22.

A different direction has been taken with the Respimat Soft Mist Inhaler which could be described as a hand-driven nebuliser.  The user twists the device which winds up an internal spring. Pressing a button releases the spring which then this squeezes a flexible container forcing the liquid out through two fine nozzles, thus forming a soft mist.

There are other aspects to using a nebuliser; ease of cleaning, mask or mouthpiece, vented or unvented, reservoir bag to hold the aerosol, etc.  All of these things should be discussed with a medically trained person along with the recommended medication to put in the nebuliser.

Finally – Travelling with nebulisers

FAA and European regulations require that a bronchodilator inhaler is included in the aircraft emergency kit on aircraft registered in Europe or the USA.

The following is extracted from the British Thoracic Society’s guidelines on air travel.

 For an acute exacerbation on board the patient’s own bronchodilator inhaler (or airline emergency kit inhaler if available) should be administered and the dose repeated until symptomatic relief is obtained.  A bronchodilator administered via a spacer is as effective as a nebuliser.

Nebulisers are not included in the airline medical kit because the aircraft oxygen system cannot provide the high flow rates needed to ensure correct dose delivery, and compressor devices are heavy and bulky.

So if you need to use a nebuliser when flying and you don’t want to use a spacer and puffer then you’ll have to take your own.  Most airlines permit use of the small dry cell battery operated nebulisers (except during takeoff and landing) but you should check in advance.