Making sure prescribed medicine is delivered exactly to where our lungs need it, when we need it, may not be as simple as it sounds. Nebulisers are standalone pieces of kit that are not expencive and can be order online from store like DearJane.com.au. They are distinct from the more common inhaler, or metered-dose inhaler (MDI) to give them their full name.

Using high pressured gas, usually compressed air is simple but may not be without risk. The machine forces prescribed liquid medication under pressure into a fine spray of droplets we then are able to breathe deep into our lungs. More modern nebulisers use ultrasound to do the same, vibrating medicine particles at such a force they scatter becoming airborne. Anyone who has used one or indeed a common ‘puffer’ knows it is not without its problems.

Synchronising breathing and nebulising takes time to get used to. Much of the medicine nebulised usually disappearing into the air or is caught in and around the nebuliser mouthpiece itself.

Know Your Nebuliser Machine
Nebulisers are not cheap and need looking after to stay safe and functioning – key reasons for their falling out of favour among doctors. They are seen by many GPs as a pretty blunt tool. Most patients either don’t know how to keep their kit clean and safe or simply do not use them properly

It should be noted that a nebuliser ideally is a personal machine and prescribed medicine is only meant for your own use. There is some debate around the harm airborne medicine might have on our face and eyes with corticosteroids for example being known to thin the skin, risking leaving nebuliser users with redness around their mouths.

To protect the skin and to better catch the medicine, doctors agree nebulisers need an extra piece of kit – a spacer – an add-on to catch the airborne liquid long enough for a couple of deep breaths. Spacers are recommended for use by children, but ideally used by all nebuliser users, just to make sure we breathe in the required dose, delivered right to where our lungs need it.

Nebuliser Uses
Doctors do agree that nebulisers are great for getting cardiovascular medicine right to where it is needed in a quick and easy session. There is some debate on the effectiveness of nebuliser use for asthma suffers. In fact, doctors in the UK no longer turn to nebulisers for day to day care though agree they are useful in emergencies, such as asthma attacks.

The common inhaler is considered safer with fewer side-effects. Being cheaper and less fiddly they are simply easier to use. Having said that many GPs accept it is still a matter of preference but the use of nebulisers is steadily on the decline.

Doctors prefer to reserve nebuliser use for more chronic lung trouble, like chronic pulmonary obstructive disease (COPD) or cystic fibrosis. In both, nebulisers help target where patients feel least able to breathe. In those cases, other drugs can be safely added to the nebulised medication. Ensuring that your medication better absorbed by your lungs, giving maximum relief from symptoms.

Nebulisers are also used in palliative care when the primary aim is to reduce and manage the pain and discomfort which is often associated with protracted or terminal illnesses.

Nebulisers are also used for managing the symptoms of AIDS-related infectious illnesses. In these cases, it is still recommended that there is a shared plan with the patient. This plan should also include an agreement to stop use once symptoms subside and the patient’s quality of life improves by becoming more mobile for example. Nebulisers are therefore clearly not for long-term use.

Having said that, even in these specific situations, the National Institute for Health and Clinical Excellence (NICE) consider nebulisers having a limited use compared to oral or injected medication. Though even NICE accept that putting aside how ineffective they may be, nebulisers have their place in helping relieve the distress of chronic lung conditions, even if to just breathe more easily.

When nebuliser use is being considered the advice is to consider the patient’s ability to use the machine. Patients should be allowed the option of using a handheld or a mouthpiece where possible. Spacers are known to improve the benefit of handheld devices. For some patients, such as those suffering from acidosis (an increased acidity in the blood and other body tissue) compressed air is preferred to oxygen which is exacerbates the symptoms.

In spite of the limitations of nebulisers, doctors in the UK and Australia accept that patients need advice and are ideally given clear, written instructions on how to use their nebuliser and, critically, knowing what to do when it doesn’t work, without panicking.

Nebuliser Tips
• Keep free of germs with a regular warm soapy wash and replace every to 3-4 months.

• Make sure you know who to call in case of emergency.

• Know what to do if your nebuliser is slow or is not working as it should.

• Get your compressor, the muscle behind your kit, an annual check over; and,

• Please: nebulisers and medicine used are both meant for your lungs only and must be only used as prescribed.