How Good Is Your Nebulizer Machine?

You May Be Getting Less Medication Than You Think

Man using nebulizer
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Parents and patients often feel or have the impression that a nebulizer machine or breathing machine is more effective than other devices that can be used to deliver asthma medications to patients. However, despite this impression there is some evidence that nebulizer machines don’t deliver as much medication to your lungs as your doctor might expect.

Nebulizers are used to deliver rescue medication or inhaled corticosteroids to patients with asthma or for treatment of​ symptoms like wheezing.

How Is A Nebulizer Machine Different From Other Medication Delivery Devices?

A nebulizer machine takes medication in a liquid form and turns it into a fine mist that can be breathed into the lungs through a pipe-like device. The advantage of this delivery method is that patients just breathe in and out and the medicine goes into their lungs (in theory).

The alternative to a nebulizer machine is the metered dose inhaler or MDI. They are more difficult to use because the MDI requires coordination, but this can be overcome with a spacer device. When used with a spacer more consistent doses can be delivered to the lungs.

Metered Dose Inhaler Versus A Nebulizer Machine

There has always been a belief among patients that treatments with a nebulizer machine were stronger than treatment with an MDI. I do not know if it is that treatments from a nebulizer machine take 5–10 minutes or if it is all the equipment that gives this impression.

This discrepancy was further exacerbated several years ago when MDIs were forced to change propellants (the chemical used to get the medication from the inhaler canister into your lung). Chlorofluorocarbons (CFC) were no longer allowed due environmental damage and CFC inhalers were switched to hydroflouroalkane (HFA) inhalers.

While studies demonstrated HFA inhalers were just as effective, many patients complained about the cost. Many patients never really felt the new inhalers worked as well and this made many of my patients ask for nebulizer machines more often

Research On Nebulizer Machines

A recent research report in Respirology demonstrated that nebulizer machines deliver less than half of the prescribed dose in commonly used inhaled corticosteroids. The researchers looked at how much of the drug was inhaled and how much made it to the lungs. The drugs examined include:

The results showed that while a nebulizer allowed the children to inhale 13% of the prescribed dose of fluticasone propionate, 21% of beclomethasone dipropionate and 25% of flunisolide, the percentage of the inhaled dose which actually reached the lungs was found to be as low as 5%, 8% and 16% respectively.

Despite what you or your doctors may think, relatively small amounts of drug are delivered and even less makes it to the lung.

This has potential significant implications for your treatment. If you are receiving less medication, your doctor may need to significantly increase your dose. While many physicians do not necessarily think about prescribing a particular nebulizer for patient use, your doctor may need to consider nebulizer performance as a factor in the future. Additionally, results of research like this may cause regulators to more closely look at nebulizer machine performance. In turn, your doctor may need to consider this when prescribing medication for you.

Other MDI Advantages

Compared to the 10 minutes most patients take to receive a treatment when using a nebulizer machine, an MDI treatment can take 30 seconds if the proper technique is used. MDIs cause less tremor and elevation of heart rate compared to nebulized treatments. Finally, MDIs are cheaper. There are no supplies (e.g. tubing, masks, breaking machines) and the cost per dose is less for MDI treatments.

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O’Callagahn C, White JA, Kantar A. Nebulization of corticosteroids to asthmatic children:Large variation in dose inhaled. Respirology (2013)

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