What to Consider with Nebulized Medication

Reviewed by Ann Mullen, RN, CNS, AE-C, CDE, TTS, Deborah A. Fending, RN

Inhalation is the preferred route for many medications used today to treat asthma, COPD, bronchiectasis and cystic fibrosis. There are a number of devices available to inhale medications. There is the metered-dose inhaler, metered-dose inhaler with a spacer, dry powder devices, a soft mist device and nebulizer. A nebulizer, or "breathing machine," is another way to take inhaled medicines. A nebulizer treatment is given with an air compressor machine. Pressurized room air is used to create a mist of the medicine solution, which is inhaled for approximately 5-10 minutes. The nebulizer is one option available for treatment if the medication is only available in a nebulized form, if a person has difficulty manipulating the other devices, coordinating inhalation with actuation, inhaling deeply or holding her/his breath for the prescribed amount of time.

As new medications have become available in a nebulized form there are a number of questions that are asked.

 

What medications are available in the nebulized form and what do you consider when buying a nebulizer and air compressor?

A variety of medications are now available in a nebulized form to treat asthma, COPD, Bronchiectasis, and Cystic Fibrosis.  Each medication has specific instructions regarding the use. Consider these questions when using a medication in a nebulizer:

  • What nebulizer do you use? Make sure you use the nebulizer that is recommended for the medication that has been prescribed. Non-disposable nebulizers are often recommended for home use, since they have a 6 month warranty and can be cleaned and sterilized.

  • How do you clean and sterilize the nebulizer? Follow the manufacturer’s guidelines for cleaning and sterilizing the nebulizer.

  • What air compressor do you use? Make sure you use the air compressor that is recommended for the medication that has been prescribed. There are some medications that are used with a specific nebulizer and air compressor.

 

Can nebulized medications be mixed?

In many situations the drug compatibility, efficacy, and safety of mixing medications has not been studied. Rarely are medications mixed in the nebulizer.

 

Is there an ideal amount of medication for nebulization?

The amount of solution to be nebulized must be enough to nebulize the medication, yet not so much the nebulized treatment takes longer than 15 minutes. Two to three ccs of solution is a reasonable amount of medication to meet both needs.

 

When is the nebulized treatment stopped?

Occasionally tapping the side of the nebulizer helps the solution drop to where it can be misted. The nebulized treatment is continued until the onset of inconsistent nebulization i.e. sputtering.

 

What diluent can medications be mixed with?

Many nebulized medications come in a premixed solution. If the medication is not premixed, normal saline is usually recommended to dilute the medication.