What Is a Nebulizer? How These Machines Can Help Lung Conditions
Updated: Aug. 17, 2021Everything you need to know about nebulizers, including what conditions they are used for to how they differ from inhalers.
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Nebulizer basics
If you have a lung condition—including asthma or chronic obstructive pulmonary disease (COPD)—you might have a prescription that requires using a specific delivery device.
That device may be a nebulizer, which is one of the most common ones used to deliver medication into the lungs.
What exactly is a nebulizer?
A nebulizer is a machine that turns liquid medication into a mist. Vaporizing the medication helps people inhale it deep into their lungs easily and efficiently.
Most nebulizers work by using air compressors, which use air to convert the liquid into mist. There are also ultrasonic nebulizers, which use sound vibration instead.
While nebulizers cannot fit into your pocket like inhalers, many are portable for on-the-go use.
Most nebulizers—even though they are relatively small and portable—do need a battery or to be plugged into an electrical outlet to function.
What is a nebulizer used for, and what conditions does it address?
A nebulizer treats various lung conditions, including COPD and asthma, explains Darren Mareiniss, MD, assistant professor of emergency medicine at Sidney Kimmel Medical College–Thomas Jefferson University.
COPD is a chronic condition that can cause symptoms like shortness of breath, fatigue, and a chronic cough. It’s the third leading cause of death in the United States and anywhere from 16 to 24 million people have it.
“Typically this causes a combination of small airway disease and destruction of lung tissue (emphysema),” Dr. Mareiniss says.
The most common cause of COPD is exposure to noxious particles like air pollution, dust, fumes, workplace chemicals, or cigarette smoke. Although anyone can get COPD, even non-smokers, cigarettes are responsible for about 90 percent of cases.
Asthma is a chronic inflammation of the lungs that can result in a spasm of the airways, or bronchioles, in reaction to allergens or other triggers, like cold air or exercise.
“In asthma attacks, this spasm and constriction of the air passages of the lungs (bronchioles) limits the patient’s ability to breathe,” Dr. Mareiniss says.
It can also lead to recurrent episodes of wheezing, chest tightness, and cough.
People with other conditions may also need nebulizers, including those with chronic bronchitis or emphysema (which are types of COPD); the flu; and even Covid-19.
How does a nebulizer work?
A nebulizer is an important tool, as it can save a person’s life by literally allowing patients to breathe more easily and get enough oxygen in their lungs, Dr. Mareiniss says.
Albuterol, ipratropium, epinephrine, and corticosteroids are some of the most common medications used in nebulizers, he explains.
When the medication turns from liquid into a mist, it is easily and comfortably inhaled via a mask in slow, deep breaths for 10 to 15 minutes.
Albuterol helps open up airflow obstruction by relaxing the bronchial smooth muscles, which contract during exacerbations of asthma and COPD.
Ipratropium blocks acetylcholine (a neurotransmitter) at sites in the smooth muscles of the lungs, essentially dilating bronchioles to allow air to flow into the lungs more easily.
“Albuterol and ipratropium nebulizer treatments dilate bronchioles that are limiting airflow or spasming during an asthma attack or COPD exacerbation,” Dr. Mareiniss explains.
Epinephrine stimulates the alpha, beta-1, and beta-2 adrenergic receptors in the lungs, which can help decrease swelling in airway emergencies like severe croup, Dr. Mareiniss notes. Croup is a barking cough and swelling of the upper airway in children, usually due to a viral infection.
This upper airway swelling can obstruct air flow in the back of the throat.
What is the difference between an inhaler and a nebulizer?
Both a nebulizer and inhaler work by delivering medication in a spray or a mist to make it easier to inhale.
The most common type of inhaler is called a metered-dose inhaler (MDI) and it works much like a spray can—the medicine is mixed with an aerosol in a canister and is delivered under pressure when you push a button.
You need to put the inhaler in your mouth, press the button, inhale, and then hold your breath for a 3 to 5 seconds, so the medicine ends up in the lungs.
Nebulizers are generally a better treatment option for children than metered-dose inhalers because they require less effort. You don’t need to press the button and inhale as with inhalers, a level of coordination that can be tricky for kids, Dr. Mareiniss notes.
“MDIs require patients to inhale at appropriate times and take more effort to use effectively,” he says.
There are a number of nebulizers for children. Some of them are designed to look like animals or cars, to make them more appealing and less scary for little ones.
A nebulizer has passive inhalation, which also translates to less work for both adults and children.
“An inhaler is more portable but lung penetration isn’t as good as the aerosolized nebulizer,” says Purvi Parikh, MD, an immunologist with Allergy & Asthma Network. “An inhaler takes more effort.”
Bottom line: Nebulizers and inhalers are both effective, but both come with pros and cons.
A nebulizer takes less effort, and can be used for longer periods, making it a potentially life-saving device for someone suffering from a severe asthma attack.
However, an inhaler is more portable, making it more accessible for emergency situations, or a more convenient option for someone with less severe symptoms.
You and your provider can decide if a nebulizer is the best way to get the medicine you need.
The choice of device may be based on whether you find a nebulizer easier to use, what type of medicine you take, and the severity of your condition, explains Dr. Parikh.
How do you use a nebulizer?
A nebulizer consists of the nebulizer machine, tubing, medicine cup, and mouthpiece or mask. The NIH’s National Asthma Education and Prevention Program (NAEPP) encourages people to follow the manufacturer’s instructions.
However, the offer the following steps to set up and use a nebulizer:
- Wash hands well.
- Put together the nebulizer machine, tubing, medicine cup, and mouthpiece or mask according to manufacturer’s instructions.
- Put the prescribed amount of medicine into the medicine cup. If your medicine comes in a pre-measured capsule or vial, empty it into the cup.
- Place the mouthpiece in your mouth and close your lips around it to form a tight seal. If your child uses a mask, make sure it fits snugly over your child’s nose and mouth. Never hold the mouthpiece or mask away from the face.
- Turn on the nebulizer machine. You should see a light mist coming from the back of the tube opposite the mouthpiece or from the mask.
- Take normal breaths through the mouth while the machine is on. Continue treatment until the medicine cup is empty or the mist stops, about 10 minutes.
- Take the mouthpiece out of your mouth (or remove the mask) and turn off the machine.
- If using an inhaled corticosteroid, rinse mouth with water and spit it out. If using a mask, also wash the face.
How do you clean/care for a nebulizer?
The NAEPP also offers tips on cleaning and caring for a nebulizer.
After each treatment
- Wash hands well.
- Wash the medicine cup and mouthpiece or mask with warm water and mild soap. Do not wash the tubing.
- Rinse well and shake off excess water.
- Air dry parts on a paper towel.
Once a week
Disinfect nebulizer parts to help kill any germs. Follow instructions for each nebulizer part listed in the package insert. Always remember:
- Do not wash or boil the tubing.
- Air dry parts on a paper towel.
Between uses
- Store nebulizer parts in a dry, clean plastic storage bag. If more than one person uses the nebulizer, keep each person’s medicine cup, mouthpiece or mask, and tubing in a separate, labeled bag to prevent the spread of germs.
- Wipe surface with a clean, damp cloth as needed. Cover nebulizer machine with a clean, dry cloth and store as manufacturer instructs.
- Replace medicine cup, mouthpiece, mask, tubing, filter, and other parts according to manufacturer’s instructions or when they appear worn or damaged.
Different types of nebulizers
In addition to kid-friendly nebulizers, there are a number of other types of models on the market.
There are medical grade nebulizers, generally higher in quality and larger in size.
There are also more portable nebulizer options, which can be taken on vacations because they are lighter.
Where to get one, how much do they cost, and does insurance cover them?
Nebulizers are available over-the-counter without a prescription, running an upward of $100.
Most major insurance companies will cover a nebulizer and the medication that goes into them if you have a prescription.
You should check with your insurance company before purchasing one.
Next, try these exercises to build stronger lungs.
- Purvi Parikh, MD, an immunologist with Allergy & Asthma Network
- Darren Mareiniss, MD, Assistant Professor of Emergency Medicine at Sidney Kimmel Medical College – Thomas Jefferson University
- National Institutes of Health: "How to Use a Nebulizer"
- NIH's National Asthma Education and Prevention Program: "How to Use a Nebulizer"
- American Lung Association: Chronic Obstructive Pulmonary Disease
