Other methods include inhalers, oral therapy such as tablets & intravenous therapy. It is largely used in clinical settings for the treatment of acute respiratory ailments as well as for the long-term treatment of obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis and bronchiectasis.

A nebulizer converts liquid medicine [either a solution or suspension] into vapour, aerosol or a mist so that it can be inhaled by the patient and effectively delivered directly into the lungs. The main purpose of nebulisation is to allow the medication to reach the lungs quickly and effortlessly, with very little need for coordination by the patient, a common challenge seen with handheld inhalers. Hence, it is the preferred mode of medication delivery for children, elderly, and patients who cannot effectively use handheld inhalers for various reasons.

Despite its wide acceptance and application, nebulisation therapy also attracts criticism. Often, the reasons for this are lack of knowledge, and misinformation about the use of nebulisers. With the aim of spreading knowledge and promoting the correct use of nebulisation therapy, Cipla has started a public initiative called Good Nebulisation Practice or, simply, GNP.

• Nebulisers can convert a liquid medication into a fine mist or aerosol, thereby making it directly available for inhalation.
• Using a nebuliser requires minimal co-ordination for inhalation.
• The jet nebulisers (these are the most commonly used nebulisers) are compatible with a variety of medication solutions.
• Nebulisers can be used in infants, very old or weak patients, or those who need immediate treatment for an acute condition
• Works in patients who are unable to breathe in deeply due to a respiratory condition [low measure of inspiratory flow].
• Breath-holding is not absolutely essential for efficacy.
• The concentration of the medicines to be used can be adjusted [by diluting with isotonic saline] if needed.
• Nebulisers have the ability to deliver larger doses compared to the other aerosol devices

Nebulisation does not cause addiction. Nebulisation uses the same medicines that are present in the tablets or syrups used for oral treatment; the only difference is that to enable nebulisation, these medicines are provided in a liquid form. Nebulisation simply converts this liquid medication into a mist or an aerosol so that it can be inhaled easily.

• Nebulisation does not need high dosages of medicine. Nebulisation converts liquid medicine into a mist or an aerosol form so that it can be inhaled and directly reaches air ways and the lungs. Since the medicine reaches directly into the lungs, the dose of medicine required is lower than that present in tablets or syrups to give the same level of therapeutic effect.
• In fact, the dosage for nebulised medicines is 10 to 20 times lower than with the oral or intravenous medicines.
• However, the dosage for nebulized medicine is higher [~2-3 times] as compared to handheld inhalers. This is because during nebulization process, some amount of mist generated is lost during exhalation.

In nebulisation, low dosage of medicine [as compared to oral medication] is used as the medicine gets converted into a mist or aerosol form that can be directly inhaled into the airways and the lungs – this focused efficacy means that the chances of side effects are also less. This is unlike oral medicines (syrups or tablets), which not only needs to be given in higher dosages to have an effect but also first has to go into the stomach and then get distributed in the body, due to which they can potentially cause more side effects.

As the medication is delivered directly to the diseased or affected area, it actually acts in a shorter time compared with oral treatments such as syrups or tablets.

Nebulisation use is not for asthmatics alone. It can be used to provide speedy relief from congestion, wheezing and breathing difficulty in many respiratory conditions, including bronchitis, asthma, COPD, cystic fibrosis and bronchiectasis. It can be especially beneficial in infants, small children and elderly individuals who face difficulties with the use of other devices. But nebulisation should be given only if recommended by the doctor.

The procedure of nebulisation is simple and can be carried out at home too as per the doctor’s recommendations.

Using a mouthpiece correctly or wearing a face mask that fits tightly will ensure that the full medicine dose reaches your airways and lungs, thereby providing you with speedy relief.

Actually, nebulisation is an effective method to deliver medicines to the lungs and airways in infants and young children. In small babies, inhaling through a nebuliser is easier than with other devices. Also, smaller dosages of medicine are required compared with oral medicines, thereby reducing the risk of side effects.

Nebulisation should be done sitting in an upright position [desired position]. You can either hold your child upright in your arms or make him/her sit in a chair. This position helps to minimise breathing difficulty and allows maximum lung expansion in order to ensure that the maximum amount of medication reaches the airways and the lungs.

A mouthpiece is better as it reduces contact of the medicine with or deposition on the facial skin or eyes and, thus, reduces the chances of side effects. It also increases the efficiency of nebulisation as the medication mist is directly taken in through the mouth. If a face mask is used, the patient should be encouraged to breathe through the mouth and not through the nose – otherwise, the medication aerosol will get filtered out in the nasal passage itself and will be unable to enter the airways.

A crying child breathes in a fast and shallow manner – the inhalations are short and the exhalations are long. Doing nebulisation at such a time will only result in reduced intake of the medication mist and lower deposition of the medicine in the lungs.

Like with every device, your nebuliser also requires proper and timely maintenance. All the parts such as the tubing, the mouthpiece or the face mask should be checked, cleaned and replaced as per the instructions provided in the device manual.

To prevent infections, the nebuliser accessories such as the face mask, mouthpiece, baffle, filter and medication cup (except the tubing) should be cleaned after every use and disinfected daily.

No, the effectiveness of treatment does not depend on longer duration of nebulisation. Nebulisation should be carried out for the specific duration recommended by your doctor after which continuing nebulisation does not impart any benefit. Typically, when you use a jet nebuliser, nebulisation should not be done for more than 10-15 minutes. You should never continue nebulisation till the liquid dries up in the medication cup. There is always some amount of liquid medicine left behind that cannot be nebulised; considering this, the dose of the medicine is already adjusted in the respule.

Nebulisation should be used only if your doctor recommends it. Your cough can be due to any other cause and needs to be properly diagnosed by the doctor before he/she can make a recommendation, if needed, for the use of a nebuliser.

Be vigilant

Close supervision is necessary when you administer nebulisation treatment to your child.

Be positive

Children can easily gauge the emotions of their parents and respond to them. Hence, it is a must to be positive and confident about nebulisation so that your child too mirrors this outlook and nebulisation takes place easily and effectively.

Communicate with your child

If your child is old enough to understand, make an effort to talk about nebulisation and how exactly it can make his/her condition better quickly.

Distract your child

It will help to keep your child distracted with other things during the nebulisation procedure – these will keep his/her mind occupied and calm and even help you both bond further. Here are a few suggestions:

• Provide a favorite toy to play with
• Narrate an interesting story
• Play some engaging cartoons or a video game
• Play or hum a favorite song for a relaxing effect

Nebulize in the right position

Some children prefer to sit upright on a chair, whereas others prefer to nestle in their parent’s arms. Children should always be held or made to sit upright while nebulising to give good results. The right position can simplify and ease the process of nebulisation.

Avoid nebulizing when your child is asleep or lying down

There is a risk that the medicine will not reach the lungs if you try to perform nebulisation on your child while sleeping as his/her mouth will be closed. When the child is asleep, the breathing is shallow and through the nose, which decreases the efficiency of nebulisation. There is also a chance that the child will get traumatised on being rudely woken with a mask on his/her face.

Get rid of the fear of the mask

• Small children may feel that they will not be able to breathe through the face mask and revolt against wearing it.
• Show them pictures of divers and snorkellers to remove this fear.
  Tell your child that he/she is a superhero and needs to wear a face mask.
• Demonstrate by wearing the face mask yourself. You can stick pictures of your child’s favourite cartoon character on the face mask to make it seem less fearful.

Use the power of touch

Touch therapy can be one of the most calming things and envelops your child with a feeling of protection. Hold your child in your arms or hold the child’s hand during nebulisation, if need be. Pat or caress your child during the nebulisation process to show encouragement and provide reassurance.

Appreciate your child

After the nebulisation is over, give your child lots of appreciation, praise and hugs for participating in the procedure. This type of positive reinforcement is necessary to remove any fear or discomfort about nebulisation.

For some patients, using nebulisers while travelling can become cumbersome. Travelling should be done after a check-up, consultation and approval from your doctor. With the availability of portable, sleek and lightweight nebulisers, travelling can be easier; however, the type of portable nebuliser to buy should be based only on your doctor’s recommendation.

The following tips can help you plan your journey if you have to travel with a nebuliser:

• Before travelling, check if you have packed all the parts of the nebuliser kit – for example, in case of a jet nebuliser, check whether you have packed the compressor, tubing, medication cup/cap, face mask/mouthpiece and one nebuliser filter.
• Pack the nebuliser kit in bubble wrap to avoid breakage or damage.
  If you have been advised to use a portable, lightweight nebuliser, ensure that you carry it safely in a pouch or as per the manufacturer’s storage instructions.
• Preferably, carry a portable nebuliser that can be plugged into a car’s accessory power outlet or a power bank (depends on the make of the nebuliser).
• Carry additional batteries for the nebuliser in case of loss or damage.
  Take an adapter if you are travelling to a different country.
• Carry enough quantity of all the necessary medicines for nebulisation that have been recommended by your doctor.
• Keep rescue medicines(inhalers with spacers) handy.
• During air travel, check whether the airline you will be flying with allows a nebuliser to be carried/used on board.
• Go for a check-up before travelling to assess your or your patient’s (if you are a caregiver) present condition and adjust the medication dosage, especially in chronic cases.
• Ensure that you clean and disinfect the nebuliser kit even when you are travelling.

1. What is a nebuliser or nebuliser system?
   A nebuliser is a medical device that turns liquid medication into a mist or an aerosol so that it can be inhaled directly into the lungs through a face mask or a mouthpiece.
2. Are inhalers and nebulisers the same thing?
   Nebulisers and inhalers are different types of devices. They both are used to deliver medicines in aerosol or mist form to the airways and the lungs. Nebulisers are usually powered by electricity or batteries. An inhaler is not powered by electricity and is usually handheld.
3. Who should undergo nebulisation?
   Nebulisation should be done only on a doctor’s prescription or recommendation. It is suitable for a certain group of patients who cannot use the handheld inhalers effectively – for example, patients who are very sick, those who are old and have comorbidities that limit their physical and cognitive skills, those who need higher dosages of medicine, or infants who cannot use handheld inhalers with or without spacers, or in emergency conditions.
4. Can I use a nebuliser at home?
   A nebuliser should be used at home only when prescribed by a doctor and after clearly understanding the instructions on how to use it. The medicine dosage and the frequency of use should be in accordance with your doctor’s prescription. Moreover, proper cleaning and maintenance of the device should be done regularly as per the instructions in the device manual
5. Does nebulisation cause addiction to the medicine?
   No, nebulisation does not create any addiction whatsoever – the medicines are the same as those that are administered through handheld inhalers.
6. Does nebulisation need a high dosage of a medicine?
   A nebuliser delivers the medication directly to the lungs and the airways. Hence, the medicine dose required is much less than that present in the tablets or syrups used for oral therapy.
7. Can nebulisation be performed in the case of infants and small children?
   Yes, it is safe to perform nebulisation in infants and small children with breathing difficulty – but it should be done only if prescribed by the physician and only after following the instructions on the use of a nebuliser correctly. As a parent or caregiver, you should first clearly understand the steps to perform nebulisation before you use it to treat your child or patient. To know more, click here for Nebulisation in Children.
8. Can I perform nebulisation on my child on my own?
   Nebulisation should be done only if it is prescribed by the doctor. The instructions pertaining to usage, dosage, cleaning and maintenance need to be followed correctly. The medication dosage, nebulisation frequency and duration should be strictly adhered to as per the doctor’s prescription.
9. How many times can nebulisation be performed in case of a child?
   A nebuliser must be used as per your doctor’s recommendation. The medication dosage, frequency and duration of the nebulisation should be strictly adhered to as per the doctor’s prescription.
10. Does nebulisation result in an overdosage of medicine?
    Nebulisation should be performed using the medicine dosage as recommended by the doctor. If it is strictly followed, there are no chances of overdosing.
11. Does nebulisation have more side effects compared with oral medicines?
    When certain medications such as steroids or anticholinergics are to be administered, there are chances of some side effects if the mist comes in contact with the skin or eyes. In such cases, the side effects can be prevented by using a mouthpiece and cleaning of the nose and mouth area after nebulisation with warm water to prevent side effects. Irrespective of any type of nebulised medication used, rinsing of the throat and mouth with water should be done. On the other hand, unlike oral medicines where a high amount of medicine is administered, the systemic side effects are much lower in nebulisation since less amount of medicine is administered.
12. How much medicine should be filled in the medication cup? Can water be used to dilute the medicine?
    The fill volume should not be less than 2 mL, especially when you are using a jet nebuliser. For mesh nebulizers, the fill volume should not be less than 0.5ml. For a nebuliser to work efficiently, the correct fill volume should be used. If dilution is required, normal saline should be used. Water should not be used as it can lead to a dangerous condition called bronchospasm, and cough.
13. Can two people share a mouthpiece or face mask?
    No, it is not advisable to share the mouthpiece or face mask. Sharing can increase the risk of spread of infections from one person to the other. If disposable nebulisers are used, they should be used once and then disposed of.
14. Is it better to use a mouthpiece or a face mask?
    A mouthpiece is better than a face mask. With the mouthpiece, the mist directly enters the respiratory system. It has been documented that nebulisation using a mouthpiece is more effective than a face mask. However, a facemask can be used, as per the doctor’s recommendations, in patients who are not co-operative and in an acute condition.
15. Why is a tight-fitting face mask important in nebulisation?
    A proper and tight-fitting mask can improve the delivery of the nebuliser medication and reduces the chances of wastage of medicine. The tight-fitting mask also prevents the medicine from coming in contact with the eyes. A patient using the face mask should be encouraged to inhale through the mouth.
16. Why do nebulisers need to be cleaned and disinfected?
    It is essential to clean the nebuliser and its accessories after every use and disinfect daily. If any liquid is left in the nebuliser and its parts, germs such as yeast, bacteria and fungus can colonise and multiply. This poses a risk of infection to the patient undergoing nebulisation. Cleaning the accessories after nebulisation and daily disinfection of the nebuliser kills these germs and ensures future germ-free treatment to the patient.
17. Why should the user be in an upright position during nebulisation?
    The user should sit comfortably in an upright position or at a 45-degree angle so as to minimise breathing difficulty and also to allow maximum lung expansion in order to ensure that the maximum amount of medication reaches into the airways and the lungs.
18. Should nebulisation be stopped after 10-15 minutes?
    When using a jet nebuliser, most of the medicine is nebulised in this time span and the leftover medicine cannot be nebulised further. When most of the medicine is nebulised, a spluttering sound is heard, which indicates that the nebulisation should be stopped. However, it is important to note that for mesh (3-10 min) and ultrasonic nebulisers (5-10min), the nebulisation time is even shorter than jet nebulisers.