Is inhaling with a nebulizer in any way better than inhaling with a spacer?

[emkana]

Because I own a nebulizer now and I was wondering whether I should ask the doc to prescribe the medication for ds to be used in the nebulizer?
Does anybody know?

a nebuliser gives you in about 10 or 15 minutes the same amount of reliever there is in an entire inhaler of salbutomal IIRC

I think it must be alot better because it always sorted dd out, whereas we had been at home giving her her inhaler through her spacer and getting no where.

I'm sure one doc told me that it gets to the lungs quicker, and is basically just a better way of doing it.

If you already have a nebulizer, I would definatly ask your doc to give you the medication for it.
We considered it for dd as we were forever going to the hospital for her to just be given the nebulizer and then sent home once she improved.

maybe a home nebuliser is different from surgery one though

That's interesting because I mentioned it to the doc at the hospital on Monday and she said there was no advantage to inhaling through a nebulizer, but I had thought that using a nebulizer seemed more effective.

Hmm i don't think they are different but I could be wrong.

It has to be better, it works so much quicker and would get rid of the need for hospitalization alot of the time I think.

According to the guidelines from the British Thoracic Society a spacer + metered dose inhaler is at least as good as a nebuliser for acute asthma in adults and children.

its a very hose dose of salbutamol though.

how is ds emakna? is his chest still not good? any closer to specialist appointment?

misdee - did you mean high dose?

Ds is still chesty near enough constantly. He had about three good days last week and three good days at the beginning of Oct, apart from that he is alway wheezy/chesty/coughing.

Specialist appointment is on the 6th of Dec.

yes i meant high dose

sorry to hear there is no improvement or let up with his wheezing, this must be so so so worrying for you.

I have a nebuliser at home for ds who's now 22 months I have been told by consultant that 10 puffs of ventolin do equal one nebule but the nebuliser seems to do the job better and has saved us several trips to a&e. He got perscribed the nebules when he was 8 months.

The main difference as far as I am aware is that the medication in a neb is delivered as a aerosol solution, as opposed to a dry powder - at least in the newer inhalers. I have seen people use just a saline solution in a neb to break up mucous so I was going to suggest that maybe the moistness in itself may help. However I googled before posting & found the following info about nebulisers:

And, because the spray is less targeted than with the inhaler, it must deliver large amounts of the drug. This increases the risk for toxicity and severe side effects. Nebulizers should not be used by children who can manage an inhaler.

If you feel that he is able to breath in the drug from a spacer it may be worth sticking with - because of the potential side effects from a higher dose. If however you feel that his breathing is not 'good' enough (for want of a better phrase) to breath the drug into his lungs then a nebuliser may be of more benefit as it is more passive. I think that the main reasons for nebs being used in hospital is that the patient normally has such a poor lung function that they need the more passive intake & they can also be simulateously administered Oxygen.

I have linked the site which I got that excerpt from.

Basically unless your child needs oxygen then a spacer with 10 puffs of a metered dose inhaler, administered properly, should be just as good.

There is a big, big move away from using nebulisers for that reason plus a couple of other ones.

With a nebuliser lots of the drug is put into the rebuliser but because of the way it is administered lots of it is wasted.

There were problems in the past when parents had nebulisers at home in that they would delay seeking medical attention because they could give nebs at home. The thinking now is that if your child does not improve significantly after 10 puffs via spacer then that child needs further medical assessment.

If it is true that a spacer is as efficient as a nebuliser, why when you take your child to A&E (or indeed when they are admitted) do they nebulise them rather than just use a spacer? I'm absolutely certain that our home nebuliser kept DS2 out of hospital many times - he was hospitalised twice, both times before we had the home nebuliser, even though we had been going up to 10 puffs of salbutamol 4-hourly via the spacer.

I don't think we'd have got a home nebuliser if we had lived here at the time though; we were in Singapore.

You can deliver a bigger dose of bronchodilator faster, and you can also deliver a bigger dose of steroids. Sometimes DS2 was on strict 4 hourly nebs at home, so I would be setting my alarm for 1 and 5 and standing over the cot. But at least we were at home.

Cross-posted with Ladida. Basically DS2 only needed oxygen once we had failed to break the cycle - and if we started nebs at the right time, we stopped him getting worse. I always saw the paed if we started nebs anyway, to check that he was not deteriorating.

The nebuliser delivers a moist, massively larger dose in the shortest possible time. It is quickly absorbed and is used when you are in dire straits and can't absorb the bronchodilator via the spacer or puffer. Not necessary to use if you are able to use the spacer, but can be lifesaving if you have difficulty getting to hospital in a hurry. I had a home nebuliser when ds was very small, after a hair-raising drive to the surgery to use theirs. I only needed to use it once more after that - but if he was ill enough to need it I would be getting medical help anyway - ie probably using it at home, then in the car on the way to hospital.

Years ago I got a chest infection which worsened my athsma to the point where I could hardly get any breath. Inhalers didn't work as I couldn't get a big enough breath in to get the stuff down. Went to the surgery and was put on a nebbuliser and it worked almost immediately.

Really frightening but it did make me finally give up the fags

tend to find it easier to take in the salbutamol via nebuliser as it comes in a water and is easier to breath in then breathing via spacer. We are considering buying DD a nebuliser for at home as like nailpolish whenever we go to hospital nebuliser relives her symtpoms in 5mins compared to having been using the inhaler all day.

If the inhaler is for maintenance & the patient is able to breath the medicine effectively there is no real benefit to a neb. It wastes drugs - risks giving a potentially toxic doses - which is why it tends to be reserved for hospital supervision.

To answer why they do use them in hospital - there are 2 main reasons. 1. Oxygen can be co-administered. 2. If you are in hospital your lung function is likely to have deteriorated to the point where you won't be able to effectively use an inhaler.

I am not sure about using a spacer - but in an adult the dose is delivered in seconds with an inhaler as opposed to minutes with a neb - so it is not quicker.

Regarding dose to answer those that say "you can get a bigger dose" with a neb. This is irrelevant as the doc will prescribe the appropriate number of puffs for the dose needed. Steroids & bronchodilators can cause serious side effects when overdosed.

HTH

Anyone seeing a neb working 'better' than an inhaler for maintenance (as opposed to rescue) of symptoms may require more assistance using their inhaler effectively.

Am an adult asthmatic who has deteriorated from chronic to acute in the last few months.
Just bought my home nebuliser yesterday as I have attended A+E so much recently for nebs they practically had a room reserved for me!!
As an asthma sufferer and also as an A+E nurse I feel that a neb is by far the better way to get relief in an acute attack.
The droplets created by the aerosal get deeper into the lungs to bring swifter relief.
When using a spacer for my daughter I have been taught to remove the inhaler from the spacer and shake it before each dose. If you use multiple puffs of ventolin via a spacer there is going to be more accelerant in there than drug.
You can also use the neb with just saline to soothe a dry inflamed airway also.

Basically with a spacer + inhaler then technique is crucial to delivery of the medication. This means that if someone is acutely unwell and very short of breath then technique will be poor so delivery likely to be more effective via nebuliser as no timing or coordination is necessary.

Can I buy saline in the pharmacy?

Thanks for all your posts, this is really interesting.

Not sure but gp could prescribe them for you and if it is for your child it will be free.

The problem with saline nebs for asthmatics/wheezy kids is that it is a high concentration of cold wet particles hitting the airways so can cause reactive bronchospasm so if used it should be with caution. Keeping well hydrated by drinking plenty is a better and less risky solution.

I don't think you can get Saline from pharmacist. I would definately let your GP/specialist know you have a nebuliser and you could then discuss whether it is suitable/a good idea to help DS. They are the best people to tell you. It may be something they havn't considered because of the prospect of providing a nebuliser for use at home on the NHS.

My cousin suffered from Asthma when she was a baby (from about 3-4m I think). I think it may have been before the spacer was invented so they were trying to give her ventolin orally - which was pretty much ineffective. I don't think inhalers were an option in such a small baby back then. After a few weeks her parents mentioned that they had an unused nebuliser & the Doc pretty much said "why the bloody hell didn't you tell me". Got her on neb & acheived great management of her asthma.