What is a nebulizer? Learn how it works and why you might need one

What is a nebulizer machine? | How does a nebulizer work? | Types of nebulizers | How to use a nebulizer | How to clean a nebulizer | Nebulizers vs. Inhalers | Where to buy a nebulizer machine | FAQs

If you have asthma, you know how difficult it can be to find relief from your symptoms. Perhaps more challenging is being a parent of a child with a respiratory condition. Watching your little one go through coughing spells is tough, but teaching them how and when to use an inhaler can be even harder. Fortunately, there’s an equally effective alternative that can be more comfortable and convenient than using an inhaler. Ask a doctor about using a nebulizer machine.

What is a nebulizer machine?

Nebulizer machines are electric devices that turn liquid medicine—like albuterol, an asthma medicine—into a fine mist. By turning these medications into a fine mist, it is easier to get the active ingredients deeper into the airways where their effects are needed the most. A nebulizer is a machine that requires a power source. While most nebulizers are relatively compact and can travel easily as long as you have access to a power source, they are not quite as convenient as metered-dose inhalers, or MDIs. MDIs also turn these medications into a breathable mist. The mist may not be as fine as the one produced by a nebulizer, and MDIs require a level of physical, mechanical, and breathing coordination that is hard to accomplish for some, especially young patients. 

How does a nebulizer work?

Nebulizers can produce the fine medication mist via a few different mechanisms. Compressor nebulizers have been around for many years and work by mechanically providing pressure which forces the liquid medication into a fine mist to be breathed in. Ultrasonic nebulizers are newer, and achieve the same result using high-frequency vibrations. The medication that has been turned into a fine mist then travels through connected tubing to either a face mask or mouthpiece where the patient can then take in slow, deep breaths which allow the medication to reach the intended deeper points of bronchial airways. It typically takes approximately 10 minutes of repeated deep breathing to complete a nebulizer treatment for most medications.

Who needs a nebulizer?

Nebulizers help treat many people with conditions like:

• Asthma and asthma attacks: Spasms of the airways that are usually caused by an allergic reaction.
• Chronic obstructive pulmonary disease (COPD): A chronic inflammatory lung disease that blocks airflow from the lungs. 
• Cystic fibrosis: A hereditary condition in which the body makes thick, sticky mucus that clogs the lungs and pancreas.
• Other respiratory diseases and coughing spells

Nebulizers help treat these conditions by allowing prescribed medications to reach the lungs, where they’re absorbed and can quickly alleviate symptoms. Medications commonly prescribed by physicians for use in nebulizers include:

• Beta2-agonists (bronchodilators): A drug that widens the airways of the lungs to increase airflow in those with breathing problems. Short-acting beta-agonists can provide fast relief to asthma symptoms.
• Corticosteroids: A steroid that stops inflammation to prevent asthma symptoms.
• Antibiotics: Inhaled antibiotics treat airway infections.

Types of nebulizer machines

Several different types of nebulizers are available for purchase. These include:

• Portable nebulizers are battery-powered and smaller than home nebulizers. They’re an option for people who need to take medication while they’re away from home.
• Ultrasonic nebulizers pass ultrasonic waves through the water to create a mist. They tend to be quieter and smaller. 
• Mesh nebulizers may deliver higher doses of medicine faster than other types of nebulizers, and are relatively lightweight and portable. 
• Jet nebulizers use compressed air to turn medicine into a mist. They can be very loud and heavy.

How to use a nebulizer

Using a nebulizer is easy to do if you follow some basic instructions. You should always follow the manufacturer’s instructions on how to use your nebulizer, but here’s a basic overview of how to use one correctly:   

1. Make sure that the nebulizer is on a flat surface that will support its weight.
2. Plug the nebulizer’s cord into an outlet.
3. Thoroughly wash and dry your hands to make sure that no dirt or bacteria gets into the nebulizer.
4. Remove the top of the nebulizer.
5. Insert your medication into the machine’s medicine holding chamber. Some nebulizer machines do not require any additional liquid apart from the medication, which means shorter treatment times.
6. Connect the nebulizer’s tube to the liquid container.
7. Attach the mouthpiece/mask. 
8. Turn the nebulizer on and make sure that the medication flows properly.
9. Sit up straight. 
10.  Place the mask around your nose and mouth, making sure there are no gaps. If you’re using a mouthpiece, place it between your teeth and seal your lips around it.  
11. Take slow, deep breaths until all of the medicine is gone. 
12. Remove the mouthpiece/mask and turn off the nebulizer. 
13. Wash and dry your hands.
14. Clean the machine.

How to administer a breathing treatment

For parents or caregivers who have to administer a nebulizer treatment to a child or someone else, many of the steps are the same as above: 

1. Make sure that the nebulizer is on a flat surface that will support its weight.
2. Plug the nebulizer’s cord into an outlet.
3. Thoroughly wash and dry your hands, so no dirt or bacteria gets into the nebulizer.
4. Remove the top of the nebulizer.
5. Insert your medication into the machine’s holding chamber.  
6. Connect the nebulizer’s tube to the liquid container.
7. Attach the mouthpiece/mask.
8. Turn the nebulizer on and make sure that the medication flows properly.
9. Have the patient sit up straight. 
10. Hold the mask up to the nose and mouth of the person receiving the treatment. Secure the mask snugly over the nose and mouth, making sure there are no gaps. You might have to hold the mask in place for someone while the nebulizer runs. 
11. Make sure that the person you’re assisting breathes in and out slowly until all of the medication is gone.
12. Remove the mouthpiece/mask and turn off the nebulizer. 
13. Wash and dry your hands.
14. Clean the machine.

Administering a nebulizer treatment for babies can be difficult because of how often they move around. Waiting until the baby is sleeping can be a great way to make sure the nebulizer treatment goes more smoothly. Some machines even have a pacifier attachment that makes administering a breathing treatment easier. 

How to clean a nebulizer?

Properly cleaning a nebulizer is an essential part of owning and using one. 70% of nebulizers used by children with cystic fibrosis are contaminated with microorganisms, according to a study in the BMC Pulmonary Medicine journal. Regular cleanings help keep dirt and bacteria out of the nebulizer, which can be harmful if inhaled. To properly clean a nebulizer, follow these steps:

1. Wash the nebulizer cup and mask or mouthpiece after each use with warm, soapy water.
2. Air dry these components before using them again.

 To disinfect a nebulizer, which should be done every three days or so, follow these steps:

1. Prepare the disinfectant solution that came with your nebulizer, or mix one part vinegar with three parts water.
2. Soak the equipment in the solution for about 30 minutes. You do not need to clean the tubing that connects the compressor to the air compressor. 
3. Thoroughly wash the parts that were soaking in disinfectant with warm soap and water.
4. Air dry completely before using it again. 

Nebulizers vs. inhalers

Nebulizers and inhalers are both used to deliver fast-acting or long-term control medications directly into the lungs. They are both used to treat many of the same conditions and administer similar medications. Commonly prescribed inhaled medications include:

• Albuterol (2 puffs of albuterol from an inhaler would be the equivalent of about 2.5 mg in a nebulizer)  
• Xopenex  
• Levalbuterol
• Pulmicort

Furthermore, there are no side effects from using a nebulizer versus an inhaler. The medication inside the device would cause any side effects that you do experience.

Inhalers are portable, handheld devices that deliver medicine as needed. Nebulizers are much larger, and often need to be connected to a power source to work. Inhalers are more challenging to use than nebulizers, especially for small children. Many doctors will prescribe nebulizers instead of inhalers for children because there’s less room for user error. 

“Inhalers require a specific technique and skill in order for the medication to go into the lungs,” says Leah Alexander, a pediatrician in New Jersey and medical consultant for Mom Loves Best. “Children and some adults use an aerochamber with their inhaler. This eliminates the risk of improperly taking the medication (such as spraying the mouth instead of inhaling the medication into the lungs). Some newer inhaler products have a dry powder formulation to facilitate the process of taking these medications.” 

In addition to dry powder inhalers, metered-dose inhalers (MDI) could be helpful to those who find it challenging to use an inhaler. MDIs will automatically release a premeasured amount of medication when someone inhales; however, this doesn’t entirely solve the problem of improper use. Inhalers deliver the medication instantaneously however nebulizer takes five to 10 minutes. Unlike inhalers, the nebulizers need to be cleaned after each use. 

Recap: Nebulizer vs Inhaler
	Nebulizer	Inhaler
Uses	Respiratory conditions, like asthma, COPD, chronic coughing	Respiratory conditions, like asthma, COPD, chronic coughing
Drug delivery	Aerosol or fine mist	Hydrofluoroalkane, soft mist, or dry powder
Size	Portable machines are available but most models must be plugged into a power source for at-home breathing treatments	Pocket-sized and portable for quick relief on the go
Ease of use	Very easy to use or administer, especially for children	Requires some coordination an inhalation technique that may be difficult for some
Treatment time	Usually 5-10 minutes	Instantaneous

Which is better?

So, is it better to use an inhaler or a nebulizer? That depends on the individual and their health condition. A doctor can recommend the right device and medication on a case-by-case basis, but infants and young children will likely need to use a nebulizer instead of an inhaler.

The best way to determine if a nebulizer or inhaler is better for you is to talk with your healthcare provider. He or she can recommend what’s best for you and prescribe the proper medication to go along with your nebulizer or inhaler.

Where to buy a nebulizer machine

Nebulizers are easy to find and are available to purchase at many pharmacies, like Walgreens or Rite Aid. They’re also sold by online retailers and in many doctor’s offices.  

You can buy a nebulizer over the counter, but you’ll likely need a prescription to purchase the medication that goes inside it. Nebulizers and medications are often prescribed together.

Nebulizers cost anywhere from $10 to over $100. The type of nebulizer you need will depend on your symptoms. A healthcare provider can recommend or prescribe a nebulizer that will work best for you. When a doctor prescribes a nebulizer, it may be covered by your health insurance plan. If not, you can still save money on the machine and medicine with a SingleCare card. SingleCare provides free coupons for prescription medications and even offers discounts on medical devices like nebulizers.

Frequently asked questions about nebulizers

What medicine goes in a nebulizer?

Most commonly, the medications that go in nebulizers are those indicated for diseases like asthma, bronchitis, and COPD. These include bronchodilators like albuterol,  levalbuterol, and ipratropium which help widen the airways. Corticosteroids such as budesonide, which help decrease inflammation in the airways, have formulations designed for nebulizers. There are some antibiotics with nebulizer formulations as well, one example being gentamicin.

You don’t have to use medication in nebulizers, sometimes your healthcare professional will recommend using sterile water or sterile saline in your nebulizers. This type of treatment serves to help moisten the mucosa (the tissue lining of your airways). This can help calm a bothersome cough and soothe allergy symptoms.

Do you need a prescription to buy a nebulizer machine?

There are certain types of nebulizers available for sale without a prescription, mostly from online retailers. They start out at about $50 in price and go up from there. The nebulizers sold in store front pharmacies are typically labeled as “rx only” meaning they require a prescription to be sold by law. Getting a prescription is typically to your advantage anyway. Most insurance plans will cover the cost of some or all of the nebulizer, but only if you have a prescription. Since your doctor is likely ordering the medication to go in the machine, have them go ahead and order the nebulizer and supplies like the tubing and mask or mouthpiece too.

What type of nebulizer is best?

All nebulizer types work to deliver the medications you need effectively, but you may need to consider portability and your access to a power source. Having a battery operated nebulizer is convenient because you will be able to use it even if you are not able to be near a plug, but you will need to consider having replacement batteries or the ability to recharge batteries. Some of the older models of compressor nebulizers are quite heavy and bulky, so if you are traveling with it, this could become a burden. There are compact, portable nebulizers which eliminate the need for tubing and have a very compact setup. It’s not uncommon for some patients to have multiple nebulizers. They may choose a more portable nebulizer for travel or diaper bag storage and have a more traditional, plug-in compressor style one for home use.

What supplies do you need to use a nebulizer?

Most nebulizers require additional supplies which you must clean regularly and replace occasionally. This includes the receptacle where you place the medication to be aerosolized. There is also tubing that runs from the medication container to the delivery piece, and then the delivery piece, which is a mask or mouthpiece. These can all be disconnected from the nebulizer after each use and washed with warm, soapy water. They should be allowed to dry completely to prevent the growth of mold or mildew. These pieces are made of plastic, which over time will become brittle and discolored, and you should replace them. These supplies are typically universal between the different brands and types of nebulizers. 

Can you take a nebulizer through airport security?

Nebulizers and other medical devices like CPAP machines can be brought through airport security in carryon bags according to the Transportation Security Administration. They must be removed from the bag and undergo x-ray screening at the security checkpoint. If it runs on an lithium ion battery, it must be in carryon luggage, but other types of batteries or power sources can generally be in carryon or checked luggage.