Nebulizer

Mary Grant · 03-24-2003, 02:05 PM

Do any of you use a nebulizer? My asthma is getting worse and I'm wondering if any of you who use one can tell me whether or not it shortens your episodes and works better than your inhalers (I use five of these suckers each day). Does anyone have a portable one? They are expensive, so before I buy one, I'd like any advice you have to offer.

Thanks - Mary

wrin · 03-24-2003, 10:42 PM

The super-portable ultrasonic nebulizers can't be used to nebulize Pulmicort.

They've found the traditional aerosol nebs that work continuously don't work so great unless you top up the fluid that goes in them -- like use more than just 2.5mL. Try going at least 5. Treatment lasts longer but you get more drug at the end of the day.

It's tough to say if they actually work better -- they are certainly a hell of a lot more expensive -- the theory is that either they work just as good as MDIs and the real benefit comes from making the patient sit and calm down and breathe deeply, or if they actually do improve lung deposition. The jury's still out on that, but if you DO buy a nebulizer, buy a good one, like a Pari. The Pari neb cups are about five times as expensive as the traditional ones but they also last six times longer, and come with a warranty, and actually work better.

If you don't actually need one, and your MDI puffers do fine, it might not be such a great investment -- medications for the nebulizer are more expensive than MDI medications, and you end up actually taking a larger dose of drug. Ventolin in MDI you get 200mcg per actuation, whereas a neb of Ventolin is 2.5 mg. It's a great way to give drugs in emerg -- in high doses -- but you'll have to check it out and see if there's a good chance of you having clinical benefit from it. They're a lot more upkeep, you have to keep replacing parts, cleaning parts properly, make sure the equipment gets maintained properly.

If you're in some parts of Canada, I know there's government agencies that will loan you the lightweight compressor required to jet nebulize medications. They'll take care of the maintenance for you.

charleyhorse · 03-25-2003, 12:44 AM

Hi Mary. I have a nebulizer but only use for Ventolin and Atrovent when I am getting too close to a visit to the emergency ward. Researchers say that a puffer and spacer work just as well, but personally I find the nebulizer does work better if I get to the point where I have virtually no air movement (I know you're not supposed to even let it get that bad, but sometimes things happen). Most hospitals in this part of Canada still use nebulizers in their emergency wards. I also use a nebulizer for a few days immediately after a hospital stay but try to switch to puffers as soon as possible.

I would suggest talking to your doctor about it. I agree with everything Wrin warned about. This is definitely not a cost saving or time saving alternative. It takes 10-20 minutes to do a treatment, depending on what you are putting in the mix.

Have you tried some of the combination puffers? I used to take up to 14 'puffs' a day when I was using Pulmicort and Serevent separately. Now I get by fairly well on just two puffs a day of Advair (combination of Flovent and Serevent).

Barb

Mary Grant · 03-25-2003, 03:28 PM

Wrin and Charleyhorse: thanks for your info.

Every day morning and evening I do one Advair, two puffs Flovent, and 4 puffs Intal. When asthma onsets, I add Combivent (4 puffs/every 4 hours), which I'm afraid of since it's contraindicated if one is allergic to peanuts and since it makes me feel very jittery, and 4 puffs Albuterol, the latter two of which are supposed to be done only every four hours. But I need them more frequently. I nave night-time asthma but lately it's happening daytime as well. I'm usually down two days in bed with extreme exhaustion. I mentioned a portable neb since I would need to bring it to work on bad days. I do have, thank God, a physician that will give me sleeping pills on bad nights. I was hoping to shorten the two days in bed by using a nebulizer. I live in California. I think you're both in Canada so we may have different names for different meds. I'm going to have to download some of the info you gave me and ask questions in a separate post because I didn't understand some of your advice.

Thank you both so very much for taking time to answer. I'll be back.

Mary

wrin · 03-29-2003, 07:15 PM

Problem with you going to nebulized solutions is you can't get advair as a nebulized solution.

You can't get flovent as a nebulized solution, and you can't get serevent as a nebulized solution.

The only corticosteroid you can get as a nebulized solution is Pulmicort, which comes as a drug suspension, and thusly can't be used in an ultrasonic nebulizer setup. This means that the portable neb that you would buy would have to be a lightweight jet compressor type unit.

Intal and combivent you can get as a nebulizer solution no problem. They can even be mixed, makes for a faster treatment.

It sounds to me like if you have to take 4 puffs of combivent every 4 hours (That's a puff an hour, or roughtly twice the recommended dose,) it's possible yo0u're not taking the puffers properly. Look into purchasing a spacing device before you get a nebulizer. They're a hell of a lot cheaper, and if that's all it takes to do the job, then great!

The different-names-for-different-meds up here ... most everything is called the same thing, except for Albuterol, which in Canada is called Ventolin. (Airomir is what 3m is marketing their HFA as but you can get some generic ones that are still called Ventolin HFA.)

Please post questions -- we'd be happy to answer!