After seeing a number of posts on here about the use of home nebulisers, I thought it would be interesting to hear peoples thoughts on the matter. There are a wide variety of Asthma suffers who use these boards so we should have a good mix of people who are a for/against the recommendations below.
Lets hear your thoughts!
The 2008 British Guideline no longer recommends nebulised therapy for the majority of asthma care. It cites evidence suggesting that a spacer and metered dose inhaler (MDI) combination can be as effective, if not more effective, in many situations in which nebulisers were formally used. This includes both acute and stable asthma.
A spacer plus MDI is to be preferred because of the following issues:.
â€¢More effective treatment with fewer side-effects because of better pattern of deposition
â€¢Problems of poor inhaler technique largely overcome but spacers need to be used properly too
â€¢Easily used by children and the elderly (except those with weak or arthritic hands)
â€¢As effective as a nebuliser in treatment of acute attacks but light, cheap, maintenance free, portable and available on prescription
â€¢Useful for treatment of first attacks of wheezing in patients who have not used inhalers before
â€¢Useful for administration of bronchodilator when testing reversibility in the surgery to establish the diagnosis of asthma
â€¢Reduced prescribing costs by basing treatment on the much cheaper metered dose inhalers
There are few cases in which the British Guideline recommends nebuliser use. It initially states that there are insufficient data to make a recommendation about their use in life-threatening asthma. However, later the Guideline does recommend that the nebulised route (oxygen-driven) is used for the delivery of high-dose beta agonists in acute asthma with life threatening features. Nebulisers have however certainly been used in this situation to deliver high-dose inhaled drugs. If a nebuliser is used in the emergency situation, there are theoretical risks of oxygen desaturation whilst using air-driven compressors. Therefore nebulisers should be oxygen-driven with a ""high flow regulator"" fitted to the cylinder in order to provide the necessary flow rate of 6 l/min.
Nebulisers are less useful for domiciliary management of stable asthma, but patient preference should be taken into account, and some patients - especially those with brittle asthma - may have more confidence in nebulisers than in MDIs. Such patients require a verbal and written plan for self-treatment and it is essential that repeated use of the nebuliser does not lead to failure to seek medical help and the prompt use of steroids.