Asthma UK community forum
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Nebulisers? Does anyone use them here?

Hi all,

Just like to ask what does everyone think about nebulisers? Did they solve your asthmatic problems?

15 Replies
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In what context are you enquiring?

Are you asking on behalf of a marketing company, publishing or other media organisation. Or on behalf of yourself or another asthmatic?

There are people here who do use nebulisers but under strict guidance from their consultants and after every other avenue of drug delivery has been tried.

There are some guidelines on the AUK main site I think and also look up the guidelines on the British Thorasic Society web site.

Incidentally, I do use one, under strict guidance. It hasn't solved my asthma but lessens the problems. I am brittle asthmatic and it helps me to try to live a normal life as I can.

My personal view is that all other methods of control should be used, eg spacers with relievers before nebulisers prescribed as people can become over reliant on them and leave them exposed to potentially fatal situations ( sorry for the alarming comment!!) if they don't get proper medical help.

Nebulisers are most often used by health care professionals in an emergency situation be it the GPs surgery, Paramedics or A&E. a safe controled environment.

I hope I have't been too harsh in my reply.

Kate

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I have to say emphatically that nebulisers absolutely do not 'solve your asthmatic problems'. Far from it.

Like Kate, who has made some excellent comments, I wonder what your motivation is for asking this. I see that you are new to the boards; do you suffer from asthma yourself, or do you have another reason to be interested in this issue?

Just some general comments on the use of nebulisers: (I've posted a lot of this before, but I make no apology for reiterating it).

Nebulised medication is liquid medication that is put into a plastic chamber – air or oxygen is then blown through it to form a mist which is breathed in via a mask or mouthpiece. Many medications can be nebulised, but the most common ones for us lot would be salbutamol, a reliever or bronchodilator (just the same stuff that’s in our salbutamol/Ventolin inhalers, but in much higher doses) and ipratropium, another reliever. Other things that are occasionally nebulised for various reasons include antibiotics, steroids and saline.

The first time someone uses a nebuliser, it can often seem like a ‘magic bullet’, dramatically reversing symptoms of wheeze and tightness. Many people, when they have used a neb for the first time, understandably want access to this apparently amazing treatment at home. Whilst compressor machines and ultrasonic nebulisers can be purchased by anyone, the medication to use in the nebuliser can only be prescribed by a doctor, and therefore it is pointless buying a machine unless you have the approval of your medical team. Hospital respiratory teams will almost always have basic ‘workhorse’ compressor machines available for loan to those who they feel need one.

The decision to give someone a home nebuliser is not one that is made lightly, and will usually be reached by a hospital respiratory consultant in conjunction with the patient, the GP and other healthcare professionals such as respiratory nurses. It is powerful medication and it can be dangerous if used incorrectly.

There are two main reasons why someone would be given a nebuliser at home:

1) If someone has attacks that are so sudden onset and severe that they need to be able to use a neb while they are waiting for the ambulance - this is very rarely the case as the vast majority of people will get as much benefit from 10 - 15 puffs of salbutamol inhaler via a spacer. If someone has a neb for this reason, they should only use it when they have called an ambulance and are waiting for it to take them to hospital, and their GP should keep a close eye on how many nebs they are getting through to make sure of this.

2) Occasionally, someone with very severe asthma who is already on pretty much maximal other treatment will find that they respond so poorly to inhalers that the only way of keeping their airways open is to use nebs fairly regularly. In order that they are not in hospital all the time, for quality of life reasons, they may be given a neb to use regularly at home. This usually happens after many hospital admissions for asthma, and after attempts whilst in hospital to get the patient off regular nebs by adding in other medication. No-one should have a neb for this reason unless they have exhausted all other treatment options without success. There is some risk inherent in this strategy, and many of us who are in this situation will have experienced attacks when they have not sought help in a timely fashion because they have a home neb. The risk has to be balanced against the quality of life issues if the patient does not have a neb at home.

In both these cases, the patient will have very strict protocols about when they can use the neb, how frequently, and how often they can use it before they have to go to hospital. Giving someone a neb at home is always done with a lot of thought and caution on the part of the doctors, and has to be very carefully considered.

There is a very real danger that someone who has a neb at home will have a false sense of security about how easily their asthma can be treated, and will keep nebbing when they really should be getting into hospital and having other treatment. In a severe attack, nebs will often not work alone, and other treatments like IV hydrocortisone, IV magnesium and IV aminophylline may be needed, or even, in an extreme case, intubation and mechanical ventilation. By the time someone gets to the stage where nebs aren't working, they are usually extremely unwell and need to be in hospital very quickly. The large majority of asthmatics, if they are ill enough to need nebs, should be in hospital. It is a very small minority of asthmatics who will benefit from and be safe to use home nebs.

A good proportion of the deaths that occur in this country due to asthma are entirely preventable, and occur because people have underestimated their symptoms and have not got themselves into hospital quickly enough - and a lot of these are associated with the use of nebs.

I hope that this answers some of your questions.

Em H

Doctor and forum moderator

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Hi

I also have a home neb machine but only use it when am quite unwell and am unable to use an inahler and spacer. I know that if I am nebbing fairly frequently I am possibly heading towards a&e and definately require a visit to the Gp!

Sarah

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I also use home nebuliser have done for 8 years under strict guidance of my consultant who is really good.

I to also think as kate said it does help with my asthma but does not take the problem away.

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I agree 100% with what EmilyH replied with, I have had Brittle Asthma with sudden attacks for many years and still my GP or Cons will not let me have a neb at home, mainly as it would prevent me from seeking their help when things get bad, when I see someone nearly always I am leant one to see me through the bad patch but I agree to a certain extent with why they do it, also I am very stubborn and would perhaps not go in for extra help if I had it at hand which can often be the wrong way of managing it.

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I only use them in A&E for an acute attack that I can't control with my inhaler and a spacer. I find that they work really well but can take a few rounds, it's easier than breathing in from an inhaler and feels moister on my lungs so less irritating. In an attack it is a relief to get to hospital and get a neb.

Reading the other very informative posts I don't think I would want the responsibility for having a machine at home unless it really did come down to there being no other option.

Jen

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I have a few concerns about nebulisers if anyone can shed any light??

I have been loaned one by my GP on two occasions, now being one of them, but never been given strict guidelines on the protocol except to use it up to 4 times a day as required. But like some people have mentioned, its difficult to sometimes decide between being safe at home using the neb or whether its time to seek some other help...also because it is a loan, and there could be other patient needing to borrow it, when to return it/versus still needing it myself..

Sorry if what i have written is a bit muddled...bit like my head at the moment..stuck at home when i would love to be back at work ( did not think i would hear myself say that lol)..this asthma lark gets you down :(

Hoping my next visit to the local con will make things a little clearer and reduce the amount of pred i have had in the past 18 months...

Sorry for moaning

Cory x

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Welcome to the forum allergy_matters. The question you asked seems a strange one. I don't think nebulisers are supposed to ""solve your asthma problems"". They are to help you to MANAGE asthma that is severe enough to require nebulised medication.

I hope you have obtained the information that you required from the many informative replies on this thread.

Maz

x

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Hi Cory,

I'm sorry you're struggling at the moment and feeling so muddled and frustrated; I think a lot of us can relate to how you're feeling.

I think you need to seek clarification from your GP or consultant as to how exactly you are supposed to use the nebuliser and what your threshold for admission should be. As previously said by myself and others, nebulised medication is powerful (typically 25 to 50 times the dose of one puff of your inhaler) and can have significant side effects, as well as the risk of giving you a false sense of security about how well your asthma is controlled. Acute attacks can often be managed by taking multiple doses of your inhaler via a spacer (consult your doctor before taking multiple doses) - this has been shown to be as effective as using a nebuliser for the majority of people.

Most people, if their asthma is troublesome enough to need nebulised medication, should be in hospital where they can be closely monitored for side effects and for deterioration in their asthma. By the time someone gets to the point where nebulisers aren't helping, they are very sick and certainly need to be in hospital. It is for this reason that a lot of doctors are very cautious about the use of home nebs. It really is worth exploring alternatives with your doctor.

Protocols for using home nebs vary vastly, according to the severity of the person's illness and the reasons for having the neb (see my post below). None of us can tell you how you should be using it. It is very difficult to assess and most of us who have home nebs would agree that there have been times when we have misjudged things, left it too late calling for help, and ended up more unwell as a result. Nebulised therapy is really not to be taken lightly.

Please do go back to your doctor for clarification of these issues - using a home neb without clear guidance is potentially dangerous.

Hope this helps

Em H

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Hi Cory

I used Nebulizer for my treatment of Asthma, they do work, however like many other medications the effect can wear of after using them over a long period of time.

My Asthma is under Control now has been for the past five years since I started using Singular 10mg at night. Also stayed away from e numbers and food colourings. I find anything that as a strong red or Orange colouring effects my Asthma badly.

Hope this helps.

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I've used a Nebuliser for 5 years with 5mg salbutamol nebs upto 4 times a day. Nearly 4 weeks a go, I had a double bypass op and my salbutamol nebs usage has halfed and inhaler usage is now nil.

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Ashtmaandtrees, I am a little concerned about your comment that nebs become less useful over time. 1st cos a an serial neb user and 2nd cos no-one has ever said that in a few years the nebs won't work. I bloomin well hope they do still keep working I can not imagine what I am going to do if the trusty neb becomes less effective. Do you have an research data to back this up. I am aware of flooding the receptors in the lungs but that is only if somewhere tries to give me nebs, IV sal and amino whilst leaving the old sub cut running at max at the same time.

Bex

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Hi Em H

Thanks for the information, will definately take on board what you have said and will head back to the docs for some instructions. Feel a bit silly that i did not ask more at the time but sometimes when feeling unwell, do not think as straight as i should. Thanks godness for the support from people on this site to keep us all sane.

Thanks again

Cory

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nebs

I have uesed a neb on and off for a long time (about 40years ) only when bad but i find thay work well

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There's no evidence at all that using nebulised beta agonists causes them to become less effective over time. Some people do experience a deterioration in their symptoms and find that their nebuliser is becoming less effective, but this is usually due to a deterioration in their underlying condition rather than the nebs 'wearing off'.

Even with high dose iv or subcut beta agonists, the issue of flooding of the receptors and the treatment gradually becoming less effective is very controversial, and many experts in difficult asthma don't consider it to be a significant issue.

If you are concerned that your medication is proving less effective, you should certainly discuss it with your consultant, but please don't let fears that the effects will 'wear off' prevent you from taking your medication as prescribed. If you have been prescribed nebs (with all the caveats I have mentioned in previous posts) then you should use them as you need them.

Em H

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