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Ryan Myers
Ryan Myers

Nebuliser


A nebuliser is a device that can deliver high doses of medicine quickly and easily. It works by changing liquid medicine into a fine mist. You then breathe this mist in through a facemask or mouthpiece.




nebuliser



Most asthma attacks and flare-ups can be treated just as effectively using a blue reliever inhaler with a spacer. This is because if you have COPD or asthma, using an inhaler instead of a nebuliser is easier and just as effective, especially if used with a spacer.


If you are living with bronchiectasis, nebulisers can be used at home to deliver a saltwater solution to help manage phlegm build-up. It works by helping to reduce the thickness of phlegm so it's easier to cough it out. Nebulisers can also be used to breathe in antibiotics if you have a bacterial infection. Read more about how bronchiectasis is treated.


If you live with COPD, there is no evidence that nebulisers are more effective at delivering drugs than handheld inhalers as part of your usual treatment. But you may use a nebuliser in hospital for a short time if you have a severe flare-up. Your consultant may also decide to arrange a nebuliser for you to use at home in some circumstances. Read more about how COPD is treated.


You might be told to keep using the nebuliser at home while you recover. Your doctor will give you a discharge plan and instructions for how to use the nebuliser. Your discharge plan should tell you when you can start using your reliever inhaler instead to treat your symptoms.


Your nebuliser needs to be cleaned every day if you use it regularly. Your healthcare professional should give you information about cleaning it. If you buy your own nebuliser, you can ask your healthcare professional how to clean it. The nebuliser may also come with instructions.


Objectives: Evaluation of the characteristics of droplet/aerosol dispersion around delivery systems during non-invasive ventilation (NIV), oxygen therapy, nebuliser treatment and chest physiotherapy by measuring droplet size, geographical distribution of droplets, decay in droplets over time after the interventions were discontinued.


Conclusions: NIV and chest physiotherapy are droplet (not aerosol)-generating procedures, producing droplets of > 10 µm in size. Due to their large mass, most fall out on to local surfaces within 1 m. The only device producing an aerosol was the nebuliser and the output profile is consistent with nebuliser characteristics rather than dissemination of large droplets from patients. These findings suggest that health-care workers providing NIV and chest physiotherapy, working within 1 m of an infected patient should have a higher level of respiratory protection, but that infection control measures designed to limit aerosol spread may have less relevance for these procedures. These results may have infection control implications for other airborne infections, such as severe acute respiratory syndrome and tuberculosis, as well as for pandemic influenza infection.


Background: Bronchodilators are a central component for treating exacerbations of chronic obstructive pulmonary disease (COPD) all over the world. Clinicians often use nebulisers as a mode of delivery, especially in the acute setting, and many patients seem to benefit from them. However, evidence supporting this choice from systematic analysis is sparse, and available data are frequently biased by the inclusion of asthma patients. Therefore, there is little or no formal guidance regarding the mode of delivery, which has led to a wide variation in practice between and within countries and even among doctors in the same hospital. We assessed the available randomised controlled trials (RCTs) to help guide practice in a more uniform way.


Objectives: To compare the effects of nebulisers versus pressurised metered dose inhalers (pMDI) plus spacer or dry powder inhalers (DPI) in bronchodilator therapy for exacerbations of COPD.


Main results: This review includes eight studies with a total of 250 participants comparing nebuliser versus pMDI plus spacer treatment. We identified no studies comparing DPI with nebulisers. We found two studies assessing the primary outcome of 'change in forced expiratory volume in one second (FEV1) one hour after dosing'. We could not pool these studies, but both showed a non-significant difference in favour of the nebuliser group, with similar frequencies of serious adverse events. For the secondary outcome, 'change in FEV1 closest to one hour after dosing': we found a significant difference of 83 ml (95% CI 10 to 156, P = 0.03) in favour of nebuliser treatment. For the secondary outcome of adverse events, we found a non-significant odds ratio of 1.65 (95% CI 0.42 to 6.48) in favour of the pMDI plus spacer group.


Authors' conclusions: There is a lack of evidence in favour of one mode of delivery over another for bronchodilators during exacerbations of COPD. We found no difference between nebulisers versus pMDI plus spacer regarding the primary outcomes of FEV1 at one hour and safety. For the secondary outcome 'change in FEV1 closest to one hour after dosing' during an exacerbation of COPD, we found a greater improvement in FEV1 when treating with nebulisers than with pMDI plus spacers.A limited amount of data are available (eight studies involving 250 participants). These studies were difficult to pool, of low quality and did not provide enough evidence to favour one mode of delivery over another. No data of sufficient quality have been published comparing nebulisers versus DPIs in this setting. More studies are required to assess the optimal mode of delivery during exacerbations of COPD.


A parallel group double-blind randomised controlled trial in 90 hospital in-patients with an acute exacerbation of COPD. Participants were randomised to receive two 2.5 mg salbutamol nebulisers, both driven by air or oxygen at 8 L/min, each delivered over 15 min with a 5 min interval in-between. The primary outcome measure was the transcutaneous partial pressure of carbon dioxide at the end of the second nebulisation (35 min). The primary analysis used a mixed linear model with fixed effects of the baseline PtCO2, time, the randomised intervention, and a time by intervention interaction term; to estimate the difference between randomised treatments at 35 min. Analysis was by intention-to-treat.


We have shown that air-driven bronchodilator nebulisation prevents the increase in arterial partial pressure of carbon dioxide (PaCO2) that results from use of oxygen-driven nebulisers in patients with stable COPD [3]. However, there are only two small non-blinded randomised controlled trials of air compared to oxygen-driven nebulisation in patients admitted to hospital with AECOPD [4, 5]. These trials reported that administration of a single bronchodilator dose using oxygen-driven nebulisation increases the PaCO2 in COPD patients who have baseline hypercapnia.


Robust determination of the risks of oxygen-driven nebulisation in AECOPD could identify whether widespread implementation of air-driven nebulisers, or use of metered-dose inhalers through a spacer, are required to ensure safe delivery of bronchodilators to this high-risk patient group. The objective of this study was to compare the effects on PaCO2 of air- and oxygen-driven bronchodilator nebulisation in AECOPD. Our hypothesis was that two doses of oxygen-driven bronchodilator nebulisation would increase the PaCO2 compared with air-driven nebulisation in patients hospitalised with an AECOPD.


Nebuliser systems are used to deliver medications to control the symptoms and the progression of lung disease in people with cystic fibrosis. Many types of nebuliser systems are available for use with various medications; however, there has been no previous systematic review which has evaluated these systems.


We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching of relevant journals and abstract books of conference proceedings. We searched the reference lists of each study for additional publications and approached the manufacturers of both nebuliser systems and nebulised medications for published and unpublished data. Date of the most recent search: 15 Oct 2012.


The search identified 40 studies with 20 of these (1936 participants) included in the review. These studies compared the delivery of tobramycin, colistin, dornase alfa, hypertonic sodium chloride and other solutions through the different nebuliser systems. This review demonstrates variability in the delivery of medication depending on the nebuliser system used. Conventional nebuliser systems providing higher flows, higher respirable fractions and smaller particles decrease treatment time, increase deposition and may be preferred by people with CF, as compared to conventional nebuliser systems providing lower flows, lower respirable fractions and larger particles. Nebulisers using adaptive aerosol delivery or vibrating mesh technology reduce treatment time to a far greater extent. Deposition (as a percentage of priming dose) is greater than conventional with adaptive aerosol delivery. Vibrating mesh technology systems may give greater deposition than conventional when measuring sputum levels, but lower deposition when measuring serum levels or using gamma scintigraphy. The available data indicate that these newer systems are safe when used with an appropriate priming dose, which may be different to the priming dose used for conventional systems. There is an indication that adherence is maintained or improved with systems which use these newer technologies, but also that some nebuliser systems using vibrating mesh technology may be subject to increased failures.


Nebulisers change a liquid medication into a mist so it can be breathed in. There are different types of nebuliser systems and no review has yet considered whether any nebuliser is better than another. 041b061a72


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