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You should only use a nebuliser if your doctor has advised you to do so.
This information sheet is designed for people already using a nebuliser and
is only intended to be used as a guide. You should always discuss the use of
your medicines with your doctor or nurse.
A nebuliser is a powerful drug delivery system. It should only be used if your
doctor has specifically recommended that you would benefit from this form
of treatment and even then, only under careful medical supervision.
Do not buy, borrow or use a nebuliser without seeking medical advice.
What is a nebuliser?
1. FACE MASK OR MOUTHPIECE.
There is a choice. In consultation with your doctor or nurse, choose which is
2. NEBULISER CHAMBER:
This is a small chamber in which a liquid drug is turned into a fine ‘mist’ or
aerosol, which you can inhale into your lungs.
This is the power source responsible for pressurising the air to produce the
aerosol. We often mistakenly refer to the compressor as the nebuliser. This only
The nebuliser and the drugs used within it are available on prescription through
Most compressors are connected to the mains electricity supply (220 to 240
volts) but portable compressors are available. These can be charged from a
12 volt supply (e.g. a special rechargeable battery, or attached to a car
You can operate some nebulisers with a foot pump, so you don’t need a
powered compressor. These nebulisers may be a useful back up, since they are
less expensive (see the information sheet ‘Nebuliser Suppliers’ for a contact
Medications used in nebulisers
Nebulisers are most commonly used by people with asthma or COPD to take
relievers such as salbutamol, terbutaline or ipratroprium (Atrovent), at a
Generally, you can get the same effect by taking four to six puffs from an
inhaler with a large volume spacer (a large plastic or metal container, with a
mouthpiece at one end and a hole for your aerosol inhaler at the other – it helps
the inhaler get more medicine into your lungs).
It’s rare for a nebuliser to be more effective than an inhaler-spacer combination
– unless you find spacers very difficult to use.
Other medications used in nebulisers are:
– helps you cough-up sticky phlegm (usually given by the
(usually budesonide) – a nebuliser is occasionally used to deliver high
– people with bronchiectasis (a condition where there is scarring
and distortion of the bronchial tubes (airways) which reduces the ability of the
tubes to clear mucus) occasionally use a nebuliser to deliver antibiotics
• Dornase alpha
– sometimes helps to liquefy phlegm in cystic fibrosis
• Morphine and similair drugs
– may be given as part of terminal care when
breathlessness cannot be treated in any other way.
Note: Medications used with nebulisers are very expensive compared to inhaler-
Caution when using nebulised drugs; you should be aware that
• Relying on a nebuliser may be potentially dangerous, particularly for
asthmatics. If you are feeling more breathless than usual and your reliever is
ineffective, taking extra doses of nebulised relievers will only disguise and delay
the need to seek medical advice. Your tight chest is a warning sign telling you to
increase your preventer treatment, possibly take a course of steroids and
• Do not use more reliever (e.g. salbutamol) than you have been prescribed.
A higher dose will only increase side effects.
Self-management for people with asthma and COPD
While using a nebuliser, it is particularly important to have your own individual,
written self-management plan agreed by your doctor or nurse so that you know
what to do if your condition gets worse. It should include Nebulisers IS16
what to do in an emergency and how to recognise danger signs, such as when:
• your normal dosage of reliever is not working
• you need a reliever (e.g. salbutamol) more often than usual
• you are waking at night with breathlessness.
Also, ask your doctor or nurse to write out instructions on how to use
your nebuliser whether you buy, hire or are loaned a compressor with a
• Keeping it clean, getting it serviced and getting it repaired
• How much medicine to use, when to take it and for how long
• How to put the medicine in the nebuliser.
With your doctor, practice nurse or other healthcare professional, you
should practice putting the whole nebulised drug delivery system together
and using it. It is useful to have a family member present to help you
remember. If you have any questions, ask your doctor, pharmacist,
physiotherapist, respiratory nurse or local lung function laboratory.
• A tiny drop of nebuliser solution is always left at the bottom of the nebuliser
• Tap the nebuliser chamber when using it. This displaces large droplets
• When using the compressor put it on a clean, hard surface, such as a table
• Always keep the compressor off the floor to prevent dust getting inside
Taking care of your nebuliser equipment
• You should have your compressor checked and maintained about
twice a year and the nebuliser chamber about every two months
• You may need to change your filters more regularly
• You should also enquire about service arrangements and emergency
provision if your existing compressor develops a fault
• Ask the manufacturer or your local lung function laboratory how
often you need to change the inlet and the outlet filters (if fitted)
Usually the filter needs changing when it becomes discoloured.
• Some hospitals have a nebuliser service providing help and advice on the care
of your nebuliser. Find out if your local hospital has such a service. It is often
operated by the lung function laboratory Nebulisers IS16
• If you are without a compressor while yours is being serviced, your
manufacturer, doctor or nurse may lend you one
• You should have some back-up in case your compressor fails. As mentioned
above, an inhaler with a large volume spacer will generally give a similar level
Keeping your nebuliser equipment clean
Your nebuliser equipment may not work properly if it becomes dirty. You should
care for all the parts of your equipment, especially the ‘nebuliser chamber’
(where the solution is changed into a 'mist'). Ask your doctor/lung function
laboratory/respiratory nurse to go through carefully how to keep your delivery
• Wash the ‘nebuliser chamber’ daily in clean, warm water. Rinse and dry
• Wash the face mask or mouthpiece about two to three times per week in
• Clean the case of the compressor with a moist cloth. The compressor must be
turned off at the mains before doing this.
Traveling or going on holiday
• Take enough medicine to cover your holiday
• Take extra emergency medicines with you
• Make sure that your insurance will cover your equipment and any problems
• If travelling abroad, take a letter from your doctor explaining your condition
and your need for a nebuliser. You may need to give this to your airline when
you book and also to show customs or security
• If flying, check with the airline that your needs will be met
• If you are visiting another country, take an adaptor (and alternative plugs) to
run your compressor on a different voltage
• Hire a portable compressor which runs on batteries or a car cigarette lighter.
Buying a nebuliser
Most people have to buy their own nebuliser. Even if a doctor recommends a
nebuliser for you, they cannot prescribe one on the NHS. If a hospital consultant
decides that a nebuliser is necessary, they can sometimes access
NHS funding, but this funding is not guaranteed. Nebulisers IS16
Although nebulisers are not exempt from VAT, you will be exempt if your doctor
has recommended that you buy one. Check with the manufacturer how to claim
VAT at zero rate for your nebuliser. They may have a form for you to complete
or you may need a letter from your doctor. Pharmacies and GP surgeries
ordering nebulisers are not normally exempt from VAT.
Advance Access publication 3 February 2005Guideline for anti-TNF-a therapy inpsoriatic arthritisS. Kyle, D. Chandler1, C. E. M. Grifﬁths2, P. Helliwell3,J. Lewis, I. McInnes4, S. Oliver5, D. Symmons6 and N. McHugh,on behalf of the British Society for RheumatologyStandards Guidelines Audit Working Group (SGAWG)Although PsA was once thought to be a benign condition, it isnow well recognized a
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