Asthma Control: Strategies for Managing Symptoms and Preventing Attacks

Allergy Conditions

Written by Dr Dr Ahmed Manjra

Endorsed by ALLSA and SACAWG

Nebulisers are devices that deliver medicines to the lungs.They are useful in asthma when large amounts of medicines need to
be rapidly delivered to the lungs.
The Nebulizer has many parts.
- An electrical pump to pump air at high pressure. They turnthe medicines into a line mist which can be easily deposited
  on the airways of the lungs
- A nebulized chamber in which the medicine is placed
- A mouth piece or face mask which is connected to the chamber
- A tubing which connects the nebulised to the nebulized chamber

They are used to deliver large amounts of medicines rapidlyto the airways of the lungs
They have an advantage over other inhalation devices, such asinhalers, diskhalers, turbuhalers and autohalers, in that they are
easy to use and don’t require co-ordination or much effort
They also work much more rapidly than medicines taken by mouth.

Inhaler devices such as diskhalers, turbuhalers and autohalersproduce similar effects as nebulisers if used in sufficiently high
doses
Space devices, such as aerochambers and volumatic spaces whichare attached to asthma pumps are also efficient as nebulisers if
used in sufficiently high doses
These devices can be efficiently used to treat mild to moderateattacks of asthma on the advice of your doctor

It may be worthwhile using a nebulizer on trial first, eitherfrom your chemist or doctor. if there is a distinct improvement
in your symptoms and peak now reading,
should you consider purchasing a home nebulizer?
Always use your peak now meter as a guide as when to use yournebulizer and also as a guide as to whether your asthma is improving
or not (see booklet A guide to peak flow in childhood asthma)
Shop around for different prices since prices vary considerablyin different pharmacies
Check with your medical aid if they pay for nebulizers. Mostmedical aids require a prescription and motivating letter from your
doctor

Reliever (Berotec, Ipradol, Venteze and Ventolin, and Atrovent)and preventor
(Lomudal Pulmicort) medicines can be used in the nebulizer
All these medicines are available as inhalers as well
The advantage of the nebulizer is that it is easier to use whenbigger doses are needed.
Many of these medicines can be mixed or used separately
Your doctor or pharmacist should advise you on the amount ofmedicines to be put in the nebulizer and how often to use these
medicines

- Keep the pump covered when not in use
- Wipe over with a damp cloth if it gets dusty
- If a filter is fitted it will need replacing or cleaning dependingon the manufacturers instructions

This does not require washing
If you do notice some condensation in the tubing, take off thenebulizer bowl, turn on the air pump and blow out the condensation
by shaking the tubing
Replace the tubing if any dirt is seen in it, or cracks appear

This needs to be rinsed in warm water after every use. Thisis because the medicine comes in a salt solution and some may get
left in the bowl. This can crystallise and block up the outlets.

After rinsing the bowl, connect up tubing to it, switch on pump,blow air through for a few seconds. Do not wipe out!
Ideally the bowl also needs to sterilised weekly if it is usedregularly. Soak for half an hour in a cold, weak solution (such
as Milton) or half water and half vinegar. Rinse well then blow

through with the air pump on for a few seconds. Don’t wipe out!
Nebulizer bowls needs replacing when they start to leak.

These should be sterilised in the same way as the bowl, at leasttwice a week * They need replacing if the crack, or the face mask
doesn’t fit snugly
The elastic on the face mask is easy to replace yourself

If your child is on Lomudal or Pulmicort nebulizing solutionhe or she will need to be nebulized three to four times a day
if your nebulizer is used for relieving symptoms only, it isbest that your doctor advises you on an action plan for your particular
needs. This is usually if
- You are wheezing, experience a tight chest, breathless orcoughing
- Your peak now reading falls by a certain amount. (Your doctormust advise you on this).
- If 15 minutes after having a dose of relieving medicinesyou are still experiencing a tight chest, wheezing or your peak
  flow has not improved, have another nebulization. If you still
  
  remain the same contact your doctor immediately
You must obtain a peak now meter to objectively guide you onwhen and how frequently to use the nebulizer

NOT all asthmatics need a nebuliser
Your doctor should advise you whether you need to buya nebuliser
Make sure you have written instructions how to use yournebuliser and how to mix the medicines
Overuse of the nebulizer is dangerous. Failure to improvein the usual way indicates worsening asthma. Do not delay
in seeking medicalhelp
Inhaler devices with spacers are as effective as nebulisers