Home Nebulisers for Asthma - Allergy Society of South Africa (ALLSA)

Written by Dr Dr Ahmed Manjra
Endorsed by ALLSA and SACAWG

What is a nebulizer?

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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 turn the 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

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They are used to deliver large amounts of medicines rapidly to the airways of the lungs
They have an advantage over other inhalation devices, such as inhalers, 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.

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Inhaler devices such as diskhalers, turbuhalers and autohalers produce similar effects as nebulisers if used in sufficiently high doses
Space devices, such as aerochambers and volumatic spaces which are 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 moderate attacks of asthma on the advice of your doctor

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Many different models of nebulisers are available in South Africa. They vary considerably in efficiency and price from R400 to R1000 each. The Allergy Society of South Africa and the South African Childhood Asthma Working Group do not endorse any particular brand of nebulizer but suggest the following:
- If your nebulizer is going to be used daily then it will be worthwhile buying a durable nebuliser with good back-up service from the manufacturer or distributor
- If you are going to use your nebulizer frequently only for acute attacks, a moderately priced nebulizer will be sufficient

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It may be worthwhile using a nebulizer on trial first, either from 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 your nebulizer 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 considerably in different pharmacies
Check with your medical aid if they pay for nebulizers. Most medical aids require a prescription and motivating letter from your doctor

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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 when bigger doses are needed.
Many of these medicines can be mixed or used separately
Your doctor or pharmacist should advise you on the amount of medicines to be put in the nebulizer and how often to use these medicines

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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 depending on the manufacturers instructions

This does not require washing
If you do notice some condensation in the tubing, take off the nebulizer 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. This is 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 used regularly. 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 least twice 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

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If your child is on Lomudal or Pulmicort nebulizing solution he or she will need to be nebulized three to four times a day
if your nebulizer is used for relieving symptoms only, it is best 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 or coughing
- Your peak now reading falls by a certain amount. (Your doctor must advise you on this).
- If 15 minutes after having a dose of relieving medicines you 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 on when and how frequently to use the nebulizer

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

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ALLSA
P.O. Box 88
Observatory, 7935
Cape Town, R.S.A.

Red Lechwe
Background: Elephant Shrew

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