Who gets a home nebulizer, and why?

[Pachinko]

I've heard a lot, all anecdotal, about nebulizers. Some asthmatic patients and their providers swear by them, others maintain that they offer no advantage over standard inhalers. I've also heard differing opinions about who should get them and at what "step" of management they should be introduced.

Anyone have an evidence-based approach to nebulizer prescription and utilization? How do you use them in your practice?

[traumaRUs, MSN, APRN]

I Rx home news all the time. Some of the reasons:

Elderly and children can't use MDI effectively.

Better penetration of medication

Can be used even when pt unable to take a deep breath

Here are some references:

Use of medication nebulizers in children

Delivery of inhaled medication in adults

Advantages and disadvantages of various aerosol devices

[TABLE=width: 1305]

[TR]

[TD=class: subtitle1, bgcolor: #EEEEEE, align: center]Type[/TD]

[TD=class: subtitle1, bgcolor: #EEEEEE, align: center]Advantages[/TD]

[TD=class: subtitle1, bgcolor: #EEEEEE, align: center]Disadvantages[/TD]

[/TR]

[TR=class: divider_bottom]

[TD]Jet nebulizer*[/TD]

[TD]Patient coordination not required

High doses possible[/TD]

[TD]Generally more expensive than metered dose inhaler (MDI)

More time required

Contamination possible

Device preparation required before treatment

Not all medications available

Less efficient than other devices (dead volume loss)[/TD]

[/TR]

[TR=class: divider_bottom]

[TD]Mesh nebulizer (eg, Aeroneb, eFlow, Omron MicroAir, I-neb)[/TD]

[TD]Patient coordination not required

High doses possible

Quiet

Faster delivery than jet nebulizer

More accurate delivery of desired dose than jet nebulizer

Portable, battery operated[/TD]

[TD]Expensive

Contamination possible

Device preparation required before treatment

Cleaning required after dose

Not all medications available[/TD]

[/TR]

[TR=class: divider_bottom]

[TD]Ultrasonic nebulizer (eg, OPTI-NEB, Beetle Neb, Lumiscope, MiniBreeze)[/TD]

[TD]Patient coordination not required

High doses possible

Small dead volume

Quiet

No drug loss during exhalation

Faster delivery than jet nebulizer[/TD]

[TD]Expensive

Contamination possible

Prone to malfunction

Device preparation required before treatment

Cannot use with medications in suspension (eg, budesonide)[/TD]

[/TR]

[TR=class: divider_bottom]

[TD]Metered dose inhaler (MDI)[/TD]

[TD]Convenient

Less expensive than nebulizer

Portable

More efficient than nebulizer

No drug preparation required

Difficult to contaminate[/TD]

[TD]Patient coordination essential

Patient actuation required

Large pharyngeal deposition

Difficult to deliver high doses

Not all medications available[/TD]

[/TR]

[TR=class: divider_bottom]

[TD]Metered dose inhaler (MDI) with holding chamber[/TD]

[TD]Less patient coordination required

Less pharyngeal deposition[/TD]

[TD]More expensive than MDI alone

Less portable than MDI alone[/TD]

[/TR]

[TR]

[TD]Dry powder inhaler (DPI)[/TD]

[TD]Less patient coordination required

Convenient

Propellant not required

Portable

Breath-actuated[/TD]

[TD]Requires moderate to high inspiratory flow

Some units are single dose

Can result in high pharyngeal deposition

Not all medications available

Difficult to deliver high doses

Cannot use with endotracheal or tracheostomy tubes

[/TD]

[/TR]

[/TABLE]

[BCgradnurse, MSN, RN, NP]

I work in an asthma and allergy practice and we frequently rx nebulizers, for the very reasons that Trauma stated. In addition, the moisture provided by the nebulizer is often beneficial. I have a lot of patients under the age of 2, and nebs are really the only way to give these little ones their medications.