Nebulisation

It is the process of transforming liquid medications into a fine spray (aerosol) or mist, which can then be carried into the respiratory system through inhalation.

Nebulisers can convert a liquid medication into a fine mist or aerosol, thereby making it directly available for inhalation.

Using a nebuliser requires minimal co-ordination for inhalation.

The jet nebulisers (these are the most commonly used nebulisers) are compatible with a variety of medication solutions.

Nebulisers can be used in infants, very old or weak patients, or those who need immediate treatment for an acute condition

Works in patients who are unable to breathe in deeply due to a respiratory condition [low measure of inspiratory flow].

Breath-holding is not absolutely essential for efficacy.

The concentration of the medicines to be used can be adjusted [by diluting with isotonic saline] if needed.

Nebulisers have the ability to deliver larger doses compared to the other aerosol devices

Nebulisation is a common and alternative method [other methods include inhalers, oral therapy such as tablets,& intravenous therapy] of delivering medication to the lungs. It is largely used in clinical settings for the treatment of acute respiratory ailments as well as for the long-term treatment of obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis and bronchiectasis.

A nebulizer converts liquid medicine [either a solution or suspension] into vapour, aerosol or a mist so that it can be inhaled by the patient and effectively delivered directly into the lungs. The main purpose of nebulisation is to allow the medication to reach the lungs quickly and effortlessly, with very little need for coordination by the patient, a common challenge seen with handheld inhalers. Hence, it is the preferred mode of medication delivery for children, elderly, and patients who cannot effectively use handheld inhalers for various reasons.

Despite its wide acceptance and application, nebulisation therapy also attracts criticism. Often, the reasons for this are lack of knowledge, and misinformation about the use of nebulisers. With the aim of spreading knowledge and promoting the correct use of nebulisation therapy, Cipla has started a public initiative called Good Nebulisation Practice or, simply, GNP.

How to make nebulisation easier for your child

Nebulisation is simple, but the complicated part can be persuading your child to undergo it. These tips will help you calm down your child (and soothe your anxiety) before and during nebulisation.

• Be vigilant
  Close supervision is necessary when you administer nebulisation treatment to your child.
• Be positive
  Children can easily gauge the emotions of their parents and respond to them. Hence, it is a must to be positive and confident about nebulisation so that your child too mirrors this outlook and nebulisation takes place easily and effectively.
• Communicate with your child
  If your child is old enough to understand, make an effort to talk about nebulisation and how exactly it can make his/her condition better quickly.
• Distract your child
  It will help to keep your child distracted with other things during the nebulisation procedure – these will keep his/her mind occupied and calm and even help you both bond further. Here are a few suggestions:
  Provide a favorite toy to play with
  Narrate an interesting story
  Play some engaging cartoons or a video game
  Play or hum a favorite song for a relaxing effect
• Nebulize in the right position
  Some children prefer to sit upright on a chair, whereas others prefer to nestle in their parent’s arms. Children should always be held or made to sit upright while nebulising to give good results. The right position can simplify and ease the process of nebulisation.
• Avoid nebulizing when your child is asleep or lying down
  There is a risk that the medicine will not reach the lungs if you try to perform nebulisation on your child while sleeping as his/her mouth will be closed. When the child is asleep, the breathing is shallow and through the nose, which decreases the efficiency of nebulisation. There is also a chance that the child will get traumatised on being rudely woken with a mask on his/her face.
• Get rid of the fear of the mask
  Small children may feel that they will not be able to breathe through the face mask and revolt against wearing it.
  Show them pictures of divers and snorkellers to remove this fear.
  Tell your child that he/she is a superhero and needs to wear a face mask
  Demonstrate by wearing the face mask yourself. You can stick pictures of your child’s favourite cartoon character on the face mask to make it seem less fearful.
• Use the power of touch
  Touch therapy can be one of the most calming things and envelops your child with a feeling of protection. Hold your child in your arms or hold the child’s hand during nebulisation, if need be. Pat or caress your child during the nebulisation process to show encouragement and provide reassurance.
• Appreciate your child
  After the nebulisation is over, give your child lots of appreciation, praise and hugs for participating in the procedure. This type of positive reinforcement is necessary to remove any fear or discomfort about nebulisation.

Living with respiratory disease can often be challenging and overwhelming as it can pose certain restrictions on activities such as travelling. For some patients, using nebulisers while travelling can become cumbersome. Travelling should be done after a check-up, consultation and approval from your doctor. With the availability of portable, sleek and lightweight nebulisers, , travelling can be easier; however, the type of portable nebuliser to buy should be based only on your doctor’s recommendation.

The following tips can help you plan your journey if you have to travel with a nebuliser:

Before travelling, check if you have packed all the parts of the nebuliser kit – for example, in case of a jet nebuliser, check whether you have packed the compressor, tubing, medication cup/cap, face mask/mouthpiece and one nebuliser filter.

Pack the nebuliser kit in bubble wrap to avoid breakage or damage.

If you have been advised to use a portable, lightweight nebuliser, ensure that you carry it safely in a pouch or as per the manufacturer’s storage instructions.

Preferably, carry a portable nebuliser that can be plugged into a car’s accessory power outlet or a power bank (depends on the make of the nebuliser).

Carry additional batteries for the nebuliser in case of loss or damage.

Take an adapter if you are travelling to a different country.

Carry enough quantity of all the necessary medicines for nebulisation that have been recommended by your doctor.

Keep rescue medicines(inhalers with spacers) handy.

During air travel, check whether the airline you will be flying with allows a nebuliser to be carried/used on board.

Go for a check-up before travelling to assess your or your patient’s (if you are a caregiver) present condition and adjust the medication dosage, especially in chronic cases.

Ensure that you clean and disinfect the nebuliser kit even when you are travelling.

J. COPD 2012; 9:58–72, Nursing Standard 25(31): 50-56, Int J Pharm Sci & Res 2019; 10(8): 3575-82. doi: 10.13040/IJPSR.0975-8232.10(8).3575-82