Choosing the Right Nebulizer for You

By: Jillian Phillips
Submitted: 2009-06-08 12:40:17
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A nebulizer is a type of DME (durable medical equipment) through which prescription inhalation drugs are administered. It consists essentially of two components:

1.  a power source such as an air compressor or ultrasonic device

2.  a dispensing mechanism consisting of flexible tubing, a mouthpiece, and liquid reservoir

Nebulizer drug therapy is administered by placing a prescription inhalation drug into the reservoir of a nebulizer. The nebulizer’s power source converts the drug into a fine spray which is inhaled by the patient.

Characteristics of good and bad nebulizer systems

Nebulizer systems offer a great range of performance. How good or bad an individual system is depends on what it is intended to do. For example, if a system is required to deliver the maximum amount of "useful" aerosol in the minimum amount of time, with a minimum of inconvenience, then the characteristics of a "good" system would include the following:

1. Fast rate of nebulization, implying that the maximum amount of nebulized aerosol is potentially available to the patient over any given time.

2. Minimum waste of drug aerosol, implying that the maximum amount of aerosol released is delivered to the patient and not emitted into the environment.

3. Low residual volume, implying that more of the volume fills will be delivered to the patient as aerosol.

4. Well-defined droplet size distribution.

If, however, the same system was required to deliver only a modest volume of drug aerosol, then the system described earlier becomes "bad" because such an efficient system of delivery will deliver an unnecessarily large aerosol dose with possible increased local and systemic side-effects.

These guidelines recognize that consideration must be given when matching nebulized drug delivery to the performance of nebulizer systems. The requirements will vary according to the needs of different patient groups or stages of the disease. The two main factors to take into account are:

1. How much nebulized drug is ideally required for delivery to the patient
2. The aerosol size required to deliver nebulized droplets to the site of action. Small aerosols (<5 µm) will deposit peripherally, whereas droplets ~5 µm will mainly deposit in airways that are more central.

Furthermore, in a study on differential deposition of aerosols in the maxillary sinus, larger droplets appeared to deposit directly in the nasal vault while smaller particles were more likely to reach the maxillary sinus. This is a major consideration when treating sinusitis.

Choosing your nebulizer system

For bronchodilator drugs, any nebulizer system that complies with your doctor’s recommendations could be used in accordance with the manufacturer’s instructions. However, end-users and purchasers should avoid using inefficient systems that may waste most of the drug dose. It is suggested that a system with a good performance review (output and droplet size) should be chosen. Such a system would require lower doses of medication, or shorter treatment times that may be more convenient for patients and also yield savings in overall treatment costs.

How to select the optimal system for a given patient or usage

Most healthcare systems currently have some system by which nebulized drugs are prescribed for each clinical application. In addition, all prescribers and users of nebulized therapy will commonly have experience using one (or more) nebulizer system for each clinical application. Local practices may differ greatly, possibly within institutions. It is recommended that a standard operating practice (SOP) be adopted for each nebulizer system in use. This will provide a baseline in determining the effectiveness of that nebulizer system for each given application.

Article source: Expert Articles