Nebulizers: Types, Mechanism, and Clinical Applications
A nebulizer converts liquid medication into an aerosol for inhalation, delivering drugs directly to the airways.
Types
| Type | Mechanism | Pros | Cons |
|---|
| Jet (pneumatic) | Compressed air through Venturi | Low cost, robust, all meds | Noisy, bulky, slower |
| Ultrasonic | Piezoelectric crystal vibration | Quiet, fast, portable | Heat may degrade proteins; not for suspensions |
| Mesh (vibrating membrane) | Micropump through fine mesh | Silent, efficient, portable, battery | Costlier, clogging risk |
Common Medications
- Bronchodilators: Albuterol, ipratropium, combination (Combivent)
- Corticosteroids: Budesonide (only nebulized steroid)
- Mucolytics: Hypertonic saline, dornase alfa (CF), acetylcysteine
- Antibiotics: Tobramycin, aztreonam (CF)
- Others: Epinephrine (croup), magnesium (severe asthma), antifungals
Clinical Indications
- Acute asthma/COPD exacerbations (ED, inpatient)
- Chronic maintenance (severe COPD, CF, bronchiectasis)
- Patients unable to use MDI/DPI (infants, elderly, cognitive impairment)
- High-dose or combination therapy
Key Points
- Use mouthpiece (not mask) when possible to reduce facial/orbital deposition.
- Rinse mouth after steroids to prevent thrush.
- Clean/disinfect per manufacturer to prevent contamination.
- Particle size (MMAD 1–5 μm) determines lung deposition.
Nebulizers remain essential for patients who cannot master handheld inhalers.
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