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What is Nebulisation?

Nebulisation is a process that transforms liquid medications into a fine aerosol or mist, allowing them to be delivered directly into the respiratory system through inhalation. This method is widely applied in treating both acute and chronic respiratory conditions like Asthma and COPD (Chronic Obstructive Pulmonary Diseases).

Types of Nebulizers

Liquid medication can be transformed into an aerosolized form through various mechanisms or types of nebulisers which are categorised into the following types:

Jet Nebulisers

In a jet nebuliser, pressurised gas or air draws liquid medication from the nebuliser cup through a narrow capillary.
This action transforms the liquid medication into a mist that contains both small and large particles. When inhaled, smaller particles are absorbed, while larger particles may hit the inner wall of the medication cup before re-entering the chamber.
Advantages
  • Cost-effective
  • Compatible with various types of liquid medications.
Disadvantages
  • Limited portability.
  • Inconsistent aerosol output.
  • Setup may be challenging for patients with physical or cognitive impairments.

Mesh Nebulisers

Mesh nebulisers create an aerosol or mist by forcing liquid through small holes in apertures or a plate.
Advantages
  • Mesh nebulisers generally produce more aerosol and deposit more medication in the lungs compared to jet nebulisers, both per unit of time and total lung deposition.
  • They operate with greater efficiency, enabling the administration of higher drug doses to patients.
  • Mesh nebulisers are quick, quiet, and portable, equipped with self-contained power sources.
Disadvantages
  • Relatively more expensive as compared to jet nebulisers.
  • Cleaning can be challenging.
  • Medication dosage may require adjustment.
  • Not suitable for viscous liquids or those prone to crystallisation on drying.

Ultrasonic Nebulisers

Ultrasonic nebulisers use a piezoelectric crystal vibrating at high frequencies to create an aerosol.
Advantages
  • Ideal for nebulising large volumes, such as administering hypertonic saline for sputum inductions.
Disadvantages
  • Tend to have large residual volumes.
  • Hard to use with viscous solutions.
  • Not recommended for suspensions and proteins due to heat sensitivity.

Steps to use your Nebuliser

Cleaning your inhaler once a week is a smart practice, even if you can’t see any medicine buildup. This keeps your inhaler from getting clogged and ensures it works properly. The key rule is to never wash or submerge the metal canister in water; only the plastic parts should be cleaned.
While your inhaler will include specific cleaning instructions, here are the main steps to clean it.

1

Clean your hands: Make sure your hands are thoroughly washed before touching the nebuliser components.

2

Assemble the nebuliser: Follow the instructions to put together the nebuliser machine, medicine cup, tubing, and the mask or mouthpiece as indicated.

3

Load the medicine cup: Put the recommended amount of medicine into the nebuliser cup.

4

Mouthpiece or the mask: When using a mouthpiece, place it securely in your mouth, closing your lips tightly around it for a firm seal. For children using a mask, make sure it fits snugly over their nose and mouth.

5

Activate the nebuliser: Switch on the nebuliser machine. Watch for a light mist to come out from the tube near the mouthpiece or the mask.

6

Breathe normally: Breathe in steadily through your mouth while the medication cup empties, or until the mist stops. This usually takes about 10 minutes.

7

Turn off the machine: After the nebuliser has delivered the medication, take the mouthpiece out of your mouth (or remove your child’s mask) and turn off the machine.

8

Rinse (if necessary): After using an inhaled corticosteroid, rinse your mouth (or your child’s mouth) with water and then spit it out to prevent mouth infections. If a mask is used, make sure to wash your child’s face as well.

Maintaining a Nebuliser

Washing Frequency
It is strongly advised to clean the different components of your nebuliser after each use. These parts include the mouthpiece or mask, top piece, and medicine cup.
Disassembly
Start by taking apart the nebuliser, disconnecting the tubing, and placing it aside. (Note: Avoid submerging the tubing in water).
Cleaning Options
Take off the mouthpiece or the mask and the medicine cup from the top piece. Keep these parts separate for cleaning. Alternatively, you can wash them in warm, soapy water and rinse thoroughly.
Drying
After cleaning, shake off any extra water and let the parts air-dry in a cool, dry place until your next use.
Weekly Deep Cleaning
Aside from daily cleaning, conduct a thorough cleaning once a week. Simply soak the mouthpiece or the mask, top piece, and medicine cup in a mild detergent and water solution for about 30 minutes, or follow the recommendations from your device manufacturer. Then, rinse and let them air-dry in a cool, dry location.
Cleaning the Compressor
Wipe the surface of the compressor and the outer part of the tubing with a cloth dampened with soapy water or a disinfectant wipe. Remember, neither the compressor nor the tubing should be submerged in water.
Filter Replacement
Finally, keep in mind that the majority of compressors have an air filter that should be changed every six months or as per the manufacturer's guidelines.
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