Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
5. Thinking a written prescription for a COPD inhaler means
the patient knows when to use it: The drug's purpose.
For treatment purposes all inhalers for COPD & asthma fall into one of
two broad categories:
a) to provide quick relief ('rescue inhalers') and
b) to improve chronic symptoms and prevent flareups ('maintenance inhalers'). Examples of rescue inhalers are albuterol (brand names Proventil HFA, ProAir HFA, Ventolin HFA) and ipratropium bromide (brand name Atrovent). Combivent contains a combination of albuterol and ipratropium bromide. Maintenance inhalers include any inhaled steroid (IS), either alone (brand names Azmacort, Qvar, Pulmicort, etc.) or in combination with a 'long acting bronchodilator' (LABD; brand names Symbicort, Advair). PROBLEM: The SAME type of delivery device (size, shape, mechanism of action) is commonly used for both rescue and maintenance inhalers. For example, as shown below, ProAir HFA (a rescue inhaler, on left) and Symbicort (a maintenance inhaler, on right) both come packaged as pressurized metered dose inhalers, and both are deep red in color. There is nothing intuitive about this. For a patient who may have both inhalers (quite common), and who becomes short of breath, it is all too easy to forget which is which.