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Advantages of a nebuliser Very effective in acute, severe asthma attacks. No cooperation required from the child. Even very young and very sick children can be nebulised with a face mask. Almost immediate effect of reliever medication by direct delivery to the lungs. Disadvantages of a nebuliser Noisy and scary for a small child. Expensive, compared to a spacer and metered dose inhaler. Bulky, difficult to carry about. Needs electricity, though manually operated ones are available sometimes. Needs several minutes for a single dose. May harbour infection, especially if one machine is used for many patients.

Nebulisers in Childhood Asthma

Nebulisers are very useful, even life saving, in children with asthma.  They have the advantage of delivering drugs directly to the lungs.  By delivering  reliever drugs  like salbutamol, terbutaline, and ipratropium straight to the lungs, a nebuliser can help relieve the cruel narrowing of a child's airways and give quick relief.

There are two types of nebulisers -- the jet nebulisers and the ultrasonic ones.  Both convert a liquid medication into fine droplets suspended in air that a child can breathe.  Older children use a mouthpiece with a nebuliser, younger ones a mask.  If the child is breathing normally, and all conditions are optimum, about 10-20% of the drug placed in the machine may reach the lungs.  However, a crying and struggling child can reduce the efficiency of the nebuliser.

What drugs can be nebulised?

Mainly  reliever drugs.  Salbutamol and terbutaline are airway dilators that are commonly used and give quick relief.  Ipratropium is another drug that can be mixed with one of the dilator drugs to give additional effect in relieving airway obstruction of asthma.

A  controller drug , budesonide, has recently become available in India for nebulisation.  It has no role in the treatment of an acute attack, and nebulisers are too tedious for the long term daily therapy of asthma.  It is thus difficult to see where this drug fits into the management of asthma.

Can nebulisers treat asthma?

No, they can't, and it's dangerous to try.  Airway narrowing is only a part of asthma; the underlying problem in  the lungs , is inflammation of the airways.  Treating only the narrowing of the airways by the use of a nebuliser allows the disease process to get worse, which can be extremely dangerous.

A nebuliser at home can be convenient, in that it relieves symptoms rapidly.  However, the device should not substitute for a doctor's care.  If a child needs nebulisation more than occasionally, regular treatment to control asthma is needed.

Last revision: July 15, 2007

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