Nebulizer therapy is a simple therapeutic intervention for delivering medications directly to the lungs, offering rapid relief from respiratory conditions such as asthma, COPD, and acute bronchospasm. Nurses assist in nebulization to ensure accurate medication administration and enhance its therapeutic effects. The role includes guiding patients on proper usage, monitoring for adverse reactions, and maintaining infection control to ensure safe and effective treatment.
Table of Contents
- What is Nebulizer Therapy?
- Indications
- Contraindications
- Equipment
- Types of Nebulizers
- Medications for Nebulization
- Assisting with Nebulizer Therapy
- Side Effects
- Nursing Considerations
- References
What is Nebulizer Therapy?
Nebulization or nebulizer therapy is a method of delivering medication directly into the lungs in aerosol form through a nebulizer. The nebulizer converts liquid medication into a fine mist that can be inhaled deeply into the respiratory tract. This treatment is commonly used for patients with respiratory conditions that benefit from bronchodilators, corticosteroids, or mucolytics.
Indications
Nebulization is used for the following respiratory conditions as it delivers medication directly to the lungs, helping open airways quickly, reduce inflammation, and alleviate symptoms like wheezing, shortness of breath, and airway constriction.
- Asthma. Helps relieve bronchoconstriction and reduce inflammation.
- Chronic Obstructive Pulmonary Disease (COPD). Improves airflow and reduces airway resistance.
- Cystic Fibrosis. Assists in loosening thick mucus secretions.
- Respiratory Infection. Supports easier breathing and clears mucus.
- Bronchiectasis. Helps mobilize and expectorate secretions.
- Patients with Acute Respiratory Distress. Provides rapid relief of symptoms.
Contraindications
Nebulization is contraindicated in cases of severe hypersensitivity to the medication, unstable cardiovascular conditions, or when patients are unable to effectively use the device, as it may worsen symptoms or pose health risks.
- Allergy to the medication. Avoid nebulization if the patient has a known hypersensitivity.
- Unstable cardiovascular conditions. Some nebulized drugs may impact heart rate or blood pressure.
- Severe anxiety or cognitive impairment. These patients may be unable to tolerate the nebulization mask or mouthpiece.
- Pulmonary edema or severe fluid overload. Nebulization may worsen symptoms in some fluid-overloaded patients.
Equipment
Nebulization involves the use of a device that converts liquid medication into a fine mist, which is inhaled through a mask or mouthpiece, ensuring direct delivery to the lungs. Here are the equipment/materials needed:
- Nebulizer Machine. Generates aerosolized medication for inhalation.
- Nebulizer Cup. Holds the liquid medication and attaches to the mouthpiece or mask.
- Tubing. Connects the nebulizer cup to the machine.
- Mouthpiece or Mask. For inhaling the aerosol mist (masks are typically used for children or patients unable to use a mouthpiece).
- Medication. Prescribed medication(s) in liquid form.
- Sterile Saline (if needed). Used to dilute medication as prescribed.
- Tissues and Water. For patient comfort, especially after treatment.
Types of Nebulizers
Nebulizers are devices that convert liquid medication into a mist for inhalation, allowing direct delivery to the lungs. Nurses often use the following types based on patient needs.
- Jet Nebulizer. Uses compressed air or oxygen to convert liquid medication into an aerosol mist. The air passes through a narrow tube, creating a vacuum that draws the liquid medication into a fine mist.
- Ultrasonic Nebulizer. Uses high-frequency sound waves to vibrate a piezoelectric crystal, converting liquid medication into a fine mist.
- Mesh Nebulizer. Uses a vibrating mesh or perforated plate to push liquid medication through fine holes, creating a mist.
- Vibrating Mesh Nebulizer (VMN). A type of mesh nebulizer that uses rapid vibrations of a mesh plate to aerosolize the medication.
Medications for Nebulization
Here’s a list of medications commonly used in aerosol inhalation administration.
| Medication | Classification | Dosage | Nursing Precautions |
|---|---|---|---|
| Albuterol (Salbutamol) | Bronchodilator (Short-acting beta-agonist) | 2.5 mg every 4-6 hours (diluted in 2.5 mL saline, as prescribed) | – Monitor respiratory status and heart rate before and after administration. – Observe for signs of tachycardia, tremors, or nervousness. – Use with caution in patients with cardiovascular conditions. |
| Budesonide | Corticosteroid | 0.25-1 mg twice daily | – Rinse the mouth after use to prevent oral thrush. – Do not use for acute asthma attacks; it is for maintenance therapy. – Monitor for signs of adrenal suppression with long-term use. |
| Ipratropium Bromide | Anticholinergic Bronchodilator | 0.5 mg every 6-8 hours | – Monitor for dry mouth, dizziness, or blurred vision. – Avoid contact with eyes to prevent blurred vision or irritation. – Use with caution in patients with glaucoma or urinary retention. |
| Acetylcysteine (Mucomyst) | Mucolytic Agent | 3-5 mL of 20% solution or 6-10 mL of 10% solution, 3-4 times daily | – Monitor for bronchospasm; may require bronchodilator pre-treatment. – Monitor for respiratory distress during treatment. – Warn about an unpleasant odor (rotten eggs) and possible throat irritation. |
| Cromolyn Sodium | Mast Cell Stabilizer | 20 mg via nebulization 4 times daily | – Cromolyn sodium is preventive, not used for acute asthma attacks. – Watch for bronchospasm after nebulization. – Avoid abrupt discontinuation as stopping suddenly may worsen symptoms. |
| Tobramycin | Antibiotic (Aminoglycoside) | 300 mg twice daily | – Monitor renal function and hearing for signs of ototoxicity. – Instruct patients not to mix with other medications in the nebulizer. – Watch for voice changes or hoarseness during therapy. |
| Epinephrine | Sympathomimetic (Adrenergic Agonist) | 0.5 mL of 1% solution diluted in 2.5 mL saline | – Monitor cardiovascular status closely for tachycardia and hypertension. – Reserve for acute settings like severe asthma or anaphylaxis. – Observe for signs of nervousness or palpitations. |
| Hypertonic Saline | Osmotic Agent | 3-5 mL of 3-7% solution 2-4 times daily | – Pre-treat with a bronchodilator if indicated to prevent bronchospasm. – Monitor for throat irritation and coughing. – Ensure patient comfort during administration. |
Assisting with Nebulizer Therapy
While the nebulizer therapy is relatively simple, it demands careful execution to ensure the effectiveness of the therapy. Below are the steps nurses should follow during nebulization.
Pre-Nebulizer Assessment
1. Measure and document the patient’s heart rate (HR), respiratory rate (RR), oxygen saturation (O₂), and lung sounds.
Baseline assessment provides a reference to gauge treatment effects and identify any contraindications, such as a high HR.
2. If the HR is above 120 bpm, delay the treatment, notify the physician, wait for 10-15 minutes, and reassess.
A high HR may indicate stress or a contraindication for bronchodilator treatment, ensuring patient safety.
Nebulization
1. Confirm the medication, dosage, and frequency as per the physician’s order.
Ensures the correct medication is administered in the prescribed dose, reducing the risk of medication errors.
2. Inform the patient of the purpose and steps of nebulization and answer any questions.
Reduces anxiety and increases cooperation, improving the effectiveness of the treatment.
3. Wash hands thoroughly and assemble the nebulizer machine, tubing, and medication cup. Prevents infection and maintains a sterile environment for medication administration.
4. Position the patient in an upright or semi-Fowler’s position.
Sitting upright allows optimal lung expansion, promoting effective delivery of the medication into the lungs.
5. Pour the prescribed medication into the nebulizer cup, attach the mouthpiece or mask, and adjust the flowmeter to the recommended setting (usually 6–8 L/min) for adequate misting. Ensuring the correct dosage and flow rate maximizes medication delivery efficiency and effectiveness.
6. Instruct the patient to close the lips around the mouthpiece with the chin up, or keep the chin up when using a mask; ensure the nebulizer remains upright.
Proper positioning allows for efficient aerosol delivery and prevents medication leakage.
7. Have the patient breathe normally through the mouthpiece or mask until the nebulizer sputters. Tap the nebulizer to release any remaining medication.
Ensures full delivery of the prescribed dose, maximizing therapeutic benefits within the typical 5-10 minute treatment time.
8. Once the nebulizer cup is empty or mist stops, turn off the machine and disconnect the equipment.
Prevents unnecessary use of the nebulizer and prepares for equipment cleaning and storage.
9. Encourage the patient to cough and expectorate secretions, and assist with oral care (if using corticosteroids).
Coughing clears loosened secretions, improving airway patency, while oral care prevents medication residue build-up.
10. Return the bed to a comfortable position for the patient after treatment.
Promotes patient comfort and relaxation post-treatment.
Post-Nebulization Assessment
1. Reassess vital signs or perform a respiratory assessment if directed. Rinse the nebulizer cup with 3 ml of sterile water, place it in a labeled plastic bag, and hang it from the oxygen regulator.
Reassessment helps detect any adverse effects, and proper cleaning and storage of the nebulizer maintain hygiene for future use.
2. Document the nebulizer administration and any patient teaching in the electronic health record (EHR).
Accurate documentation ensures continuity of care and provides a legal record of the treatment and education provided.
Side Effects
Nebulization can cause side effects since the medication is directly delivered to the lungs, potentially leading to local irritation, and it may also enter the bloodstream, causing systemic effects. The following are the side effects of nebulization:
- Increased heart rate (tachycardia). Some bronchodilators, especially beta-agonists, can cause an elevated heart rate, which may lead to discomfort or palpitations.
- Shakiness or tremors. Common with beta-agonist bronchodilators, these effects are temporary but may be distressing for the patient.
- Dry mouth and throat irritation. Continuous nebulization may cause throat dryness or mild irritation, which can be uncomfortable.
- Oral thrush (with corticosteroids). Using inhaled corticosteroids can lead to fungal growth in the mouth, necessitating oral rinsing after each use.
- Headache or dizziness. Rapid medication delivery may cause transient headaches or dizziness, particularly if the patient hyperventilates.
Nursing Considerations
Nurses should check the patient’s respiratory status, proper functioning of the nebulizer, and correct medication dosage during nebulization. Observing for adverse reactions and ensuring the equipment is clean and upright are also needed.
1. Check vital signs, especially respiratory rate, oxygen saturation, and heart rate, before and after nebulization.
Allows monitoring for therapeutic effectiveness and any adverse reactions.
2. Double-check medication type, dose, and expiration date before administration.
Ensures accurate dosing and prevents medication errors.
3. Assess lung sounds, breathing pattern, and cough effectiveness before and after treatment.
Provides a baseline for evaluating treatment effectiveness and helps detect any new complications.
4. Monitor for side effects like tremors, tachycardia, or respiratory distress.
Immediate identification and intervention for adverse reactions protect patient safety.
5. Guide the patient to stay calm and breathe slowly during the treatment.
Prevents hyperventilation, which may cause dizziness or worsen respiratory distress.
6. Clean the nebulizer components after each use and store it in a dry area.
Reduces the risk of bacterial contamination and ensures safe use in future treatments.
7. Teach patients to use and clean their nebulizer correctly, especially for home use.
Empowers patients to manage their therapy independently and ensures safe, effective treatment.
8. Educate on specific precautions, such as rinsing the mouth after corticosteroids and recognizing side effects of bronchodilators.
Reduces the risk of complications like oral thrush and improves patient awareness of potential side effects.
References
- Dougherty, L. & Lister S., (2015). The Royal Marsden Manual of Clinical Nursing Procedures.
- Martin, A. R., & Finlay, W. H. (2014). Nebulizers for drug delivery to the lungs. Expert Opinion on Drug Delivery, 12(6), 889–900.
- McCarthy, S. D., González, H. E., & Higgins, B. D. (2020). Future trends in nebulized therapies for pulmonary disease. Journal of Personalized Medicine, 10(2), 37.
- Rello, J., Rouby, J. J., Sole-Lleonart, C., Chastre, J., Blot, S., Luyt, C. E., … & Roberts, J. A. (2017). Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients. Clinical Microbiology and Infection, 23(9), 640-646.
- Thiago C Carvalho, Jason T McConville, The function and performance of aqueous aerosol devices for inhalation therapy. Journal of Pharmacy and Pharmacology, Volume 68, Issue 5, May 2016, Pages 556–578.