Author Archives: Jackie Aim

What to do if your nebuliser breaks down

Breakdown truck Keep a written plan in an agreed place (e.g. beside the nebuliser) of what to do in case of an emergency and the instructions for using your nebuliser.

If the nebuliser times are becoming slower, for example > 10 minutes, clean the equipment and try again.
If the nebuliser is still slow use a spare nebuliser or arrange a service.

Maintenance of a nebuliser

Check with your supplier how often you will need to renew all the disposable pieces (e.g. mouthpiece, mask, tubing, chamber).
Change the filters in the compressor / nebuliser machine. Check how often you need to replace filters. (available from manufacturer).
Arrange for the compressor to be serviced every year by the manufacturer or local service provider as advised by manufacturer.
Some Health Boards have special local arrangements for servicing Nebulisers.
You should be given clear instructions for your local servicing arrangements.

Cleaning a nebuliser

A nebuliser should be cleaned regularly including the masks/ mouth pieces/ medication chamber. If the nebuliser is not cleaned regularly the medication will take much longer to nebulise and use.

Cleaning

Clean everything daily if the nebuliser is in regular use.
If the nebuliser is not used daily clean it after every use.
Disconnect the mask, mouthpiece and medication chamber. Wash all the pieces in a warm water and detergent solution and rinse.
Leave these pieces to air dry and put back together again the next morning.
Do not use towels, tissues, a hair dryer or on a radiator to help drying in case you damage the equipment.
DON’T wash the tubing this should remain dry.
Run the nebuliser for a few seconds before you add the next dose of medication.

Video provided with permission from the Irish Thoracic Society.

If symptoms persist

If your breathing symptoms do not settle after using all the medication in the medication chamber you should check your written instructions or self management plan.
A self treatment plan will include information on:
1. Using your hand held inhalers.
2. The dosages you should use with the nebuliser.
3. How often you should take a routine dosage by nebuliser.
4. How long between you should wait before repeating a nebuliser dose in an urgent situation.
5. When to contact your GP or respiratory nurse.
Do not increase the dose or frequency of the nebuliser medication without prior discussion with the GP, consultant or nurse.
Breathing control exercises may be help. Ask your GP for a referral to a respiratory physiotherapist for instructions on breathing control exercises
Always seek medical advice if there is any confusion or if you are not sure about the treatment or condition.

Side effects of nebulised medication

Cartoon image of body with alert sign
All medications may have short lasting side effects.
The most commonly reported side effects of nebulised therapy are:

Rapid heartbeat
Mild tremor
Dryness of the mouth
Headache

If these symptoms are a problem or persist for more than 30 minutes discuss this with your GP or practice nurse at a review meeting.

An uncommon side effect of the medications, atrovent or combivent, is glaucoma (raised pressure behind the eye). Check with your optician annually as you may not notice small changes at first. Tell the optician you are on this medication using a nebuliser.

Important

You must contact your GP if any signs of or symptoms of this condition appear.

Eye pain
Blurred vision
Nausea

Instructions for use of a nebuliser

Before using the nebuliser, attach the medication chamber to the tubing and run the machine for a few seconds, to make sure the jet holes are clean with no obstructions.
Empty contents of the nebule/medication into the medication chamber.
Make sure that the mask, tubing and chamber are all attached and connected to the compressor and the compressor is working.
Place the nebuliser on a hard surface such as a table or bedside cabinet. Never place the machine on a carpet or similar surface.
While using a nebuliser you should sit it upright, well supported in a chair or a bed.
Attach the mask or mouthpiece and switch the machine on. Relax and breathe normally.
The nebuliser will deliver the medicine in a fine mist, which will take less than 10 minutes.
When the nebuliser begins to ‘splutter’, this is a sign the pot is nearly empty. Tap the side of the chamber to ensure any medication on side of pot can be nebulised and continue for about 1 more minute.

The Nebuliser

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There are three or four parts to a nebuliser:

Mouthpiece or facemask:
The mouthpiece is known to be the most effective way of getting the nebulised medication into the lungs.
It is usually preferred by people in acute breathlessness situations.
When the mouthpiece is used it reduces the risk of the mist entering the eyes and causing problems.
If you are unable to use a mouthpiece you should discuss other options with the respiratory nurse or GP
The face mask is used with children, or with adults who cannot use a mouthpiece.
Nebuliser or medication chamber:
The nebuliser chamber is where the liquid medication is placed.
The fluid is turned into the fine mist which is simply breathed in.
Air compressor:
This is the main part of the nebuliser. It pumps air into the nebuliser chamber. This changes the liquid medication into a mist so that it can be simply breathed in.

Advice for patients using a nebuliser

Female patient using a nebuliser
Background

Most people with COPD will not need a nebuliser if you have a good inhaler technique which is effectively getting medication in to the lungs. You may use a nebuliser if you are admitted to hospital during an exacerbation. Once you have recovered you may not need a nebuliser at home.
Nebulisers are used to deliver medication, in higher doses than is possible by just using a hand held inhaler.
The aim of using a nebuliser is to make sure that a drug is delivered in the correct dose to the lung in order to give improved treatment of symptoms.
The nebuliser works by turning a liquid medication into a fine mist so that it can be inhaled deep into the lungs.
The mist is made by a compressor pumping air or oxygen through the liquid in the medication chamber.

Frequently asked questions

Q: How often should my medication be reviewed?

A: The medicine that you are prescribed will be reviewed once a year when you have your annual COPD review. If at any time you feel that the medicine is not relieving your symptoms as well as they used to, you should make an appointment with your GP or practice nurse to have a review. Your local community pharmacist may be able to advise you too, for example, to check that you are using the inhalers correctly.

Q. Can my medicine go out of date?

A. All medicine should have a use by date on the box or bottle. Keep to this date and ask your pharmacy to dispose of any old medicine. Never put medicine into a different bottle or container.

Q. What should I do if I think I am having side effects?

A. Discuss with your GP, specialist nurse or local pharmacist. They can all give advice about any side effects.

Q. Is it safe to stop taking my medicine when I am feeling well again?

A. You should follow the guidance you were given from your GP, specialist nurse or pharmacist. Even though you may feel much better you should not stop medicine unless you have been told to do so. Some medicine is given to prevent symptoms over a long period of time. Always finish the whole course if you have been given an antibiotic.

Q. I feel sick when I take my medicine, what can I do?

A. Ask for advice from your GP, specialist nurse or pharmacist. There may be different medicines you can try or you may be given something to stop the sick feeling. Check if you should take the medicine before, with or after food as this can have an effect on sickness.

Q. I am using my inhaler more often to get the same effect as I used to. Is this normal?

A. No if you need to take your inhaler more often this can be a sign that you need to have a change or increase in your inhaler. It may be that the way you have been taking your inhaler is not as effective as it could be. Discuss with your GP, specialist nurse or pharmacist. They can check the way you have been taking your inhaler.

Q. I am more breathless and cough at night, can medicine help this?

A. There may be different reasons for breathlessness at night. The temperature of your room, the position you sleep in or if you are more anxious at night. The treatment for breathlessness at night will depend on the cause. There are medicines to settle your cough, you should discuss night time symptoms with your GP or specialist nurse.

Q. Can I get antibiotics to keep at home for emergencies when I need them?

A. If you have had several exacerbations over a short period your doctor may decide to give you some “rescue ” or “stand by ” medicine which is only used in the early stages of an exacerbation. This will help to treat the exacerbation or flare up quickly and may prevent severe symptoms and hospital admission.

Q. I had a nebuliser when I was in hospital and this really worked. Can I get one for home?

A. Very few people with COPD will need a nebuliser at home. If you do, you will have an assessment by a doctor and one will be prescribed for you. Most people who are taking their inhalers correctly will not need a nebuliser. It is not advisable to buy a nebuliser yourself because unless it has been prescribed for you, a GP will not prescribe the medicine to go into the nebuliser.

What medicines are used to treat COPD?

Inhaled medicines are used to help treat symptoms of breathlessness in COPD. Inhalers come in all different styles, shapes and sizes. They may be aerosol inhalers or single dose capsules loaded into an inhaler device. See our Practical guide to inhalers section on this website for more information.

Some people who have difficulty using an inhaler may be advised to use a spacer device. This is a plastic balloon like container which your inhaler fits on to. You shake your inhaler, attach it to the spacer and as normal breathe out. Place your lips around the spacer mouthpiece, and spray the inhaler into the spacer using your recommended number of “puffs”. You can then take several breaths to get all of the inhaler medication in to your lungs. This is useful for people who have poor hand coordination or who find it difficult to coordinate the single inhaled breath and the use of the inhaler at the same time.

Some of these medicines are the same as those used for asthma.

Not all medication is taken by inhalation. Tablets are used, for example, oral steroids or antibiotics for exacerbations or flare ups of COPD or capsules which help reduce the mucus produced in COPD, which can be troublesome for some people.

Understanding and using your medicines and inhalers is one key part for self managing your COPD effectively. If you are not sure about any aspect of your medication, speak to your health care professionals who can help