A nubulizer is a device that takes a liquid solution and turns it into a fine mist that can be inhaled. I frequently hear patients refer to it as a “breathing machine” that gives a “breathing treatment”. Albuterol is the most common nebulized medication and is used to treat wheezing and chest tightness in asthmatics and emphysema patients. The primary advantage to nebulizers is that they are very easy to use. Place the medication in the machine, flip the switch, and breathe normally from the mouthpiece or mask til the medication is finished- around 10 minutes.
The alternative to nebulizers is the simple metered-dose inhaler, or MDI. MDIs are harder to coordinate than a nebulizer, but when they are used with a spacer device,
as pictured on the right, coordination is much easier and the delivered dose is more consistent. Learning to use a spacer device takes under a minute.
There is a common misconception that nebulizer therapy is a stronger treatment than an MDI. This is simply not true. Multiple studies have shown that patients receiving albuterol from an MDI/spacer combination do just as well as, if not better than, patients receiving nebulized albuterol.
MDIs offer several advantages. First, they are much quicker to use. Two puffs from an MDI/spacer takes 30 seconds or so if done properly vs. 10 minutes or so for a nebulizer treatment. Second, MDIs cause fewer side effects. Nebulized albuterol causes much more heart rate increase and tremor than albuterol from an MDI/spacer. Third, MDIs are much cheaper to use. Not including the cost of the nebulizer and related supplies, nebulized albuterol costs $2-$2.50 per dose versus $.40-$.50 per dose for MDI delivered albuterol.
So, MDIs are cheaper, quicker, have fewer side effects and have equal effectiveness. Sounds like we have a winner.