The surprising answer is, “No, not necessarily and not usually.” Several studies have demonstrated that inhaled asthma medication delivered from an inhaler (MDI or DPI) is just as effective as that administered via a nebulizer,provided that a valved holding chamber is used with the MDI and the patient has mastered appropriate MDI or DPI technique.
MDIs, like DPIs, are inexpensive, basically maintenance free, highly portable, and very convenient. Nebulizers are more cumbersome, require a power source, and need frequent cleaning. The same medicine that can be administered in 2 or 3 minutes by an MDI will take at least a quarter of an hour by nebulization.
There are defined circumstances when a nebulizer rather than an MDI+VHC setup or DPI might be considered. Babies and very young children (less than 5 years old) who are too young to learn inhaler technique should receive their medicine by nebulization, usually via a face mask. Most children can be taught correct MDI and DPI technique when they are of kindergarten age, particularly if there is a motivated adult in the home to supervise and encourage the child. Many of those children can also be prescribed a nebulizer to keep in reserve at home for emergency use under the guidance of a doctor in the case of a severe exacerbation.
A patient of any age who cannot master correct inhaler technique will require medication administration by nebulizer. Persons who are unable to use inhalers, perhaps because of physical or neurological impairments, can usually receive their prescribed medicine via a nebulizer. Finally, some individuals with badly compromised lung function cannot inhale from an MDI deeply enough to benefit and should switch to a nebulizer. The last scenario is unusual in a person with asthma alone and is more likely with a cigarette-associated lung condition, such as advanced emphysema.
A special caution concerns nebulizer use in toddlers and young children. A child younger than 5 years must use a face mask when nebulized medication is administered. To obtain maximal benefit from the treatment, the face mask must create a tight seal over the child’s nose and mouth. Delivering nebulized medicine using what has been called the blow-by technique is totally ineffective.
The blow-by method attempts to deliver medication by holding the bulb that contains the medicine under the child’s nose and mouth, with the hope that it will reach the lungs. Unfortunately, it does not work! The blow-by technique does not require that you hold a mask to the child’s face, so although a parent may believe they are still treating their child’s asthma effectively, the fact is that only insignificant amounts of medicine reach the breathing passages.
Medications used in the treatment of asthma available in liquid form for nebulization include short-acting bronchodilators (AccuNeb, generic albuterol solution, Proventil solution, Xopenex solution), corticosteroids (Pulmicort Respules), and mast-cell stabilizers (Intal, Tilade).