Breath Actuated Nebulizer

Breath actuated nebulizers create aerosolized droplets in coordination with respiration.  They can deliver higher doses of medications but need longer nebulization times to do so. A study of children with acute asthma exacerbations showed that one dose of albuterol delivered by a breath-actuated nebulizer was more efficacious than a single dose or continuous nebulization via jet nebulizer.

 

There are differences between types of jet nebulizers.  Some deliver medication to the site of action faster, while others have increased accuracy of drug delivery.,3

 

Proper technique for a jet nebulizer is as follows:9

  • The patient should be in a comfortable supine position (recumbent position can cause medication spillage).
  • Assemble device.
  • Add medication to the drug reservoir.
  • Use a fill volume of 3-6 ml.
    • Attach compressor or pressurized gas supply.
    • Activate device.
    • Inhale through the mouth with slow inspiratory flow.
    • Take deep breaths occasionally. 
    • Tap or shake the reservoir to free impacted droplets.
    • Shut off the device when the nebulizer sputters despite tapping.

    Proper cleaning is imperative to prevent contamination with allergens and bacterial/fungal contamination.  Store the plastic tubing and medication chamber in a plastic bag between uses.  The nebulizer should be disassembled and cleaned once or twice a week.  The components should be washed in warm, soapy water and then disinfected with a 1.25% acetic acid soak for one hour.  A quaternary ammonium compound, such as benzalkonium chloride, can be used as well.  These compounds have a shorter duration soak time of 10 minutes.  The disinfection solution should be a dilution of 1 ounce to 1 gallon distilled water. Patients should be instructed to wear a mask while cleaning to avoid directly inhaling the cleaning solution. Allow the nebulizer and components to air dry completely before use.

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