How to Use a Nebuliser Step by Step

Before you start: know the plan

Have the doctor's instructions in writing:

• Which medicine (name and strength), how many doses and how often.
• How much saline, if any, to add, and whether the medicine comes in single-dose vials (called unit doses or respules) or needs measuring.
• When to use it: regularly, or only when breathless, and the maximum number of treatments per day.
• What to do if it does not help, and when to call the doctor or 112.

Keep this with the machine. See building a COPD action plan with your doctor and nebulisers: types, use and cleaning. Never give extra treatments because breathing feels worse; call the doctor, and call 112 if your parent is severely breathless, blue around the lips, exhausted, confused or has chest pain.

What you need

• The nebuliser compressor or device.
• The medicine cup, mask or mouthpiece, and tubing.
• The prescribed medicine, checked against the doctor's note and the expiry date.
• Tissues, a small towel and a glass of water.
• A clean, dry surface near a socket.
• An oximeter, if advised; see pulse oximeters: how they work and how to use one.
• A watch or clock.

Step-by-step method

1. Wash your hands with soap and water, and dry them.

2. Prepare the space. Sit your parent comfortably in a chair with a back, upright, or propped up in bed with pillows. A slightly forward-leaning posture, with elbows on a table, helps breathing. Do not give a nebuliser while lying flat.

3. Check the equipment. Look at the cup, mask or mouthpiece and tubing for cracks, residue or damp. If dirty, wash before use. Place the compressor on a stable, hard surface, not on a bed or sofa, where the air intake could be blocked.

4. Check the medicine. Confirm the name, strength and expiry date against the prescription. Do not use if cloudy (unless it is a suspension that is meant to be cloudy), discoloured or past date. Do not use leftover opened vials from the day before unless the pharmacist says that is acceptable.

5. Measure and pour. Twist off the top of a single-dose vial and squeeze the contents into the cup. If the doctor has told you to add saline, add exactly the amount stated. Do not add water, herbal drops, steam additives or any other liquid. Do not exceed the maximum fill line of the cup.

6. Assemble. Screw the cup lid closed. Attach the mask or mouthpiece to the cup. Connect the tubing between the cup and the compressor outlet, making sure it is firm at both ends. Keep the cup upright, since tilting it spills medicine and reduces mist.

7. Switch on the compressor. Check that a mist is coming from the mask or mouthpiece. If there is no mist, check the tubing for a kink or a loose connection.

8. Position the mask or mouthpiece.

• Mouthpiece: have your parent hold it between the teeth with lips sealed around it, breathing in and out through the mouth.
• Mask: place it over the nose and mouth with a snug fit. Hold it in place gently, with the elastic strap if one is provided. Avoid pressing so hard that it is uncomfortable. A blow-by technique, holding the mask away from the face, wastes the dose and is not recommended.

9. Breathe normally. Ask your parent to breathe slowly and calmly, with occasional deeper breaths, through the mouth if possible. They do not need to breathe hard or hold their breath. Encourage them to relax their shoulders. If they cough, let them pause, sip water and carry on.

10. Keep going until the mist stops. Treatment usually takes 5 to 15 minutes, until the cup sputters and little liquid remains. Tap the cup gently now and then to shake the last droplets down. Do not stop early or keep going for much longer after it starts spluttering.

11. Switch off the compressor, and remove the mask or mouthpiece.

12. Aftercare.

• Rinse the mouth with water and spit it out, particularly after steroid medicines, to reduce thrush; some doctors also advise this after other medicines. Wash the face if a mask was used, to remove medicine from the skin and around the eyes.
• Check how your parent feels. Many people feel easier within minutes. Note any shakiness, palpitations, nausea or throat irritation.
• Check oxygen with an oximeter if advised.
• Write it down: date, time, medicine, reaction and symptoms. See keeping a health record at home.

13. Clean the equipment as set out below.

Breathing technique tips

• Slow, calm breaths are better than rapid or forced ones.
• Sit upright and leaning slightly forward with arms supported.
• Use pursed-lip breathing after the treatment if breathless; see breathlessness: positions and breathing techniques that help.
• Tell the person what you are doing and keep calm, since fear worsens breathlessness.
• For people with dementia, use a gentle, familiar voice, short instructions and, if necessary, try a mouthpiece rather than a mask. See communicating with someone who has dementia. Do not restrain.

Cleaning after each treatment

1. Disconnect the tubing from the cup (leave the tubing attached to the compressor). 2. Take the cup apart: lid, baffle and base, and the mask or mouthpiece. 3. Rinse the parts in warm running water, shake off water and leave to air-dry on a clean cloth or paper towel. 4. Run the compressor with the tubing attached for a minute (nothing in the cup) to dry the tubing. 5. Store the dry parts in a clean, covered container.

Daily or as advised: wash the parts in warm soapy water, rinse and dry. Weekly or as advised: disinfect, as in the maker's manual; common methods include soaking in a vinegar and water solution, or boiling parts that are heat-safe. Do not use the same method for all parts without checking the manual. Do not wet the compressor. Replace the cup, mask and tubing at the recommended intervals, or if they are cracked or cloudy, and change the air filter as directed. See a cleaning schedule for breathing equipment. Humid weather encourages mould, so make sure parts are fully dry.

Troubleshooting

• Little or no mist: check the tubing connection, the cup assembly, the filter and the power. A blocked cup may need washing. Replace worn parts.
• Mist but a very long treatment: a worn cup or a weak compressor. Contact the supplier.
• Compressor hot or noisy: switch off and let it cool; do not cover vents.
• Medicine in the eyes (with a mask): wash eyes with clean water; report persistent irritation. Consider a mouthpiece.
• Cough or wheeze after the treatment: pause and sip water; report if it continues, as some medicines can cause a paradoxical tightening in rare cases.
• Shaking or fast heartbeat: common with some relievers. Rest. Report to the doctor, particularly if severe or if your parent has heart disease.
• Treatment not helping: do not repeat doses beyond the plan. Call the doctor, and 112 if severe.

When using oxygen

If your parent is on home oxygen, ask the doctor how to give nebuliser treatments. Many people need oxygen to continue during the nebuliser through a cannula, with the nebuliser driven by air. Some doctors prescribe an oxygen-driven nebuliser at a specific flow. Do not connect the nebuliser to the oxygen supply or alter flow unless your doctor and the supplier have shown you how. Keep all flames and smoking away. See using an oxygen concentrator safely at home and oxygen flow rates and prescriptions: what families should know.

Common mistakes

• Using a medicine that was not prescribed or an expired vial.
• Adding water, herbal remedies, camphor or essential oils.
• Stopping when the mist first weakens, or continuing for a long time after spluttering.
• Giving the treatment lying down.
• Holding the mask loosely away from the face.
• Not rinsing the mouth after steroids.
• Not cleaning or drying the cup, leading to infection.
• Repeating treatments too often when breathless, instead of calling for help.
• Sharing masks or cups among family members.

Warning signs

Call the doctor the same day if your parent needs the nebuliser more often than usual, if the effect wears off sooner, if sputum changes colour or increases, if there is fever, if side effects appear or if breathlessness is worsening.

Call 112 now if your parent:

• Is struggling to breathe or cannot speak in full sentences.
• Has blue or grey lips.
• Is confused, very drowsy or exhausted.
• Has chest pain or a very fast, irregular heartbeat with weakness.
• Does not improve after the prescribed treatment as described in the action plan.

When to ask a professional

Ask your doctor, nurse or physiotherapist to watch you give a treatment and correct your technique. Ask the pharmacist about medicines, storage and compatibility. Ask for a written plan stating when to use the nebuliser and when to call. Ask whether an inhaler with a spacer would work as well; see inhaler technique and spacers for older adults. Call 112 for emergencies.