Nebulizer Treatment

A nebulizer is a device that changes liquid medication into a fine mist that can be easily inhaled.

Order of nebulizer treatment

Patients with cystic fibrosis should always take their medications and use airway clearance techniques in a specific order. This is important because each medication achieves a different result.

Not all patients will be on the same medications, but the order listed here should be followed for any combination of medications.

  1. Albuterol (or any bronchodilator) should be given first. A bronchodilator helps open the airways that move air to or from the lungs. Not all people with cystic fibrosis will respond to bronchodilators, so they may not be ordered. Any type of nebulizer may be used with this medication.
  2. Pulmozyme, a mucolytic, breaks down the DNA structure of the mucus produced by people with cystic fibrosis. This helps them cough out the thick secretions. This drug may be given using a PARI or a Sidestream nebulizer.
  3. Inhaled antibiotics such as Tobi and Tobramycin should be given last. The object of inhaled antibiotics is to attack the bacteria within the lungs. The airways should be open and cleared of as much mucus as possible before receiving this therapy. Only Pari nebulizers can be used with this medication.

Airway clearance techniques

The following techniques are used to clear the airway:

  • Coughing or huffing (a gentle cough)
  • Chest physical therapy (CPT), which involves lying in various positions and clapping on the chest
  • Using a positive expiratory pressure (PEP) device, which is often a mask or a mouthpiece attached to a special machine. An acapella valve is one type of PEP device.
  • Breathing out through a flutter device (also known as oscillating positive expiratory pressure)
  • Wearing a special vest that is attached to a machine that vibrates at a high frequency. Albuterol and Pulmozyme may be given during this type of treatment, but not inhaled antibiotics.
  • Autogenic drainage, or drainage controlled by the person with cystic fibrosis. This is often hard for young children to perform.

Nebulizer care

Cleaning your nebulizer

  1. Wash your hands with antibacterial soap before cleaning your nebulizer.
  2. Remove any dried and caked on secretions from your nebulizer.
  3. After each use, rinse your nebulizer with sterile water. Do not use tap water because it contains pseudomonas (a common bacteria that can cause infection).
  4. Place the pieces of your nebulizer on a paper towel to air dry. Place another paper towel on top of the pieces of your nebulizer.

Disinfecting your nebulizer

Your nebulizer should be disinfected every other day.

  1. Wash your hands with antibacterial soap before cleaning your nebulizer.
  2. Boil your nebulizer in boiling water for five minutes.
  3. Let cool.
  4. Place the pieces of your nebulizer on a paper towel to air dry. Place another paper towel on top of the pieces of your nebulizer.

Changing your nebulizer

  • Change the PARI nebulizer (used for TOBI and/or Pulmozyme) every six months.
  • Change the Sidestream (used for Pulmozyme) every year.