Nebulization Guidelines

Indications for Nebulization

The American Thoracic Society recommends nebulization for acute severe asthma and COPD exacerbations, and when metered-dose inhalers are ineffective or cannot be used properly 1, 2
Nebulization is indicated for severe acute asthma in adults with inability to complete sentences, respiratory rate >25/min, heart rate >110/min, and peak expiratory flow <50% of best value 3, 4
Nebulization is indicated for severe acute asthma in children with inability to speak or feed, respiratory rate >50/min, heart rate >140/min, and peak expiratory flow <50% of predicted value 3, 4
The European Respiratory Society recommends nebulization for COPD exacerbations with significant respiratory distress 1, 2

The American Thoracic Society recommends avoiding oxygen for nebulization in patients with CO2 retention (COPD with hypercapnia) due to risk of worsening CO2 retention 2
The European Respiratory Society recommends using compressed air for nebulization in patients with CO2 retention (COPD with hypercapnia) 2
The American Thoracic Society recommends avoiding water for nebulization due to risk of bronchoconstriction, and using 0.9% saline solution instead 1, 2

The British Thoracic Society recommends salbutamol 2.5-5 mg, repeated every 4-6 hours as needed, for bronchodilation in adults 3, 4
The British Thoracic Society recommends ipratropium 500 µg, added if no response to beta-agonists, for bronchodilation in adults 3, 4
The American Academy of Pediatrics recommends salbutamol 5 mg (or 0.15 mg/kg), repeated every 1-4 hours as needed, for bronchodilation in children 3, 4

The American Thoracic Society recommends a gas flow rate of 6-8 L/min for nebulization 1, 2, 3
The European Respiratory Society recommends a liquid volume of 2-4.5 mL (using 0.9% saline solution to complete volume if necessary) for nebulization 1, 2, 3
The American Thoracic Society recommends a nebulization time of 10 minutes for bronchodilators 1, 2

The American Thoracic Society recommends changing disposable components (tubing, nebulizer chamber, mask or mouthpiece) every 3-4 months 5, 3, 6
The European Respiratory Society recommends annual servicing of the compressor 5, 3, 6
The American Thoracic Society recommends daily cleaning for regular use: disconnect, disassemble, wash with warm water and detergent, and dry overnight 5
The American Thoracic Society recommends using special filters for nebulized antibiotics to prevent exposure of personnel and family 1, 2