Medication Use in Mesh Nebulizers

Primary Medication Categories

Beta-agonists, such as albuterol, are commonly nebulized for acute and chronic airway obstruction, according to the American Thoracic Society, with a recommended volume of 2.0-4.5 mL 1, 2, 3.
Anticholinergics, including ipratropium bromide, are frequently used, particularly in COPD and when combined with beta-agonists, as recommended by the European Respiratory Society 1, 2.
Inhaled corticosteroids, such as budesonide, are recommended for nebulization, with a mouthpiece used to prevent facial deposition and reduce the risk of oral thrush, as suggested by the National Asthma Education and Prevention Program 1, 4, 5.

Colistin and gentamicin are nebulized for patients with cystic fibrosis, with a mouthpiece and filter used to prevent exhalation of antibiotic particles, as recommended by the Cystic Fibrosis Foundation 1, 2, 3, 4.
Pentamidine is used for HIV-positive patients as treatment or prophylaxis for Pneumocystis carinii pneumonia, according to the Centers for Disease Control and Prevention 1, 2, 3.

Patients should sit upright, take normal steady breaths, and keep the nebulizer upright during treatment, as recommended by the American Association for Respiratory Care 4.
Nebulizers should only be used on a physician's recommendation, with treatment typically taking 10 minutes for bronchodilators, as suggested by the American College of Chest Physicians 1, 2, 3.
The risk of cross-contamination exists if equipment is not properly cleaned, according to the World Health Organization 1, 3.
Glaucoma exacerbation can occur with anticholinergics when using a mask; a mouthpiece should be used instead, as recommended by the American Academy of Ophthalmology 1, 4.

The American Thoracic Society recommends ipratropium bromide for home nebulizer use at doses of 250-500 µg four times daily 6
Standard nebulization volume is 2.0-4.5 mL, with treatment typically taking 10 minutes, according to the British Thoracic Society guidelines 7
Air should be used as the driving gas unless oxygen is specifically prescribed, as recommended by the European Respiratory Society 7

Acetylcysteine is more viscous than standard bronchodilators and requires specially chosen equipment for effective nebulization, according to the American College of Chest Physicians 7
Nebulization may take longer than the standard 10 minutes to deliver the full dose due to the solution's viscosity, as noted by the European Respiratory Society 7

Patients must receive formal instruction on nebulizer use, with the first dose given under supervision, as recommended by the American Thoracic Society 8
The nebulizer should be emptied after each use and washed at least once daily in warm water with detergent to prevent bacterial growth, according to the Centers for Disease Control and Prevention 7, 8
Standard jet nebulizers and tubing should be changed every three months, as recommended by the European Respiratory Society 8
Patients should know when to call their physician rather than waiting too long to seek help, according to the American College of Chest Physicians 7
Regular review at a respiratory clinic is recommended for patients on long-term home nebulizer therapy, as noted by the British Thoracic Society 6