When an asthma patient is newly diagnosed with this condition, he is given instructions on how to administer his medication from a metered dose inhaler. A nurse or respiratory therapist shows him how to press the medication canister down (actuating the inhaler), then breathe the spray in. The therapist instructs him to inhale deeply so the medication gets further down into his lungs; after inhaling, he is supposed to hold his breath, usually for 10 seconds.
Some patients aren’t able to do this. If they are very young pediatric patients, for instance, they won’t understand the instructions; if they are elderly, they may be able to understand, but not coordinate the steps correctly. Some may have such severe asthma symptoms they cannot breathe in deeply enough for the medication to have a beneficial effect while others won’t be able to hold their breath for even a short time.
These patients can ask their doctor to prescribe their medications in another form. Durable medical companies make nebulizers, which are compressors that convert liquid medication into a mist. Patients who use a nebulizer inhale the mist, either through a mask or a medicine cup with a mouthpiece. The nebulizer enables them to breathe the mist into their lungs, getting the full benefit of a breathing treatment.
Short-acting Beta 2 Agonists
These medications are the short acting, quick relief medications that stop an attack when it is happening. When your child is not able to use a metered dose inhaler, her doctor can prescribe a liquid medication for asthma. Her doctor writes a prescription for the nebulizer form. These medications include albuterol or Proventil, levalbuterol and metaprotenol (Xopenex) and pirbuterol or terbutaline (Maxair). When this medication is converted to mist in the nebulizer cup, you child can sit quietly with a mask over her mouth and nose or with the medicine cup’s mouthpiece clenched between her teeth. Tell her to breathe normally; the medication gets deeper into her lungs and she should begin to breathe more easily in just a few minutes.
Side effects include a rapid heartbeat, anxiety, shaky hands or nervousness, headache and dizziness, skin rash or hives, and nausea, vomiting and diarrhea.
Frequent use of a rescue medication may result in your child needing more of the medication to get the same results (she develops a tolerance to the medication), causing her to need to use more to get her symptoms under control.
Another quick-relief medication is Atrovent, which can be used alone or in combination with albuterol. This medication is also available in liquid form and can be nebulized.
The most common side effect of Atrovent is a dry throat; if the nebulized mist gets into your child’s eyes, she may experience blurred vision for a short time.
Combination asthma medications, containing both albuterol and ipratropium (Duoneb or Combivent) help control asthma symptoms.
As with Atrovent, if the medication goes into your child’s eyes, she may feel discomfort, blurred vision and irritation. Call her doctor if this happens. Side effects can include body aches, cough, sometimes producing mucus, chills or fever, trouble breathing, chest tightness loss of voice, ear congestion, nasal congestion, sneezing, runny nose, shortness of breath, sore throat or unusual weakness.
Less common side effects can include congestion, diarrhea, chest pain, hoarseness, general ill feeling, joint pain and muscle aches, loss of appetite, nausea, vomiting, noisy breathing, pain around the eyes and cheekbones, sweating, shivering, swollen neck glands, trouble swallowing, voice changes and trouble sleeping. Rare side effects may include a skin rash or hives, swelling of the face, eyelids, lips, mouth or throat or an irregular heartbeat; dizziness, change in taste, nervousness, dry mouth or tremor.
Duoneb or Combivent may cause an anaphylactic reaction, which can be life-threatening. If this happens, your child requires immediate medical attention –– call for help right away if she develops itching, a body rash, hives, trouble breathing or swallowing or swelling of her face, hands or mouth.
Cromolyn sodium (Intal) is used to prevent bronchial asthma and decrease severity of asthma attacks. This medication should not be used as a rescue inhaler. Intal works as a mast cell stabilizer, preventing mast cells in your body from releasing chemicals that lead to asthma attacks.
This medication is available as a liquid medication for asthma, meaning you are able to administer it to your child in a nebulizer, either alone or in combination with an albuterol nebulizer solution. Make sure your child uses her medication as prescribed, even when she is not experiencing asthma symptoms.
Some side effects of this medication can include drowsiness, a bad taste, nausea, hoarseness, sneezing, wheezing, throat irritation or tightness in the lungs.
If your child develops severe side effects (rash or hives, tightness in the chest, difficult breathing, swelling of the lips, mouth, tongue or face), get medical attention for her immediately.
This medication is not recommended for children younger than two years of age; if your child undergoes any dental or medical treatments, surgery or emergency care, let the dentist or doctor know she is using Intal in a nebulizer form.
Using a Nebulizer
Position the nebulizer on a flat, sturdy surface, then plug the cord into a grounded outlet. Measure each medication as prescribed into the cup (most medications come in premeasured vials). Connect the tubing to the machine, then assemble the medicine cup and mouthpiece or mask, then connect the tubing to the nebulizer medicine cup or mask.
Place the mask over your child’s face or have her hold the medicine cup and hold the mouthpiece between her teeth, and turn the machine on. Remind your child to breathe deeply so she gets the medication deep into her lungs. It may take up to 15 minutes for her to complete her treatment. Turn the machine off and disconnect the medicine cup or mask from the tubing and wash them in warm water and allow them to air-dry until the next use. Place the nebulizer in a safe place and cover it with a plastic bag or old towel until the next use.
National Jewish Health: Mixing Nebulized Asthma Medications – https://www.nationaljewish.org/healthinfo/medications/lung-diseases/devices/nebulizers/mixing-nebulized-medications.aspx
MedicineNet: Nebulizer for Asthma Center –– Medford, OR – https://www.medicinenet.com/nebulizer_for_asthma/medford-or_city.htm
WebMD: Short-Acting Beta 2 Agonists For Quick Relief of Asthma Symptoms – https://www.webmd.com/asthma/short-acting-beta2-agonists-for-quick-relief-of-asthma-symptoms
WebMD: Bronchodilators and Asthma – https://www.webmd.com/asthma/guide/asthma_inhalers_bronchodilators?page=2
Drugs.com: Duoneb – https://www.drugs.com/cons/duoneb.html
Drugs.com: Intal Nebulizer Solution – https://www.drugs.com/cdi/intal-nebulizer-solution.html