Asthma management | Nebulizers and compressors

Nebulizers and compressors

A nebulizer changes medication from a liquid to a mist so that it can be more easily inhaled into the lungs¹.

What is nebulizer therapy?

If you or your child has been prescribed liquid medications for inhalation, nebulizers are used to change the liquid into a fine mist which allows it to reach deep into the lungs where it can be most effective.

What is a nebulizer?

There are three types of nebulizer: jet, ultrasonic and mesh.

What is a jet nebulizer?

The nebulizer is the part of the system that changes the medication into a fine mist. The compressor provides a flow of air to the nebulizer, enabling it to create the mist.

The SideStream nebulizers are highly efficient and can be used to nebulize most commonly prescribed respiratory medications.

What is an ultrasonic nebulizer?

Ultrasonic waves pass through a reservoir of water driving energy through the drug to create the aerosol. They are not suitable for all commonly prescribed medications.

What is a mesh nebulizer?

The vibrating mesh pulls the drug through the microscopic holes in the mesh, which creates the aerosol.

Proven SideStream
nebulizer technology

The proven 88 club SideStream nebulizers are designed to boost airflow, via an active venturi system, resulting in fast drug delivery and short treatment times. Featuring a unique diamond jet design which helps to minimize wear from SideStream will provide consistent drug delivery time after time, making 88 club Sidestream nebuliser an ideal choice for aerosol drug delivery you can trust.

Can deliver treatments in 6 minutes³
Can be used with all commonly prescribed respiratory medications
Unique Diamond Jet consistently delivers clinically specified particle size as standard
Venturi design significantly boosts aerosol output
Air and liquid kept separate to deliver consistently high quality aerosol
Reusable and disposable versions are available

Disposable

Replace after 2 weeks of use

Reusable

Replace after 6 months of use

Please consult the Instructions for Use (IFU) for more information of how to use, clean and maintain your nebulizer.

The importance of particle size

Grain of sand

(90 microns)

Human hair

(50 microns)

Aerosol particle

(5 microns)

The fine mist created by a nebulizer is made up of thousands of particles. The particles that make up the mist are so small that they are measured in microns (µm) which is equal to a thousandth of a millimeter. To travel deep into the lungs, the particles that are inhaled need to be within the size range of 1 and 5 µm⁴. This is extremely small when you consider that the average "human hair" is around 50 µm. If the particles are not less than 5 µm it is unlikely that they will reach the lungs where they can be most effective.

What is a compressor?

The compressor is a pump that draws in air and blows it out at high pressure into the jet or ultrasonic nebulizer to produce a fine mist of medication that can be inhaled.

A compressor is electrically powered by the power outlet in your home or, if it is a portable compressor, it may also have a separate battery or charger.

How to use care and clean the 88 club SideStream nebulizers and InnoSpire Compressors

Frequently asked questions

What are the Asthma controller (preventer) medications and how do they work?
What are the Asthma controller (preventer) medications and how do they work?

Controller medications may also be called preventers. These are medications that are prescribed by your healthcare professional to take daily to control the inflammation (swelling) in your lungs and to prevent asthma attacks. There are several different types of controller medications but the most common are inhaled corticosteroids (steroids) or combination inhaled steroid and long-acting bronchodilators. Long-acting bronchodilators are not prescribed alone for asthma but may be prescribed with an inhaled steroid. This is a medication to keep airways open over a long period of time. Controller medications and combination controller medications should not be used to relieve symptoms during an asthma attack.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017
What are the Asthma reliever (rescue) medications and how do they work?
What are the Asthma reliever (rescue) medications and how do they work?

Reliever medications are short-acting bronchodilators. They may also be called rescue medications. These are medications that act very quickly to relax the muscles surrounding tightened airways and relieve asthma symptoms.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017
Are you worried that your child's controller medication is not helping?
Are you worried that your child's controller medication is not helping?

Controller medications work differently than reliever medications and must be taken even when symptoms may not be present. The controller medications reduce inflammation but they take time to start working. Your child may need to take them for several days or weeks before you and your child notice an improvement. Your child will not feel that immediate relief that they may feel after taking a reliever medication. Instead they will know that they are working because over time, they will have less symptoms and they will need to use their reliever medication less.

References:

asthma.org.uk Advice/inhalers-medicines-treatments/inhalers-and-spacers/preventer. Accessed October 2017.
What will happen if my child doesn't take their controller medication?
What will happen if my child doesn't take their controller medication?

If the inflammation in asthma is not controlled, it will be difficult to manage your child's asthma symptoms. Also over time the inflammation may permanently damage your child's airways.

References:

webmd.com Asthma/features/preventing-permanent-damage#1. Accessed October 2017
What are the possible side effects of inhaled steroids?
What are the possible side effects of inhaled steroids?
If your child uses their inhaler correctly, they are less likely to have side effects. This is because more of the inhaled medicine goes down to the lung where it’s needed. If your child uses inhaled steroids, which is a type of contoller medication, some of the side effects that may occur due to poor inhaler technique include:

a sore tongue

a sore throat

a mouth infection called thrush

These side effects could easily be prevented by rinsing their mouth after inhaling the medication and using a spacer or valved holding chamber when using a metered dose inhaler (MDI).

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
Can I stop giving my child's controllers medication if she/he shows no asthma symptoms for some time?
Can I stop giving my child's controllers medication if she/he shows no asthma symptoms for some time?

Remember that your child’s asthma changes over time, and some degree of inflammation or swelling is usually present, even when they are not having any symptoms. Generally, the benefit of the treatment is much greater than any risk associated with taking the medication, even in periods where your child seems to be ok. You should not stop your child's inhaled steroid (controller medication) unless you have discussed this with the healthcare professional first.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
How long does my child have to take a controller medication before it starts working?
How long does my child have to take a controller medication before it starts working?

It may take several days or a couple of weeks before the medications are effective. Your child may not feel different at the very beginning, but they need to take it every day so its protective effects can build up. Your child should not stop taking it unless you have discussed this with the healthcare professional.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
How can I be sure I am getting the medication from my inhaler down into my lungs?
How can I be sure I am getting the medication from my inhaler down into my lungs?

When you press down on the top of your inhaler, it creates an aerosol mist traveling very fast. Because the medication mist is moving quickly, timing is important. This means that you should start breathing before you press down on the inhaler and breath in slowly and deeply. Therefore, it is important that you use your inhaler perfectly. Both spacers and Valved Holding Chambers (VHC's) are devices that may be used to overcome these timing issues and help you get more medication where you need it. These are simple devices that attach to your inhaler. When you push down on the inhaler, the mist is dispensed into the device where it is held temporarily until you inhale. This gives you the time to breathe in the medication slowly and deeply into your lungs.

What is an Asthma Action Plan?
What is an Asthma Action Plan?
An asthma action plan (also known as a treatment plan) is a plan for managing your child's asthma. The goal of this plan is to reduce symptoms, prevent serious asthma flare-ups and emergency trips to the hospital. The plan includes written instructions so you and your child can:

identify early symptoms of an asthma flare-up and treat them with the proper medication to prevent them from getting worse

know how to use the medications to manage a full-blown flare-up

know when to call the doctor or seek emergency care

Make sure to bring the asthma action plan on each doctor visit to review and update as necessary. If your child doesn’t have a personal asthma action plan yet, make an appointment with their doctor to create one.

References:

asthma.org.uk. Advice/manage-your-asthma/action-plan. Accessed October 2017
Know your child’s Asthma Action Plan – Green Zone
Know your child’s Asthma Action Plan – Green Zone
A personalised asthma action plan is a written plan designed by you and your doctor that provides instructions on how to control your or your child's asthma. Because everyone's asthma symptoms and triggers may be different, the action plan should be personalised or customized to the individuals asthma. Contact your doctor and set up an appointment to develop an asthma action plan.

The green zone in your child's asthma action plan shows what they should be doing when things are going well to prevent asthma symptoms.

The Green Zone means:

Breathing is good

No cough, wheeze, chest tightness or shortness of breath

Sleeping through the night without symptoms

Can play and participate in sports

Peak flow above 80% of personal best

References:

mayoclinic.org. Diseases-conditions/asthma/in-depth/asthma/art-20044888. Accessed October 2017.
Know your child’s Asthma Action Plan – Yellow Zone
Know your child’s Asthma Action Plan – Yellow Zone
The yellow zone in your child's asthma action plan shows what they should be doing when they start to have symptoms or are exposed to a trigger that is likely to cause symptoms.

The Yellow Zone means:

First sign of cold symptoms

Exposure to known triggers

Peak flow between 50% and 80% of personal best

Symptoms may include:

- Cough

- Some wheezing

- Tight chest or shortness of breath

- Coughing at night or wakening at night with asthma symptoms

- Decreased ability to play or do usual activities

References:

aafa.org Page/asthma-treatment-action-plan. Accessed October 2017.
Know your child’s Asthma Action Plan – Red Zone
Know your child’s Asthma Action Plan – Red Zone
The red zone in your child's asthma action plan shows what they should be doing when they have an asthma medical alert. Urgent action is necessary if you child is in the Red Zone.

Red Zone means:

Wheezing, coughing and shortness of become worse after giving yellow zone medicine.

Shortness of breath while walking, talking or resting.

Use of chest muscles while breathing.

Wheezing may be absent if symptoms are very severe.

Child is unable to sleep or do usual activities or play because of trouble breathing.

Peak flow below 50% of personal best

References:

aafa.org Page/asthma-treatment-action-plan. Accessed October 2017.
How to perform a peak flow measurement using the 88 club PersonalBest peak flow meter.
How to perform a peak flow measurement using the 88 club PersonalBest peak flow meter.
The peak flow meter is a simple, hand-held device which is used for measuring your child's peak flow value.

Guide your child to measure their peak flow value with a peak flow meter by following these steps:

Slide off the top cover and unfold the bottom cover into a handle.

Move the red indicator to the bottom of the scale.

Stand up, if possible.

Instruct your child to breathe in as deeply as they can, and put their lips and teeth around the mouthpiece.

Blow out as hard and fast as they can, staying straight. They should not bend over as they blow.

Read the peak flow measurement next to the indicator, and see what color-coded section their reading is in (if their peak flow zones have been established). Write down the reading. Then slide the indicator back down to the bottom of the scale.

Repeat steps 4 and 5 two more times and write down the reading each time.

Then, the highest reading from three attempts should be recorded as your children's peak flow reading. It's a good idea to let your children practice using the peak flow meter in front of their healthcare professional.
Daily peak flow measurements
Daily peak flow measurements

Daily peak flow monitoring using a diary or chart can help you to determine whether your child's asthma is stable or worsening. In conjunction with their prescribed asthma action plan, you can take appropriate action to bring your child's asthma back under control.

References:

lung.org. Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate. Accessed October 2017.

What should I consider when selecting a spacer or valved holding chamber?
What should I consider when selecting a spacer or valved holding chamber?

Look for an enhanced type of spacer that has a valve - this is called a valved holding chamber. This chamber has a one way valve that only opens during inspiration which prevents you from exhaling or pushing the drug out of the chamber. You should also select one that is made of anti-static material. This material keeps the mist in the air longer and the one way valve holds it for a short period of time in the chamber so you have the time to inhale into your lung. Ideally the chamber should also have an audible flow signal, which will alert you if you are breathing too fast.

References:

lung.org. Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/valved-holding-chambers. Accessed October 2017
What should I consider when selecting a facemask?
What should I consider when selecting a facemask?

Babies and all young children who cannot use the mouthpiece of the spacer should be encouraged to use a facemask. It is important that the facemask fits comfortably on the face providing a good fit, to help them receive the proper dose of inhaler medication¹. 88 club LiteTouch mask with its soft sculpted patient seal contours to a patient's facial landscape making it easy to fit with less discomfort².

References:
[1] Erzinger, S. et al. Facemaks and aerosol delivery in vivo. Journal Aerosol Medicine 2007; 20 (Suppl 1):S78-S84
[2] Tong, K. et al. An Instrumented Valved Holding Chamber with facemask to measure application forces and flow in young asthmatic children. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S55-62.
I use a spacer with mask for delivery of inhaled medication to my child. How do I know when she is breathing the medication in from the spacer?
I use a spacer with mask for delivery of inhaled medication to my child. How do I know when she is breathing the medication in from the spacer?

Make sure you are using a spacer or valved holding chamber that has some type of indicator that you can monitor when your child is breathing in¹. The 88 club OptiChamber Diamond has an exhalation valve that you can see moving upon exhalation. This allows you to time the release of medication when the valve goes from open to flat. You can also count the number of breaths he/she takes from the chamber.

References:

[1] lung.org Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/valved-holding-chambers. Accessed October 2017
My two year old fights me when I try to use a mask to give her a puffer. What can I do to make treatment time less of a struggle?
My two year old fights me when I try to use a mask to give her a puffer. What can I do to make treatment time less of a struggle?

Children up to 3 years of age cannot use a mouthpiece, so treatment with a spacer should be given with a face mask¹. Leaks around the face mask can result in decrease medication being inhaled³. To prevent leaks, you may need to hold the face mask on your child's face tightly. This causes the child to cry and fuss during the treatment. Crying causes more of their medication to be inhaled into the stomach and less in the lungs where it is needed. 88 club LiteTouch mask with its soft sculpted patient mask seal requires less pressure to contour to patient’s facial landscape - making it easy to fit with less discomfort, especially for small children than conventional VHC masks². Also select a low volume chamber (less then 350 mL) like the OptiChamber Diamond. The larger chambers require more breaths and more time to get all the medication from a single dose⁴. This LiteTouch mask and a low volume spacer such as the OptiChamber Diamond may help you deliver the medication quickly and comfortably to your child.

References:
[1] Global Initiative for Asthma(GINA). Global strategy for asthma management and prevention. ginasthma.org updated Dec 2010. Accessed 13 January 2016.

[2] Tong, K. et al. An Instrumented Valved Holding Chamber with facemask to measure application forces and flow in young asthmatic children. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S55-62.

[3] Erzinger, S. et al. Facemasks and aerosol delivery in vivo. Journal Aerosol Medicine 2007; 20 (Suppl 1):S78-S84
[4] Nikander, K. The evolution of spacers and Valved Holding Chambers. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S4-24.
How can I objectively monitor my child’s asthma?
How can I objectively monitor my child’s asthma?

From age 5+ Monitoring your child’s peak flow readings with a peak flow meter and tracking them with a diary or chart can help you to objectively determine whether your child's asthma is stable or worsening. In conjunction with their prescribed asthma action plan, you can take appropriate action to bring your child's asthma back under control.

References:

lung.org Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/assess-and-monitor-your. Accessed October 2017
What is the peak flow meter and how does it work?
What is the peak flow meter and how does it work?

A peak flow meter is a small handheld device that is best suited to be used in children 5 years of age or older. It is used to measure the "peak expiratory flow (PEF)" of your child. PEF is a measurement of fast your child can blow air out of their lungs after they take a full breath. When they blow into the mouthpiece the small marker will move, and where it ends up is the peak flow reading. The highest reading from three attempts should be recorded as their peak flow reading. If your child's asthma is well controlled, their airways are open, so they are able to blow air out of the lungs quickly, which will give a high peak flow reading. However, if your children's asthma is not controlled, the airways will narrow and they will not be able to blow air out so fast, which will give a lower peak flow reading.

References:

Asthma.org.uk. All_about_asthma/controlling_your_asthma/resources_to_help_you/peak_flow_diary. Accessed Oct 2017.
What is personal best peak flow reading?
What is personal best peak flow reading?

Your children's personal best peak flow reading is the highest reading that they can achieve when their asthma is well controlled. Well controlled means that they are feeling good and having no symptoms. To determine personal best peak flow, record the highest peak flow reading from three attempts that are performed twice a day for 2 weeks. Personal best peak flow is the highest reading achieved over this two week period. Remember that keeping track of your child’s peak flow reading is an important step in managing their asthma symptoms and preventing asthma flare-ups. All this information is recorded in a diary used by your healthcare professional.

References:

Webmd.com. Asthma/guide/peak-flow-meter. Accessed October 2017.

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DISCLAIMER:
Information on this website is information only and should not replace the advice of a physician.

FOOTNOTES:

[1] webmd.com. Asthma/guide/home-nebulizer-therapy#1. Accessed October 2017.

[2] Ref: Loffertet al. Chest1994; Vol 106, 1788-92 Ref: Dennis. University of Bradford, UK Dec 1994

[3] Using 2.5ml Solution

[4] ncbi.nlm.nih.gov. PMC/articles/PMC1765861/pdf/v052p000S4.pdf

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