What is the process for a patient with asthma or COPD to obtain and use a nebulizer for treatment?

How to Order a Nebulizer for Asthma or COPD

Patients requiring long-term nebulizer therapy should be referred to a centralized nebulizer service for formal assessment by a hospital specialist before initiating treatment, as nebulizers should only be prescribed after demonstrating that appropriate doses of hand-held inhalers have failed. 1

Clinical Assessment Before Ordering

Indications for Nebulizer Therapy

Nebulizers are primarily indicated for:

• Acute severe asthma or COPD exacerbations requiring emergency treatment 1, 2
• Chronic persistent asthma only after formal evaluation demonstrates benefit from specialist units and failure of hand-held inhalers at appropriate doses 1
• Patients unable to use hand-held inhalers due to severe illness, poor coordination, cognitive impairment, or inadequate inspiratory flow 1, 3, 4

Formal Evaluation Requirements

Before prescribing long-term nebulizer therapy, the British Thoracic Society mandates:

• Documented failure of hand-held inhalers at appropriate doses (not just patient preference) 1
• Formal assessment by a specialist (chest physician or paediatrician) demonstrating objective benefit 1
• Improvements in pulmonary function and reduction in respiratory exacerbations must be demonstrated 1
• Patients wishing to purchase their own compressor should be discouraged from commencing long-term treatment without this assessment 1

Ordering Process Through Nebulizer Service

Centralized Service Requirements

All patients needing nebulizer treatment should access a centralized local nebulizer service that provides: 1

• Provision of compressors, nebulizers, and disposable components 1
• Equipment for emergency replacement in case of breakdown 1
• System for repair, servicing, and maintenance 1
• Patient and staff education 1
• Detailed assessment schemes for long-term treatment suitability 1
• Standard written instructions including telephone numbers for emergency replacements 1

Equipment Specifications to Order

The nebulizer system must include: 1

• Electrical compressor with flow rate of 6-8 L/min (standard) or >8 L/min (high flow) 1
• Jet nebulizer chamber matched to the compressor for adequate output 1
• Connecting tubing (disposable) 1
• Mouthpiece or face mask (interchangeable; masks better for emergencies and infants) 1
• Spare nebulizer chamber for backup when primary becomes inefficient 1

Compressors must conform to BS5724 or IEL 601-1 standards (or European Medical Devices Directive compliance) 1

Patient Education Requirements

Initial Training Protocol

Before sending a patient home with a nebulizer: 1

• First treatment must always be done under supervision 1
• Patients must be shown how to use, clean, and assemble the equipment 1
• Written instructions must be provided by the local nebulizer service or derived from BTS guidelines 1
• Emergency contact information must be clearly documented (local nebulizer service or practice nurse) 1

Critical Safety Instructions

Patients must know: 1

• When to use nebulizer treatment versus hand-held inhalers 1
• What to do if equipment breaks down (disassemble, wash, try spare; if still inefficient, seek medical help and use multiple doses of hand-held inhalers) 1
• When to call their general practitioner rather than waiting too long to come to hospital 1
• For asthmatic patients specifically, when and which treatment to take 1

Maintenance and Follow-Up Orders

Disposable Component Replacement Schedule

Order replacement supplies every 3-4 months: 1

• Plastic tubing 1
• Nebulizer cup 1
• Mouthpiece or mask 1

These are available from chemists, manufacturers, or local nebulizer service 1

Annual Servicing Requirements

Compressors require annual servicing by the local nebulizer service or manufacturer 1

Common Pitfalls to Avoid

Critical errors when ordering nebulizers:

• Never prescribe long-term nebulizer therapy without prior specialist assessment and documented failure of hand-held inhalers 1
• Do not allow patients to self-purchase compressors and commence treatment without formal evaluation 1
• Ensure the compressor and nebulizer are matched for adequate performance with each drug class (bronchodilators, steroids, antibiotics) 1
• Do not prescribe nebulizers based solely on patient preference when hand-held inhalers at appropriate doses would be adequate 1

For COPD patients specifically, never order oxygen-driven nebulizers for home use if CO2 retention is present; air-driven compressors must be used 2