Nebulizer Therapy For COPD – Can It Help Me Breathe Easier?

Nebulizer Therapy For COPD: When To Consider 

Dear Dr. Mahler:

I have severe COPD and attend pulmonary rehab sessions at the nearby hospital.  I take Advair in the purple disk twice a day and Spiriva powder in the capsule each morning. One of the other patients at rehab told me that she uses medicines in a nebulizer machine and this helps her breathe much better than when she used different inhalers in the past. Do you think that nebulizer therapy might help me?

Tracy from Bellingham, WA

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Dear Tracy,

There are four different delivery systems for inhaled medications to treat those with COPD: metered-dose inhalers (commonly called puffers); dry powder inhalers; soft mist inhalers; and nebulizers. In general, pharmaceutical companies have mainly been developing new bronchodilator medications as dry powders.

With dry powder inhalers, you need to take a hard and fast breath in – in order to pull the powder out of the device and overcome its internal resistance. Some individuals, especially those with more advanced COPD, may not have enough strength to successfully break up the powder packet in the inhaler device and then inhale the powder particles deep into the lower parts of the lungs.

Nebulizer therapy is used frequently to deliver bronchodilator medications to those with COPD who are experiencing a flare-up both in the Emergency Department and in the hospital. Many patients with COPD find that this approach works better because you just breathe in and out normally from the nebulizer. There is no need to hold your breath as you do with the other delivery systems.

Hand held nebulizer

There are four major reasons why your health care provider might prescribe nebulizer therapy:

1. cognitive impairment – such as dementia or confusion

2. problems with use of hands – such as arthritis of the hands and wrists

3. difficulty coordinating release of the medication from the device, not inhaling correctly, and not holding your breath long enough

4. a low inspiratory force required to break up and then inhale powder particle out of a dry powder inhaler

I suggest that you ask your health care professional whether medications in a nebulizer would work for you. This is especially important since you don’t feel it is easier to breathe with your current inhalers.

Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.

Sincerely,

Donald A. Mahler, M.D.