Should a nebuliser be used routinely to treat an asthma attack?
Nebulised bronchodilator therapy is no longer recommended for most people with asthma (BTS and Scottish Intercollegiate Guideline Network, 2009).
Evidence suggests that the metered dose inhaler and spacer is “at least as good as” as nebulisers in adults and children and is the preferred method for administration of bronchodilator therapy (BTS and SIGN, 2009). Treatment using an inhaler results in improved deposition of the drug in the lungs compared with a nebuliser and patients experience fewer side effects.
The BTS/SIGN (2009) guideline does recommend nebuliser use in acute life-threatening asthma. This is initially to administer a bolus dose, although continuous nebulisation may be required if the response to initial therapy is poor.
If a nebuliser is used to treat an acute asthma attack in an emergency situation, there are risks of oxygen desaturation and oxygen rather than an air-driven compressors should be used. The oxygen should be delivered using piped oxygen or a cylinder with a high flow regulator at a flow rate of greater than 6L/min (BTS and SIGN, 2009).
British Thoracic Society and Scottish Intercollegiate Network(2009)The British Guideline on the Management of Asthma
British Thoracic Society (2008) Guidelines for Emergency Oxygen use in Adult Patients: Executive Summary
Author Carol Kelly is senior lecturer/programme lead at Faculty of Health, Edge Hill University
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