Nebuliser overuse

Expert warns about nebuliser overuse

Jodi Yeats

A respiratory physician is raising concerns about over-use of nebulisers for asthma and COPD, sparked by a case where the specialist weaned a patient off her nebuliser with transformative results.

Robin Taylor, medical advisor to the Asthma and Res-piratory Foundation of New Zeal-and, had his interest sparked when a home-bound patient with lifelong asthma was referred to him because she couldn’t stop using her nebuliser. After a closely supervised programme weaned her off the device, she was able to swim and walk again.

Professor Taylor says nebulisers are intended for use in acute asthma and COPD episodes and should be used for three to five days. However, in many instances patients continue to use nebulisers without supervision after an acute episode and obtain repeat prescriptions for the drugs. In fact, there is now evidence use of an inhaler and a spacer is as effective as a nebuliser in the vast majority of cases, he says.

Patients who have a doctor’s recommendation can buy or rent nebulisers for home use.

Professor Taylor’s concern is the high dose of beta-agonists, with a single “nebule” being equal to 25 or 50 puffs of bronchodilator from a metered dose inhaler. In the short term, that’s not an issue, but in the longer term beta-agonists cause inflammation of the airways.

Professor Taylor tells his patients it is similar to using soap, where washing your hands several times a day is good for hygiene but, if you were to wash your hands 24 times a day, you would start to harm your skin. In the same way, more than 10 puffs of inhaler per day, or equivalent, has a pro-inflammatory effect.

The Asthma and Respiratory Foundation is releasing a new guideline to encourage GPs to be far more selective in advising patients to use nebulisers. In addition, they need to be prepared to tell patients to stop using nebulisers, he says.

Where patients have difficulty weaning off nebulisers, GPs should refer them to a specialist for supervised withdrawal.

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