Good News for Asthma and COPD Patients

What will you do if you need a nebulizer treatment and the electricity is off? And you have no generator? And you have no battery-powered nebulizer?  And you’re too short...

What will you do if you need a nebulizer treatment and the electricity is off? And you have no generator? And you have no battery-powered nebulizer?  And you’re too short of breath to use your hand-held albuterol properly?

Many asthmatics and COPD patients depend on nebulizer treatments, either on a regular basis or intermittently when their disease flares.  Having a back-up power source and/or a battery-powered nebulizer is the best short-term answer, but what if this fails?

Finding an answer was this week’s project.

It turns out, a nebulizer is a little more complicated than I believed. Though I’ve used one for years in my office, I hadn’t given it much thought.  You plug it in, add the medicine, turn it on, and voila, the aerosol appears (definition of aerosol = mixture of gas and liquid particles, such as a mist.)  The medicine is delivered in a gentler, extended fashion, than with a hand-held inhaler and does not require coordination with inhalation or deep breathing to use.

I had figured you could make something similar by simply bubbling air through a liquid medicine – wrong.  This just produces large droplets and no mist.  The droplets must be as small as 1-5 micrometers to reach the lower, branching airways.

The main consideration is the size and strength of the air stream. Though the tubing from the nebulizer compressor to the medication chamber is about the size of IV tubing, the final opening where the air leaves the tubing and enters the chamber is only pinhole size.  This thin stream of high-pressure air hits a baffle (or protruding plastic piece), “shattering” droplets of water into micro-droplets, which then become the aerosol. You could probably manufacture your own medication chamber if you were determined enough, but with the entire kit (tubing plus medication chamber) available for under $5 online (and without a prescription – see Amazon and elsewhere) it would make most sense to stock up with a dozen or more.

Next for a compressor. The air stream coming from the typical electric compressor is enough to blow up a balloon.  Therefore, my next thought was a balloon pump, which does indeed work to a degree.  The inexpensive balloon pumps require a lot of manpower to keep the mist flowing – doable, but difficult (and an asthmatic patient likely could not do this unaided). A high quality pump, or perhaps a bicycle pump should work better.

What I tried next was a new garden sprayer, the kind you pump to compress the air to generate the spray.  The sprayer can be pumped without adding any liquid, and worked quite well, though only generated enough pressure to produce an aerosol for a short time.  My one-gallon tank required re-pumping after about 30 seconds.  Still, it is an inexpensive and highly effective solution to a common question.  In an office or hospital setting time-efficient treatment is currently of the essence, but medically speaking, the medicine does not need to be delivered all at once.  Treating for 30 seconds, re-pumping, and repeating the process several times until the medication is gone is not a concern when everyone’s not always in a hurry.

Stockpiling quick-acting medication for a nebulizer is much less expensive than the hand-held inhalers. You can get 225 individual vials of albuterol or ipratropium for $10 at a discount pharmacy (with a prescription).

What about controller medication? Generally speaking, these are more expensive and require a prescription, but there is one over-the-counter exception to consider.  Years ago cromolyn was commonly prescribed as a controller drug.  You can get the same medication in the OTC drug NasalCrom (which used to be prescription as well).  Cromolyn works best for patients with allergic asthma.

Wikipedia has a nice article on the history of nebulizers, including hand-pump and steam-powered devices.

Note – as of today no news yet on the release of Primatene HFA.

Copyright © 2012 Cynthia J. Koelker

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