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 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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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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8 Responses to Good News for Asthma and COPD Patients

  1. Randy says:

    I did some research on the Primatene / Asthmanefrin situation and came up with several updated facts:

    Primatene with a CFC-free nebulizer using HFA has been submitted to the FDA (Foot Dragging Administrators?) as evidenced here

    Asthamanefrin has now run afoul of the FDAs regulatory nitpicking. They sent a potentially product-stopping 9/24/13 Warning letter to Nephron listed here citing Asthmanefrin as an unapproved drug.

    I have not been able to find a response from Nephron to the Warning letter.


  2. Randy says:

    A friend uses a battery powered e cig that she re-charges with a small case with solar cells on one side. It vaporizes nicotine oil beautifully. I’m going to try it with a .5ml vial of asthmanefrin. Might work for albuterol vials as well… If it works, we might package everything up as a kit for preppers for about $50-60 with a wall/car charger or a solar case as an option.

    Comments or Suggestions?

  3. Amanda says:

    I have an inverter for the cigarette lighter in my car that I plug my nebulizer into. Hopefully the car would be available, but as a prepper you make a back up plan to that.

  4. Paul S says:

    I have a battery operated nebulizer that I had my doctor write a order for. That would be something to look at. I also bought a extra battery for it. Have not had to use it much so I am unable to give any kind of idea on how long the battery would last. Just an idea. Very small and light. Hope this helps. Not cheap but not to expensive. I have a chronic lung disease called chronic beryllium disease I got from my job so this is a big concern for me.

  5. Gemshoot says:

    My daughter is an asthma sufferer. Thank you for this article. I have very little knowledge of scuba gear, but would it be possible to use a scuba tank and regulator to give continuous pressure? May work for CPAP if the pressure could be regulated to the right level. Please let me know your thoughts. BTW this is my first time on your site.

    [I have not tried either, but they might work. Bicycle pumps are a good option that I have tested and know to work. – Doc Cindy]

  6. JJ, MD says:

    I have always thought that a fish aerator pump would work as a nebulizer compressor. . . the pressure seems the same and tubing seems similar size. There are many different sizes. I will try it and see.

  7. Linda says:

    What online sites sell hand-pump nebulizers?

    • Doc Cindy says:

      I don’t know of any. However, I have experimented with balloon pumps, garden sprayers, and bicycle pumps. Some balloon pumps will work, but not all. Garden sprayers (unused ones, of course) work fairly well, but bicycle pumps seem to give the best results. You may need an adapter for the nebulizer tubing, however. A foot pump seems to work a little easier than a hand pump. – Doc Cindy

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