Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
A neb treatment has 2500 mcg of Albuterol, while two puffs of an MDI is 200 mcg of the same medicine. The increase in heart rate often noted with the neb reflects the higher dose. So how do we explain the often reported similar subjective and lung response in patients regardless of delivery method ? I’m not sure, but I wonder if the neb dose could be lowered without sacrificing response for those instances where the MDI is effective. Or approach nebs like we do with an MDI: start with 500 – 1000 mcg, and if desired take a second treatment.