Why Nebulizers Matter: Real-Life COPD Experience and Expert Guidance

[Arnelle Konde] (0:07 - 1:25)

Welcome to the Lung Health Champion Podcast brought to you by the COPD Foundation. Each episode brings practical tips, expert insights, and a powerful lived experience. If you have lungs, you belong here.

So let's take a deep breath together and get started. I'm your host, Arnelle, and today I am co-hosting with Jonnie Korinko, the director of education at the COPD Foundation. And this episode is all about nebulizers, what they are, why they help, and how they help people living with COPD and other lung conditions.

To bring this conversation to life, we're joined by two very special guests. First, we have Bonnie, who uses nebulizers every day to manage her COPD. And we're also joined by Matthew Dartt, a respiratory therapist who helps people with lungs.

One of the most important things about nebulizers is that we have to help people with lung problems use their inhaled medicines more effectively. Whether you're living with COPD, caring for someone who is, or just want to be more informed, this episode is for you. Matt and Bonnie, thank you so much for being here today.

So I just want to jump right in about how nebulizers work. Matt, can you explain how a nebulizer works for our listeners?

[Matthew Dartt] (1:26 - 2:27)

Sure, so when you think about nebulizers, if you haven't seen one before, I think everybody's seeing the little puffers we have, or an inhaler, or an MDI. So an inhaler creates a fine mist. It hits usually a baffle and turns into a mist in a little cup.

And you'll see people breathing those in. So if anybody's ever been hospitalized, they will have seen those. And it works either through compressor, compressed air, pushes that air into the cup, and then it hits that baffle and nebulizers.

There's also vibrating mesh nebulizers, which have very fine holes, like 1,000, 100,000 little tiny apertures, and they vibrate together, and they create this very, very fine mist. And once that mist is created, patients can breathe normally, and they can take deep breaths in, or they can take normal breaths in. Or if they're in distress, having an exacerbation, they can kind of breathe how they want to breathe, and they'll still get that medication, or at least some of it.

[Arnelle Konde] (2:28 - 2:32)

Yeah, and for comparison, how do inhalers work versus nebulizers?

[Matthew Dartt] (2:33 - 3:24)

So the nebulizers work, how I just discussed. And inhalers, there's different kinds. So there's soft mist inhalers that kind of create.

That's that mist we were just talking about. There's what I just showed you, which is called a meter dose inhaler. And that one has a can with the actuator, and that creates a mist as well that comes out.

There's also a dry powder inhaler as well, where patients have to inhale rapidly to get that medication in. So with the MDIs, with those inhalers, they're very patient-dependent. So it takes a lot of coordination on the patient's part, or the practitioner's part, teaching them how to do that as well.

So the devices are highly technique-dependent. So patients have to have the right timing coordination, the inspiratory flow. You want them to have breath holds to get optimal deposition as well under their lower airways.

So if any of those steps break down, the delivery can become very inconsistent.

[Jonnie Korinko] (3:25 - 3:36)

So Bonnie, when you were first given a nebulizer, how was it described to you? How were you kind of told how a nebulizer works?

[Bonnie Truelsen] (3:37 - 4:20)

So when I first had a nebulizer prescribed, it was through a pulmonologist who didn't explain anything. But I had a DME company, durable medical equipment company, deliver my nebulizer with a respiratory therapist. So she went over all the details and made sure that I could operate.

But I really didn't understand. It took me a while. I had to go back and ask questions.

It seemed complicated at first. That was a long time ago. So yeah, today it seems very different.

But originally, it seemed a challenge to me, for sure.

[Jonnie Korinko] (4:20 - 5:14)

Yeah, I think that's a great point, is our pulmonologists are doctors and whoever we get our nebulizer from, right? Because it might be our primary care doctor or whomever. They're extremely knowledgeable and they're great, but they only have a small amount of time with us.

So a lot of times, the education that we get from them isn't necessarily all of the information that we need. So it's great that you had a respiratory therapist from their DME company who was able to give you some of that knowledge. But kind of to your point, they only have a small amount of time too, right?

And a lot of times, it is almost like a checklist. Do we have the equipment that we need? Do we have everything?

And the education is kind of an afterthought. So when you started taking nebulizers, did you use inhalers or anything first? Or was this kind of like your first line of medication?

[Bonnie Truelsen] (5:15 - 5:45)

So this was 19 years ago for me. And I used an inhaler, and I used a nebulizer for flare-ups. These days, I use a nebulizer because I can no longer breathe deeply enough for an inhaler.

So I use a nebulizer instead. So that might have been my evolution. But in the beginning, it was just on an as-needed basis for an exacerbation, right?

[Arnelle Konde] (5:46 - 5:57)

Well, thank you for that breakdown. So I imagine a nebulizer doing the hard work for you. So no deep breaths needed.

Just steady breathing so the machine gets deep into your lungs. Am I correct?

[Matthew Dartt] (5:57 - 6:21)

Yeah, so it doesn't take away the fact that you need to have proper techniques. So oftentimes, respiratory therapists, especially on the inpatient setting, will still instruct patients to take a nice slow deep breath and hold it similar to the way you would with an MDI. But the difference is that if you are in an exacerbation or you're short of breath or just not feeling well, you'll still probably get more of that medication than you would if you were just using a DPI or MDI.

[Bonnie Truelsen] (6:22 - 6:53)

And inhaler means I need to deeply inhale to pull that medicine into my lungs. And I might have a spacer to help me do that. But for me in the progression of my lung disease, I no longer have that depth of breath.

So I don't need that with the nebulizer. I can breathe much more easily. And actually, I'm getting more medication.

So I get a better benefit of the medication.

[Jonnie Korinko] (6:55 - 9:03)

Absolutely. And there are a couple different types of inhalers, right? And they all have their pros and their cons.

And the thing is, inhalers are great for the people who they're great for. You know, we have the meter dose inhalers that you have to be able to press down effectively and then time your breath correctly. And that's so it's funny.

I have both my son, my youngest son and my husband are asthmatic. And my husband, I swear, he's like the least patient person. And when he's having a flare, it's like he does not have time for the inhaler.

He's like, I can't breathe now. I'm not trying to figure out how to coordinate my breaths, right? And so for someone with COPD or some other chronic lung conditions where you have symptoms every single day and you're trying to breathe every single day, trying to struggle to get your breath can be difficult.

And some of our dry powered inhalers to try to actuate some of those and actually get the medicine out. It's fun. I was a teacher before I came here and I had a lab where my students had to mimic all of these.

And, you know, I'd have 20 year olds with with no lung conditions and they couldn't actuate some of these inhalers. And I'm like, okay, so now I'm matching you with a lung condition trying to actuate these. So again, inhalers are absolutely great for the people that they're great for.

But if you can't get the medicine out, they can't help you. And we know that someone's lung symptoms, whether it's COPD, whether it's spunk yet, no matter what it is, right, they can change over time. So can you explain to me how nebulizers in your perspective can help with your everyday symptoms or how they can help when symptoms worsen, like when you're having a lung attack or a flare up?

[Bonnie Truelsen] (9:03 - 10:25)

So there's a couple of answers for that I think for me. So one of them is there's the use of a nebulizer when you're having a flare up or maybe like an asthma attack would be, or for a COPD or a other lung, you know, some kind of worsening of your symptoms. That might be temporary.

And then the other part is some of the new biologics we have out there now are only used by nebulizers. I also use one of those. So that's the only option that you get for a new kind of medication that can be really helpful with symptoms.

And then I fit into this final camp for me in my evolution of at 74. I'm in a severe state of COPD and I can no longer inhale deeply enough. So I'm a pure nebulizer person now.

I still have a rescue inhaler of albuterol with this fascia, but that's the other medicine all comes via nebulizer now. And of course, then I get the most benefit from the maximum benefit from the medicine that I can get. So that right for someone who deals with shortness of breath or mucus production or coughing, all of those things, then it becomes critical to quality of life for sure.

[Matthew Dartt] (10:25 - 11:20)

Yeah. So if your symptoms flare up and you're breathing hard and you can't take that deep breath. You know, if you don't have to squeeze or coordinate tech Greek.

Also, if you have any kind of arthritis or just, you know, weakening in your hands, those devices can become much more difficult to utilize. So if you were having a flare up COPD exacerbation, for instance, and you can't take a deep breath. You could you can just hold that in your mouth like a pipe.

It looks like a little pipe usually or even a mask. You're going to get more medication if you use the the actual one that looks like a pipe. And then you can just breathe the way you're breathing at the time.

Whereas, you know, with our MDIs or DPIs, it's a lot of coordination. So if you're very short of breath, it's going to be incredibly difficult to time that, expect if you have a worsening dyspnea or shortness of breath, as we say. So if you're having that flare up, that nebulizer is going to be a lot more beneficial to you.

[Arnelle Konde] (11:20 - 11:24)

And speaking of benefits, like what are what would you say are the main benefits of using these?

[Matthew Dartt] (11:25 - 12:06)

They don't require as much coordination. They're pretty easy to utilize for the most parts. They can be readily available.

So they are pretty easy to clean afterwards as well. But yeah, usually the medication, you just take it out. It's in a little packet and you put it right into the nebulizer and you're good to go.

So there's ease of use for just from a device standpoint. And there's ease of use just from your breathing standpoint and coordination as well. So it can be there readily available for you.

Similar to the way inhalers are as well, actually. So people can get scared by them because they can look a little bit bulky. And like there's a lot of equipment, but actually once you're properly instructed on them, they're very, very easy to use.

[Jonnie Korinko] (12:06 - 12:23)

So I want to kind of go back to when you were first given a nebulizer. What was your reaction? Like kind of what was your first thought and like emotional reaction to this new device that you now have to use?

[Bonnie Truelsen] (12:24 - 14:09)

So it came at the same time as my diagnosis. So it was, I was overwhelmed by the diagnosis and the nebulizer seemed over the top. I wasn't happy about it.

That's a nice way of saying it. At the time I was still working, it seemed like it took a long time. It wasn't.

I didn't have a positive attitude towards it. That's my truth. The reality is, I really couldn't function without it.

In those days, I got sick quite often. So I needed that every four hours. What's the prescription?

Without that, it would be a trip to the hospital then. So I quickly learned, because I don't always learn easily, I quickly learned that no matter what my personal opinion of the nebulizer was, it was to my benefit to do it. So I didn't embrace it.

I didn't say, oh, this is lovely. I want to do this. I came to it via a different path.

And then over time, right? COPD is a tough disease on many levels. Not being able to breathe, of course, is one of its hallmarks.

And the idea that I could breathe better, or breathe at all, or breathe and go to work, or breathe and get my dishes done, that really is the change of heart that I went through. And since then, I would be the first one to tell you that nebulizing is a standard for me. And not only am I in a different place with it, but I'm grateful for it.

It allows me to live a quality of life. I'm not sure I would have otherwise. So that's my evolution.

[Jonnie Korinko] (14:10 - 14:58)

That is so nice to hear that you've had such a great experience with something that, like you said, wasn't necessarily positive in the beginning. Yeah, because you didn't have the resources in the beginning, that education to be, you know, and kind of off of that, you know, you've used nebulizers for many years at this point. So for those who are beginners, for someone who, like you, is dropped in nebulizer for the first time, and kind of with not a lot of information, what questions do you think?

They should ask their doctor, their respiratory therapist, someone at the DME, when they're starting off, to make sure that they're given the tools to be successful. Right.

[Bonnie Truelsen] (14:58 - 16:04)

So I think, for me, I think getting a proper education, and I would say this, Jim, I would say, to make sure that you're heard and to make sure that you get the information you need, not just say, oh, yes, or not just let someone hand you something to read, you need to be able to understand, especially if you're mixing medications. It's one thing if you're doing a single dose. It's completely different when you start adding things together.

It's like being a chemist. So it's very important that you get the education that you need to do it properly. And the second piece about that is to make sure that you know how to clean and maintain your nebulizer and the cuffs that we use.

And I got some conflicting information in the beginning on that. Thankfully, that didn't leave me down a different path. But that's what I would take away today is how critical it is to know what you're doing and maybe why you're doing it.

But it's important that you know the process.

[Jonnie Korinko] (16:05 - 16:37)

That's a great point. You know, I would compound upon that. Keep asking, right?

It's not clear. Go back. You know, exactly.

You're ordered another medication. Okay, well, I was just ordered these two, but now this one's added. Well, what steps do I take?

Which one do I do first? Can I mix these two? Which ones can I not mix?

Does this one need to be refrigerated? Whatever the case may be, right? Because it's not known until it's explained to you.

[Matthew Dartt] (16:38 - 18:03)

They should be asking, is this device correct for me? If they're getting a lot of taste of it in their mouth, especially with the MDI, they're probably utilizing it incorrectly. And they may not be able to coordinate that.

So they could be asking, would a regularizer give me more consistent medication delivery than I'm getting right now? So am I using my inhaler correctly right now? You know, the respiratory therapist, the nurse or physician should be assessing that for them in the clinic as well?

Again, are they generating enough inspiratory flow for those DPI's, especially? Is there a hand strength strong enough to be utilizing how well their inhaler works? So it's kind of difficult to press down on those sometimes or even to open them.

So that could be, you know, that could affect the way patients either take or do not take their medication. If it's too hard for them, they may not even take their maintenance medication. So they may want to ask, are my inhaled medications available in nebulizer form?

Which type of nebulizer is best for this situation? How often should they clean or replace their nebulizer parts? If they're going to wear a mask, does that mask fit appropriately?

Some people with little faces may need a pediatric size mask if they're going to just use that with their jet nebulizer. But in general, if they just get a standard nebulizer at home, the one that looks like a little bit like a pipe, that's kind of a one size fit all. So as long as they're getting their mouth on there and not blocking it with their tongue, it should work for everybody.

[Arnelle Konde] (18:03 - 18:11)

Those will be really helpful questions for our patients. Is there anything else about nebulizers that you would like patients to know or take from this episode?

[Matthew Dartt] (18:12 - 18:45)

They don't need to be simply emergency devices or last resort therapies. They're very consistent. They're there when you need them.

They're not as device dependent as the MDIs and DPI's we discussed. I think they can look scary because it's basically, in simple terms, it's a box with a tube and it looks like it's a lot more equipment, but they're actually quite easy to maintain and they don't have to just be for emergencies. They can be for your maintenance medications, too, if you're having trouble with your inhalers.

[Arnelle Konde] (18:45 - 18:55)

And before we close, I would love one final takeaway from each of you. To you, Matt, what is one thing that you wish everyone knew about nebulizers?

[Matthew Dartt] (18:56 - 19:21)

So, you know, we just did a study recently with the COPD Foundation and patients and providers. They both perceive nebulizers as more effective than handheld inhalers for managing COPD exacerbations. So, I think that they're actually underutilized.

So, we see that patients like them better and, you know, the providers, the respiratory therapist, the physicians all prefer nebulizers as well. So, I think that is a really good takeaway for the listeners.

[Bonnie Truelsen] (19:22 - 19:59)

I think what I'd like to share with someone new to the process is to focus on the benefits and recognize there will be benefits. That's if you've been prescribed a nebulizer and there might be a variety of reasons for that, right? But focusing on the positive, which is the benefits you experience, I think it's a good way to walk into whatever change that's going to be, whatever time it takes, whatever effort, whatever education you're going to learn, all that's to benefit either your breathing, your mucus production, it is to improve your quality of life.

So, that's how I would say it. Yeah.

[Arnelle Konde] (19:59 - 20:22)

Well, thank you so much, Matt and Bonnie, for being here. I hope this helps explain how nebulizers are useful for people with COPD. They deliver a medicine in a gentle mist that doesn't need timed or deep breaths.

For some, that's all their lungs need. If this episode resonated with you, share this with someone who needs to hear it. And thank you for listening to the Lung Health Champion podcast.

[Disclaimer] (20:24 - 21:22)

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