Are Nebulizers Better Than Inhalers for COPD and Asthma?

Inhalers and nebulizers are devices that deliver medicine directly into the lungs. The difference between the two devices is in the way they deliver the medication.

An inhaler relies on pressure, while a nebulizer releases the medicine as a fine mist. When you use an inhaler, you inhale the medication through a mouthpiece. With a nebulizer, you breathe in the medication via a mask that fits over your mouth and nose.

These devices are essential for treating lung-specific diseases like chronic obstructive pulmonary disease (COPD) and asthma. Which device you choose ultimately depends on your personal preference, your healthcare provider's recommendation, and your insurance coverage.

This article looks at the basic differences between nebulizers and inhalers, and offers some suggestions on how to choose the device that's right for you.

Inhalers vs. Nebulizers

Inhalers send short bursts of aerosolized medication directly into the mouth and can work in seconds. With a metered-dose inhaler, the mouthpiece has to be tightly sealed with the lips and inhaled while maintaining the seal.

Nebulizers, in contrast, create a cloud of mist that's breathed through a face mask. The dosage process takes slightly longer (anywhere from 5 to 20 minutes). Nebulizers may be easier for children to use since they can be more accurate in terms of dosage delivery.

While most people with COPD tend to use inhalers thanks to their fast-acting abilities and small size, nebulizers are often the device of choice in hospitals. This is because they're easy to use, can be quickly adapted (to accommodate a mouthpiece, mask, tracheostomy collar, or endotracheal tube), and can deliver a host of different medications simply by pouring the drug into the device.

While the proper technique is important for both inhalers and nebulizers, the general consensus is that there is more room for error when it comes to using an inhaler, which requires more coordination and manipulation than a nebulizer. In fact, one study showed that only 10% of patients use a metered-dose inhaler correctly.

Types of Nebulizers

There are two types of nebulizers: atomizer and ultrasonic. Prices for each range from $50 to $200, and both are available as tabletop or portable models. Both fast-acting and long-term medications can be used with a nebulizer, including bronchodilators and corticosteroids.

Atomizer Nebulizers

The most common type of nebulizer is an atomizer or compressor nebulizer. This type creates vaporized droplets of medicine. The vapor is inhaled through a mouthpiece or face mask.

Examples include:

• PARI Vios PRO Nebulizer System with LC Sprint
• PARI Trek S Portable Nebulizer System with LC Sprint
• Philips Respironics Sami the Seal Pediatric Compressor Nebulizer

Ultrasonic Nebulizers

This type of nebulizer is also known as a mesh nebulizer. It utilizes high-frequency ultrasonic waves to vaporize medication. It is usually quieter than an atomizer and can deliver medication more quickly.

Examples include:

• Philips Innospire Go Portable Mesh Nebulizer
• Lumiscope Portable Ultrasonic Nebulizer
• Omron Mesh Nebulizer
• Flyp HypersoniQ Portable Nebulizer

Types of Inhalers

There are three types of inhalers used to treat people with COPD, asthma, or other lung conditions. Because inhalers can be expensive, costing around $350 each, it's important to find the one that works best for you. Using your inhaler confidently helps you minimize wasted dosages and keep up with your treatment plan.

Hydrofluoroalkane Inhalers (HFA)

HFAs contain aerosolized liquid medication in a pressurized canister attached to a metered valve. As you inhale, you'll need to press down on the canister and breathe in the medication.

As HFA delivery results in some medication loss, a spacer may be useful. A spacer is an attachment connected to an inhaler that catches the mist as it leaves the device and allows you to take in the medication.

Examples include:

• Proair HFA (albuterol)
• Xopenex HFA (levalbuterol)

Using HFAs requires some manual dexterity and may be difficult for those with grip issues or arthritis.

Dry Powder Inhalers (DPIs)

Dry powder inhalers send out a puff of dry, powdered medication rather than a sprayed liquid, and don't contain any propellants, just the medicine.

DPIs are breath-activated and will only release medication when you take a deep inhale. For this reason, they may not be effective among elderly COPD patients, as a fairly forceful inhale is necessary.

To use a DPI, you'll need to close your mouth around the mouthpiece and inhale deeply. No spacer is required. Hold your breath for up to 10 seconds, then remove the device from your mouth before exhaling so that any moist air from your mouth doesn't contaminate the device and clump up the powder.

Examples include:

• Advair Diskus (fluticasone)
• Spiriva HandiHaler (tiotropium bromide)
• ProAir Respiclick (albuterol)

Soft Mist Inhalers (SMIs)

SMIs deliver a lower dosage and release a gentle mist of pre-measured medication that is slowly inhaled. Unlike other forms of inhalers, SMIs don't require you to sync your breaths with the medication delivery. SMIs are highly effective at delivering medication into the lungs.

Examples include:

• Spiriva Respimat (tiotropium)
• Merxin MRX004 (tiotropium/olodaterol)
• Striverdi Respimat (olodaterol)
• Combivent Respimat (ipratropium bromide and albuterol sulfate)

Side Effects

Side effects usually happen because of the medications, not the delivery systems. Still, there are a few problems that may stem from device usage. It's essential to properly and routinely clean your device in order to minimize the risk of infection and skin irritation.

Potential side effects from both inhalers and nebulizers include:

• Dizziness
• Agitation
• Damaged optic nerve
• Recurring infections
• Skin or eye irritation from leaking mist

Summary

Nebulizers and inhalers are two types of devices that deliver medication directly into the lungs. An inhaler uses pressure to deliver medication through a mouthpiece, while a nebulizer delivers a fine mist of medication through a mask worn over the nose and mouth.

Nebulizers may be easier to use than inhalers, especially for children. Because it's easier to take in the medication, they can deliver a more accurate dose. 

Inhalers, on the other hand, require coordination and correct technique in order to deliver the right amount of medication. With practice, inhalers can be just as effective as nebulizers.

A Word From Verywell

There is really no medical reason to change your device if the one you have has been working well for you and you have mastered the proper technique to use it. If you aren't getting the benefit you think you should from your current device, speak with your healthcare provider to see if there are things you can do to improve its ease of use.