European Respiratory Society Guidelines on the use of nebulizers.

Abstract

The European Respiratory Society (ERS) recognizes that there are an increasing number of national and international guidelines for the management of asthma, chronic obstructive pulmonary disease (COPD) and other chest diseases. Some of these guidelines recommend nebulizer use in specific circumstances, using either a jet nebulizer or an ultrasonic nebulizer to administer a drug to the airways or lungs in the form of an aerosolized mist of fine droplets. Although many patients with severe chest disease are given nebulized treatment both in hospitals and in their own homes, it is recognized that much of this practice may not be evidence-based. Some present practice may be ineffective or even harmful. The manufacturers of hand-held inhalers are obliged to meet exacting standards such as dose-to-dose reproducibility. However, nebulizer devices are sold separately from nebulized drugs and the dose delivered to the lung can be increased 10-fold or more by changing from an inefficient nebulizer system to a highly efficient one. For these reasons, the ERS commissioned a Task Force to review the scientific and clinical principles of nebulized therapy and to produce a set of guidelines (evidence-based whenever possible) for users of nebulized treatment in Europe. It is hoped that the guidelines will improve clinical practice in the use of nebulized therapy throughout Europe. The most important considerations should be efficacy and patient safety. The guidelines will also serve as an educational and scientific resource for clinicians and scientists with an interest in inhaled therapy. These guidelines are aimed at a wide group of healthcare professionals practising in very different healthcare systems throughout Europe. The immediate target audience for the guidelines will be pulmonary physicians, but it is hoped that the messages will be communicated to all healthcare workers who are involved in treating patients with nebulized medication (doctors, nurses, pharmacists, paramedics, …