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Nebulizer Myths and Facts

"Rescuing" Too Frequently? If you are using your rescue inhaler (like albuterol) more and more often, you may need to talk to your doctor. Read more.
Doctor Discussion Guide for Patients with COPD Talking with your doctor about your COPD treatment can be difficult. Use this guide to prepare for a conversation with your doctor. Make a plan.
Frequently Asked Questions Answers to frequently asked questions. PERFOROMIST FAQs.

There are different kinds of devices you can use to take bronchodilator medications. You may have heard of metered dose inhalers (MDIs) or dry powder inhalers (DPIs), which are handheld portable devices you can carry in your pocket or purse.

You may be less familiar with nebulizers. If you have heard of nebulizers, you may think they are large machines like ventilators. Many of the new nebulizers are actually small devices that can fit in a purse or the palm of your hand. For the majority of people, these devices are easy to use at home and are an effective and relatively simple way to take your maintenance medication.18

There are advantages and disadvantages to each type of device.

Image of various nebulizers

Myth

Nebulizers are complicated.

Fact

Nebulizers are not complicated. Newer nebulizers are lightweight, portable and only a little bigger than a handheld inhaler. Many nebulizers weigh less than a pound.20 There's no need to carry a nebulizer with you all day, as you might with a handheld inhaler, because you use a nebulizer twice a day at home (morning and night) as part of your daily routine when using it with a medication like PERFOROMIST®. If you are traveling, a nebulizer can easily fit into a bag or suitcase for use twice daily.

Unlike when using an inhaler, no coordination of actions is required when receiving treatment from a nebulizer.18,21 You set up a nebulizer with just a few simple steps; then, breathe normally and calmly into a mouthpiece or facemask to take the medication.1,21

Handheld inhalers, like an MDI or DPI, are small, can be carried around easily in a pocket or purse and can be used quickly.21 However, up to 70% of people use them incorrectly.18

To use an MDI, you must breathe in deeply and slowly, and hold your breath for 10 seconds.22,23 It also requires coordinating your breathing with squeezing the device.18 Unfortunately, up to 86% of people with COPD do not use their MDI correctly.23 If not used correctly, you may not get the full dose of medicine, which means your symptoms may not be controlled as well as they could be.24

Using a DPI (another type of handheld inhaler) requires breathing in a dry powder deeply and quickly, and holding your breath while the medication works, which may be difficult if you have COPD.18,26,27 Some people do not have adequate ability (cannot take a deep enough breath)18 to inhale the drug properly.21 As with an MDI, people commonly misuse their DPI23 because a DPI requires multiple steps.23 Also, because a DPI uses dry powder, accidentally breathing out a little can blow away the medication, inhaling can result in medication on the back of your throat and tongue, and high humidity can cause the medication to clump.28

Myth

With either a handheld inhaler or a nebulizer, you know you're getting the appropriate dose of medication every time.

Fact

All types of devices are designed to deliver a full dose of medication. Unfortunately, many people have trouble using their handheld inhaler properly.5,18,23 If you don't coordinate your breathing and actions correctly or don't take a deep enough breath when using an MDI or DPI, then you will not get the full dose.18,24

Because a nebulizer does not require you to coordinate actions or breathe differently than normal, you know you're getting the appropriate dose during every use as long as you use the nebulizer for the entire specified time (until no more mist is formed in the nebulizer; with PERFOROMIST this is about nine minutes).1 Getting the appropriate dose may be important to achieving the goal of improving your lung function.

Myth

A nebulizer is a big, bulky machine, like a ventilator.

Fact

Today's nebulizers are easier to use and smaller than they used to be.21 Most nebulizers are lightweight—many weigh less than a pound20—and portable, about the size of a small box you can hold in your hand. A nebulizer can sit on your kitchen table or on a side table and can be used while you read or watch TV. When using a nebulizer with a medication like PERFOROMIST, there is no need to carry it around with you, since you use it twice a day at home.

Myth

You use a nebulizer like an inhaler, taking a deep breath while pressing down on the device and holding your breath for 10 seconds.

Fact

You can breathe normally and calmly when using a nebulizer to take PERFOROMIST.21 Unlike with an inhaler, no coordination of actions is required and no special effort is necessary during treatment.18,21

Myth

You have to carry a nebulizer with you when you go out.

Fact

When using a nebulizer for maintenance therapy, you only need to use it twice a day, for a few minutes each time (for PERFOROMIST, it takes about nine minutes).1 You can schedule when you take your COPD medication and work it into your daily routine, since you know you'll be taking it once in the morning and once in the evening. There's no need to take a nebulizer outside of your home, unless you'll be traveling overnight. And if you do travel, a nebulizer is very portable—many can run on batteries and some weigh less than a pound.20

Myth

A nebulizer is like an oxygen tank: only for very sick people with COPD.

Fact

A nebulizer may be a good choice (and patient preferred method) for any person with moderate-to-severe COPD. It delivers medicine, not oxygen. A nebulizer is just a different way to take a maintenance COPD medication like PERFOROMIST.

A nebulizer may be a good choice for someone who has arthritis and has trouble handling and pressing down on an inhaler, or for someone who can't take a really deep breath and hold it, which is needed to get a full dose with some inhalers.

Many People with COPD Breathe Easier with Nebulizers

2009 Nebulization for Easier Breathing (NEB) survey

Nine out of ten people with COPD said that nebulization helped them breathe easier.25
Almost three out of four people with COPD said that nebulization helped them live more active lives.25
One out of four people with COPD said that device immobility is a disadvantage.25

Nebulization helped these patients feel that they had more control of their symptoms, needed less help from friends and family and experienced more comfort in their chest.25

Caregivers Can Help with Devices

Caring for a loved one with COPD means that you are in a good position to judge what kind of device may be the best choice. For instance, if the person you care for has arthritis, he/she may struggle with handheld inhalers and may not be getting a complete dose. You may want to take a look at the facts yourself and see if there's anything you want to talk over with the one you care for.

In a 2009 survey of people with COPD and their caregivers, caregivers agreed that nebulized therapies made caregiving easier, and wished the people they cared for had been given nebulization therapy sooner.25 Talk to your doctor for more information.

Next topic: "Rescuing" Too Frequently?

References

  1. PERFOROMIST Prescribing Information. Napa, CA: Dey Pharma, L.P. 2010.
  2. Gross NJ, Nelson HS, Lapidus RJ, et al; Formoterol Study Group. Efficacy and safety of formoterol fumarate delivered by nebulization to COPD patients. Respir Med. 2008;102(2):189-197.
  3. Mannino DM et al. MMWR Surveill Summ. 2002;51:1-13.
  4. National Institutes of Health/U.S. Department of Health & Human Services. National Heart Lung and Blood Institute Diseases and Conditions Index. What is COPD? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html. Accessed July 13, 2011.
  5. Rodriguez-Roisin R, Anzueto A, Bourbeau J, et al; GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2009). Global Initiative for Chronic Obstructive Lung Disease website: http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html. Accessed March 8, 2010.
  6. National Heart Lung and Blood Institute: National Institutes of Health. When you are diagnosed with COPD. Available at: http://www.nhlbi.nih.gov/health/public/lung/copd/breathing-better/taking-action.htm. Accessed July 13, 2011.
  7. American Lung Association. Living with COPD: a life change. Available at: http://www.lungusa.org/lung-disease/copd/living-with-copd/life-change.html. Accessed July 13, 2011.
  8. CDC FastStats: Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema. Available at: http://www.cdc.gov/nchs/fastats/copd.htm. Accessed April 11, 2011.
  9. CDC Vital and Health Statistics. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009. Hyattsville, Maryland. 8/2010.
  10. U.S. Department of Health and Human Services. Caregiver tip sheet. Available at: http://www.strokecamp.com/content/resourcesCAR/CaregiverTipSheet.pdf. Accessed on July 13, 2011.
  11. Data on file. Evaluation of concepts for Perforomist. Dey #0257 Final research report (market research). LinguiSearch. March 23, 2011.
  12. U.S. Department of Health and Human Services/NIH. Living with COPD. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_LivingWith.html. Access July 13, 2011.
  13. Nelson HS, Gross NJ, Levine B, et al. Formoterol Study Group. Cardiac safety profile of nebulized formoterol in adults with COPD: a 12-week, multicenter, ranodmized, double-blind, double-dummy, placebo- and active-controlled trial [published correction appears in Clin Ther. 2009;31(4):920].
  14. Proventil HFA Prescribing Information. Kenilworth, NJ: Schering-Plough. 1998.
  15. Atrovent HFA Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. 2010.
  16. Combivent Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. September 2010.
  17. Spiriva HandiHaler Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. and New York, NY: Pfizer Inc. 2010.
  18. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol treatment: evidence-based guidelines. Chest. 2005;127(1):335-371.
  19. Theophylline extended-release tablets prescribing information. Kansas City, MO: Nostrum Laboratories, Inc. May 2009.
  20. Pari Trek S Compact Compressor Nebulizer System. Instructions for use. Revised 2006.
  21. Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care. 2005;50:1313-1321.
  22. Advair HFA Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
  23. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. In press.
  24. Van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL, Seydel ER. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Pt Ed Couns. 1997;32:S87-S95.
  25. Data on file. Survey conducted by KRC Research: COPD Patient and Caregiver Studies, March 2009. Dey Pharma, LP.
  26. Advair Diskus Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
  27. Pulmicort Flexhaler Prescribing Information. Södertälje, Sweden: AstraZeneca. 2010.
  28. Mayo Clinic. Asthma inhalers: which one’s right for you? Available at: http://www.mayoclinic.com/health/asthma-inhalers/HQ01081/METHOD=print. Accessed August 22, 2011.
  29. American Lung Association of Minnesota/Minnesota COPD Coalition/NCQA Certified Disease Management. Understanding & managing your chronic obstructive pulmonary disease (COPD) brochure. 09/07.
  30. Ventolin HFA Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2009.
  31. American Lung Association. My COPD Action Plan. Available at: http://www.lungusa.org/lung-disease/copd/living-with-copd/copd-management-tools.html. Accessed August 22, 2011.
  32. American Thoracic Society. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine. 1995;152:S77-S120
  33. National Heart, Lung, and Blood Institute: National Institutes of Health. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Full Report 2007.
  34. Symbicort Prescribing Information. Dunkerque, France: AstraZeneca. 2010.
  35. Centers for Medicare & Medicaid Services. Department of Health and Human Services, USA. Medicare and Home Health Care. Available at: www.medicare.gov.
  36. Centers for Medicare & Medicaid Services. Medicaid Program—General Information: Overview. Available at: www.cms.gov/MedicaidGenInfo/. Accessed June 23, 2011.

Please see full Prescribing Information and Medication Guide, including Boxed Warning.

Indication

PERFOROMIST (formoterol fumarate) Inhalation Solution is used for the long-term treatment of chronic obstructive pulmonary disease (COPD) including chronic inflammation of the lungs (bronchitis) and emphysema. It is only to be used with a nebulizer and is taken twice daily (morning and evening).

WARNING: ASTHMA-RELATED DEATH

PERFOROMIST Inhalation Solution belongs to a class of drugs called long-acting beta2-agonists (LABA). People with asthma who take LABA such as PERFOROMIST Inhalation Solution have an increased risk of death from asthma problems. Do not use PERFOROMIST Inhalation Solution if you have asthma without using a long-term asthma control medicine.

IMPORTANT SAFETY INFORMATION

Warnings and Precautions
PERFOROMIST Inhalation Solution should not be used instead of rescue inhaler or nebulized medicine for the treatment of acute symptoms. Extra doses of PERFOROMIST Inhalation Solution should not be used for that purpose since overuse can cause serious heart problems, including death. Acute or sudden symptoms should be treated with an inhaled short-acting beta2-agonist. Seek immediate medical attention if:

  • your symptoms quickly worsen despite recommended doses of PERFOROMIST Inhalation Solution
  • PERFOROMIST Inhalation Solution treatment becomes less effective
  • you need more inhalations of a short-acting beta2-agonist (rescue inhaler or nebulized medicine) than usual.

Do not use PERFOROMIST Inhalation Solution with other LABA medicines for any reason.

How to Use PERFOROMIST Inhalation Solution
Use PERFOROMIST Inhalation Solution exactly as directed by your health care professional. Do not stop using PERFOROMIST Inhalation Solution or other medicines to control or treat your COPD unless told to do so by your health care professional because your symptoms might get worse. Your health care professional will change your medicines as needed.

Co-existing Conditions
The use of PERFOROMIST Inhalation Solution with certain health conditions or with certain medications can cause serious side effects. Tell your health care professional about all of your health conditions, including if you:

  • have heart problems
  • have high blood pressure
  • have diabetes
  • have seizures
  • have thyroid problems
  • have liver problems
  • are pregnant or planning to become pregnant. It is not known if PERFOROMIST Inhalation Solution can harm an unborn baby.
  • are breastfeeding. It is not known if PERFOROMIST Inhalation Solution passes into breast milk and if it can harm your baby.

Drug Interactions
Tell your health care professional about all the medicines you take including prescription and over-the-counter medicines, vitamins and herbal supplements. PERFOROMIST Inhalation Solution and certain other medicines may interact with each other and cause serious side effects.

Side Effects
The most common side effects reported in patients taking PERFOROMIST Inhalation Solution were diarrhea, nausea, nasopharyngitis, dry mouth, dizziness, and insomnia. Serious side effects may include sudden shortness of breath, serious allergic reactions, chest pain, increased or decreased blood pressure, a fast and irregular heartbeat, low blood potassium, high blood sugar, and high blood acid.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.