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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.17

There are advantages and disadvantages to each type of device.

Image of various nebulizers


Nebulizers are complicated.


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.17,21 You set up a nebulizer; then, breathe normally and calmly into a mouthpiece or facemask to take the medication.11,21

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.17

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.17 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.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.17,25,26 Some people do not have adequate ability (cannot take a deep enough breath)17 to inhale the drug properly.21 As with an MDI, people commonly misuse their DPI.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.27


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


All types of devices are designed to deliver a full dose of medication. Unfortunately, many people have trouble using their handheld inhaler properly.3,17,23 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.17,24

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).11 Getting the appropriate dose may be important to getting the relief you need to help treat your COPD symptoms.


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


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.


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


Unlike with an inhaler, you can breathe normally and calmly when using a nebulizer to take PERFOROMIST.17,21


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


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).11 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


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


A nebulizer may be a good choice 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 coordination difficulties 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.

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 coordination difficulties, 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.

Next topic: Rescuing Too Frequently?

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


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 jet nebulizer and is taken twice daily (morning and evening).

Important Limitations for Use:

  • PERFOROMIST should not be used as a rescue medication
  • PERFOROMIST is not indicated to treat asthma. The safety and effectiveness of PERFOROMIST Inhalation Solution in asthma has not been established.


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.


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.

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
It is important to inform your healthcare professional of all prescription or over the counter medications you are taking including: beta-blockers, some antidepressants (tricyclic and MAO inhibitors), steroids, diuretics, xanthine derivatives (e.g. theophylline), as well as vitamins and herbal supplements. PERFOROMIST Inhalation Solution and certain medicines may interact with each other and cause serious side effects.

Immediate allergic reactions may occur after taking PERFOROMIST Inhalation Solution, including anaphylactic reactions, hives, generalized swelling including the airway, rash, and bronchospasm.

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.

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.

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