Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
Caveats: While most asthma patients use their inhaler medications for months and years, the benefits of the combination inhaler were tested in predominantly 12-week trials, thus there may be less or more benefit when their use is extended.
The symptom reductions in these trials that were found with combination therapy were very small. Typically the therapy led to pumps/day fewer uses of the rescue (beta-agonist) inhaler, and about 10% more 'symptom-free days' during the 12-week study periods. Despite these findings there was no 'Quality of Life' advantage. However, these advantages may be greater if the asthma is more severe. This may be a consideration for patients with severe relapsing asthma that leads to multiple hospital admissions. On the other hand, these patients may also be at highest risk for a fatal or severe attack, which would make LABA medicines potentially dangerous. This difficult balance will have to be struck by physicians and patients in concert based on symptoms, risk thresholds, and patient values.
Of the 48 trials represented in this review, 44 were sponsored by the pharmaceutical maker of the combination therapy. A long history of misrepresentation of data and occasionally fraudulent reporting of data suggests that industry sponsored results are often more optimistic than subsequent data produced by researchers and parties that do not have a financial stake in the results.
We have chosen to designate this therapy RED (no benefits) rather then BLACK (harms> benefits) because of the small benefit and the possibility of a trade-off of harms and benefits that may be worthwhile based on individual circumstances. In addition, while asthma-related deaths increase, all-cause mortality was unchanged in the reviewed studies, making the overall harm impact less definitive in terms of fatalities.
The preventers are usually steroids, and are often taken nebulised in a similar manner to the relievers. One of the most common is budesonide, often sold under the trade name ‘Pulmicort’; another that is commonly used is beclamethasone dipropionate. These steroid medications work by reducing inflammation in the lungs, and helping to keep the airways open, and reducing the sensitivity of the lung tissue to triggers. Unlike the relievers, preventers are no use for relief from asthma attacks; instead, regular dosing is required for their effects to be apparent.