Introduction

• Wheezing, often characterised by a “whistling” sound when inhaling or exhaling, is caused when the small breathing tubes in the lung (bronchial tubes) swell or are obstructed. Wheezing can be caused by asthma, bronchitis, viral lung infections,¹ or an allergic reaction, such as hayfever
• It is important to be prepared, especially if there are underlying conditions like asthma and chronic obstructive pulmonary disease (COPD)
• To relieve symptoms of wheezing, nebulisers and inhalers are often used

Understanding inhalers and nebulisers

Inhalers

An inhaler is a handheld device that releases medications as a spray or mist when activated. Inhalers allow for quick and direct delivery of medication into the lungs. (write as a separate heading of nebuliser) 

There are 3 types of inhalers

1. Metered-dose inhalers with spacers: these are pressured canisters that contain multiple doses of medicine. When you press the canister down, the medicine is released through a mouthpiece. They often have spacers in them which helps ensure the proper use of inhalers by making it easier to inhale the medication
2. Dry powder inhalers (DPIs): these are dry powders of the medicine usually in a capsules, discs, or tubes. When you need the medicine, you place it in your mouth and take a deep breath. This will cause the device to activate and the medicine to be released, as no pressure mechanism is involved in this device
3. Soft mist inhalers (SMIs): these devices convert liquid medicine into a slow-moving mist that can be inhaled

What medication is in inhalers?

Medications that are used for inhalers are generally 

• Corticosteroids: function to reduce inflammation (swelling) in the lungs
• Bronchodilators: these medications work to help the muscles that are around your lung relax to facilitate easier breathing. They can be either short-acting (for immediate relief) or long-acting (for ongoing control) bronchodilators

Nebulisers

A nebuliser is an electronic device that converts liquid medication into a mist, which is inhaled through a mouthpiece or a mask. 

What medication is used in nebulizers?

Similar to inhalers, nebulisers deliver:

• Corticosteroids: reduces inflammation of lungs
• Bronchodilators: help to open the airways 

Best practices for an Inhaler

1. Regularly clean the mouthpiece to prevent blockages and maintain hygiene 
2. Use a spacer (with MDIs) and time when to inhaler the medication to ensure you are getting the proper dosage 
3. Shake the inhaler before using it to mix medication properly
4. Use a inhaler with a tracker to track medication usage

Advantages of an Inhaler

1. Inhalers are handheld devices that can provide medication directly to your lungs which makes them convenient 
2. Inhalers are cost-effective compared to nebuliser 
3. Inhalers can be preventative and help manage the onset of an asthma attack, especially in children²
4. Rescue inhalers can help manage symptoms whilst waiting for further help and can also provide relief in an emergency situation

Disadvantages of an inhaler

1. Proper technique is crucial for effectiveness. You have to be using it correctly and time yourself between puffs to ensure that you are taking in (inhaling) the medication to get the proper dose
2. DPIs require strong inhalation, which may be difficult during severe attacks.³ In an emergency situation if you are having trouble inhaling, this can prove challenging
3. Some DPI’s inhalers do not clearly show whether the medication has been taken. Since the capsules aren’t always clear⁴
4. If you are using an inhaler without a counter, you may not be taking the right dose to help ease the coughing and wheezing

Best practices for a nebuliser 

1. Clean and sterilise all the parts of the nebuliser to prevent infection 
2. Ensure that the mouthpiece or mask is positioned correctly for effective medication delivery
3. Use the nebuliser in a calm environment to focus on proper breathing 
4. Track medication is used and the duration to ensure proper treatment

Advantages of a nebuliser

1. It can provide high doses of medication more efficiently 
2. Can use medication besides those used to treat asthma and COPD. Can be used with saline solution to loosen phlegm (mucus) in the lung to be coughed out
3. Antibiotics can be administered using a nebuliser to treat lung infections

Disadvantages of a nebuliser

1. The mouthpiece needs to be positioned correctly to achieve the best results 
2. You need to be able to fit the mouthpiece on in an emergency 
3. The parts of the nebuliser need to be cleaned well (sterile) to prevent infections
4. Maintenance and part replacements are important when using a nebuliser 
5. Proper technique and inhalation is important to ensure that you are getting the dose required
6. Tracking medication usage is important, especially when using a combination of treatments

When to seek medical help

• If you have taken the medication via an inhaler or a nebuliser and notice that the symptoms or wheezing does not improve
• If you are worried that you are not getting enough medication or if you think that you have overdosed 
• Always consult your healthcare professional with persistent wheezing despite following the prescribed treatment plan

Additional tips for managing wheezing

• Identify and avoid triggers. These could be pollen, cigarette smoke, vaping, pollution, and other smoke
• Monitor lung function using a peak flow meter (a small device that measures your ability to push air out your lungs) to track air flow
• Track your symptoms and discuss them with your healthcare provider to optimise your treatment plan 

Summary

Many environmental and physical factors trigger wheezing. Understanding what triggers a wheezing episode, helps in preparation and prevention.

• Having a handheld device such as an inhaler can provide quick relief during an episode, while a nebuliser is useful for delivering higher doses of medication when needed
• Prevention is always better if you have other underlying conditions like asthma or COPD, and knowing the correct dosage to effectively manage wheezing is important for safety reasons
• Proper inhaler and nebuliser techniques are crucial for effective treatment. Always follow medical advice, monitor symptoms, and seek professional help if wheezing persists