A nebulizer is a medical device that transforms liquid medication into a fine mist, or aerosol, which a person inhales directly into the lungs. This method delivers bronchodilators and other respiratory treatments for conditions like asthma or Chronic Obstructive Pulmonary Disease (COPD). When a person relies on this mist for relief, a lack of symptom improvement can be alarming. This suggests a failure in the delivery system, requiring immediate and methodical troubleshooting.
Checking Equipment and Technique
If a nebulizer fails to provide relief, the first step is to check the device itself, as malfunctioning equipment prevents medication from reaching the airways. Verify the power source, ensuring the compressor is plugged into a functioning electrical outlet or that the battery is charged. If the compressor motor stops suddenly, it may be due to a built-in thermal overload protector, requiring the machine to cool down before restarting.
Inspect the air tubing connecting the compressor to the nebulizer cup for kinks, cracks, or loose connections that impede airflow. A whistling sound often signals an air leak that needs to be sealed by tightening connections. Check the air filter for discoloration; a dirty, gray filter restricts air intake, leading to low mist output.
The nebulizer cup assembly must be correct for effective aerosolization. Inside the cup is the baffle, which is instrumental in creating the fine mist. If the baffle is missing, incorrectly positioned, or clogged with residue, the machine will run but produce little useful mist. Ensure the cup is securely closed and contains the correct volume of medication, as under-filling or over-filling prevents proper aerosolization.
Proper inhalation technique is important for ensuring medication reaches the lower airways. Sit upright to maximize lung capacity and keep the nebulizer cup upright to maintain the flow of liquid medication. The mask or mouthpiece must form a tight seal around the mouth and nose to prevent the mist from escaping. During treatment, breathe slowly and deeply through the mouth, periodically holding your breath for two to three seconds before exhaling. This brief breath-hold allows the tiny aerosol particles time to settle deeper within the lungs.
Reviewing Medication and Storage
Once the equipment is confirmed to be working correctly, the focus should shift to the medication itself, as its chemical stability is necessary for treatment efficacy. Check the expiration date printed on the packaging or individual vials. The shelf life of unit-dose vials changes significantly once the protective foil pouch is opened, often requiring use within one to two weeks.
Improper storage conditions, particularly exposure to excessive heat, light, or moisture, can compromise the medication’s integrity. Medications should be kept at room temperature, ideally between 68°F and 77°F, and never left in a hot car or steamy bathroom. If the liquid medication appears discolored, cloudy, or has floating particles, discard it immediately, as these changes indicate chemical degradation.
Confirming the correct substance is being administered for the current symptoms is also a necessary step. Bronchodilators, such as albuterol, quickly relax airway muscles, while medications like corticosteroids manage inflammation over time. If the treatment requires mixing the medication with a diluent, such as sterile saline, ensure the correct ratio is used, as this affects the total volume and concentration of the inhaled dose.
Recognizing Signs of Worsening Distress
If breathing difficulty persists or increases after a complete nebulizer treatment, stop troubleshooting and seek immediate medical attention. Several physical symptoms indicate the body is not getting enough oxygen, which is a medical emergency. A bluish discoloration around the lips, inside the mouth, or on the fingernails, known as cyanosis, is a marker of severe oxygen deprivation.
Observe the person’s breathing effort for retractions, where the skin visibly sinks in below the neck, under the breastbone, or between the ribs with each breath. Retractions show the body is using accessory muscles to forcefully pull air into the lungs. Another sign of increased effort is the flaring of the nostrils, an involuntary attempt to maximize the opening of the nasal passages.
Changes in mental status are also a serious concern, including confusion, unusual lethargy, or severe panic. Difficulty speaking in full sentences because of the need to gasp for air signals that the respiratory system is overwhelmed. A sudden cessation of wheezing after a period of intense distress can be an ominous sign that the airways have become so tight that no air can pass.
If any of these severe symptoms are present, particularly color changes or significant changes in mental status, seek immediate emergency assistance. Do not attempt another treatment or delay care to continue technical troubleshooting. Contacting emergency medical services is necessary when a person’s respiratory condition is rapidly deteriorating despite prescribed medication.