Indications
- • Acute asthma / COPD exacerbation
- • Bronchiectasis sputum clearance
- • Croup (adrenaline neb)
- • Upper-airway oedema (post-extubation)
Contraindications
- ⚠ Caution in tachyarrhythmia with high-dose β-agonist
- ⚠ Use air-driven (not O₂) in chronic CO₂ retainers
Equipment
- • Nebuliser chamber + mouthpiece/mask
- • Gas source — O₂ 6–8 L/min or compressed air
- • Drug ampoule (e.g. salbutamol 2.5–5 mg, ipratropium 0.5 mg)
Technique
- • Sit patient upright, explain procedure
- • Decant drug into chamber, attach to gas at 6–8 L/min
- • Apply mask (or mouthpiece) tightly
- • Encourage slow deep breaths until chamber empties (~10 min)
- • In COPD use compressed air + nasal O₂ to maintain SpO₂ 88–92%
- • Document drug, dose, route, response (PEF before/after)
Complications
- ⚠ Tremor, tachycardia, hypokalaemia (β-agonist)
- ⚠ Paradoxical bronchospasm
- ⚠ Dry mouth, urinary retention (ipratropium)
- ⚠ Eye pain if leak — protect eyes in glaucoma
Aftercare
- • Repeat PEF / SpO₂
- • Reassess clinical response within 15 min
- • Step up to back-to-back nebs or IV magnesium if no response
Clinical pearls
- • Back-to-back salbutamol 5 mg every 15 min for severe asthma
- • Ipratropium adds benefit in COPD + severe asthma
- • Adrenaline nebs (5 mL of 1:1000) for life-threatening upper-airway oedema
Perform under supervision until competent. Follow local SOPs and consent policy.
