The nebuliser - a user's guide
It sounds like a monster from Doctor Who, but the nebuliser is a key part of the lives of many people. Hook yourself up to this little machine and breathe deeply...
What is it?
A nebuliser is an important device for people with certain lung conditions. It dissolves drugs into a mist which is inhaled through a mouthpiece, allowing it to reach the affected areas quickly and directly.
Is it big?
Nebulisers have been around since 1981. Originally the machines were all fairly large and noisy. Users had to stick pipes out of the window (like a tumble dryer vent) so that others in the same room weren't also medicated. These days they're small handheld devices and have snazzy names like I-neb and the eFlow.
Who uses them?
People with cystic fibrosis (CF) are the main users of nebulisers - they need the machines several times a day to manage their condition. CF sufferers will often have one or more machines at home.
CF is a life-limiting genetic condition which stops movement of salt and water around the body. This doesn't sound like it should cause much harm (a bit of salt and water?) but in reality it means that mucus in the lungs doesn't get broken down - it becomes sticky and hard to shift with damage resulting. The condition also stops food being digested properly.
Among other things, a nebuliser can enable CF sufferers to inhale saline solutions which thin the sticky mucus and deliver antibiotics, ensuring bacteria doesn't grow in what would otherwise become a warm and welcoming environment.
Does it take long to nebulise?
It's all about the time. 28-year-old Gemma Gleave lives in West Yorkshire with her husband. She has cystic fibrosis and estimates that she must spend up to two hours on her machines daily.
"I neb about nine times a day - each session takes five to 15 minutes," she says. The old-style nebulisers took two or three times longer. "They were really noisy, you couldn't even watch television while on them because you couldn't hear it."
Gleave spends around five hours each day managing her condition and just looking after herself. This involves taking medication (including insulin for a related diabetes condition), physiotherapy, IV treatments, taking exercise, using the nebuliser plus cleaning and sterilising its mouthpieces, tubes and chambers around the clock - a task she patiently describes as "repetitive". She gave up work five years ago to concentrate on her health.
Sorry, did you just say some people with CF spend five hours a day looking after themselves?
Yes. It depends how well you are on a given day but it all takes time. Louise Banks at the Cystic Fibrosis Trust says that if you're in good health you can slot nebulising into your routine.
"People with CF have been doing this for their whole life, like you brushing your teeth. Often we do hear of people struggling against it during their teenage years - they lose interest and decide not to bother."
Who else uses them?
Nebulisers are also used by people with chronic obstructive pulmonary disease (COPD). However, those with respiratory problems like chronic bronchitis, emphysema or asthma are now advised that a standard blue relief inhaler is the go-to solution in an attack, and that nebulisers are only for acute difficulty.
These groups are only likely to use a nebuliser at their doctor's surgery or in A&E and are generally advised against having one at home. Asthma UK say that having to use one could mean you aren't managing your condition well. They say you should be assessed if you have an acute attack, rather than self-medicating with a nebuliser.