Last reviewed: 9 October 2026

Inhalers and Nebulisers

Overview

Inhalers and nebulisers are medical devices used to deliver medicines directly into the airways and lungs. They are commonly used to treat asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and some respiratory complications associated with aspergillosis.

Different devices work in different ways. Pressurised inhalers release medication as an aerosol spray, dry-powder inhalers deliver powdered medication, and nebulisers convert liquid medication into an aerosol that can be breathed in through a mouthpiece or mask.

Delivering medication directly to the lungs has several advantages:

• the medicine reaches the airways where it is needed
• smaller doses may be sufficient compared with some medicines taken by mouth
• side effects elsewhere in the body may be reduced

However, inhaled medicines can still cause side effects, and the amount reaching the lungs depends on the device, medication and breathing technique.

Inhalers

Hand-held inhalers are commonly used to treat asthma and other lung conditions. They are small, portable devices that deliver medication directly into the airways.

Correct inhaler technique is essential. Your doctor, respiratory nurse or pharmacist can demonstrate how to use your particular device and check your technique regularly.

Reliever inhalers

Reliever medicines help open narrowed airways and ease symptoms such as wheezing, chest tightness and breathlessness.

Salbutamol (often known by the brand name Ventolin) is a short-acting bronchodilator. However, current asthma treatment increasingly uses combination inhalers containing an inhaled corticosteroid and a rapid-acting bronchodilator, rather than relying on salbutamol alone.

Preventer inhalers

Preventer inhalers reduce inflammation in the airways and help prevent asthma attacks. Many contain inhaled corticosteroids, such as:

• beclometasone
• budesonide
• fluticasone

Some inhalers combine an inhaled corticosteroid with a long-acting bronchodilator.

After using an inhaled corticosteroid, rinse your mouth and spit out the water to reduce the risk of oral thrush. A spacer can also help reduce medicine depositing in the mouth when using a compatible pressurised inhaler.

AIR and MART treatment

Asthma prescribing has changed in recent years. Two approaches you may hear about are:

• AIR (anti-inflammatory reliever): using a prescribed combination inhaler containing an inhaled corticosteroid and formoterol when symptoms occur, so that relief of airway narrowing is accompanied by anti-inflammatory treatment.
• MART (maintenance and reliever therapy): using a suitable combination inhaler regularly to prevent symptoms and also taking additional doses of the same inhaler when needed, according to a personalised asthma action plan.

Not all combination inhalers can be used for AIR or MART. The medication, device, licensed indication and prescribed dosing instructions matter. Do not change how you use your inhaler without discussing it with your asthma team.

For more information, see Blue Inhalers, Combination Inhalers and Aspergillosis: What Patients Need to Know.

Some patients use a spacer device with a compatible pressurised metered-dose inhaler. A spacer can make coordination easier and improve medication delivery. Spacers are not used with dry-powder inhalers.

Changes to inhaler types

Your inhaler may be changed because of prescribing guidance, medication availability, individual treatment needs or efforts to reduce the environmental impact of inhaler propellants.

Dry-powder inhalers do not use propellant gases, but they require a sufficiently strong and appropriately performed inhalation to release the medication effectively. Some patients may find this difficult, particularly during severe breathlessness or an exacerbation.

A change of device should include a check that you can use the replacement correctly. The most environmentally favourable inhaler is not necessarily the most clinically suitable one for every patient.

If a new inhaler is difficult to use, or your symptoms become less well controlled, ask your healthcare professional to review your technique and treatment options.

Types of inhaler devices

Nebulisers

Nebulisers convert liquid medication into an aerosol that is inhaled through a mouthpiece or mask, usually over several minutes.

They may be prescribed when:

• a medicine is specifically formulated for nebulised delivery
• a patient cannot use an appropriate hand-held inhaler effectively
• a particular treatment or dose requires nebulised administration

Nebulisers are not automatically more effective than inhalers. For many inhaled bronchodilator treatments, a correctly used pressurised inhaler with a spacer can be similarly effective.

Medicines and solutions delivered by nebuliser may include:

• bronchodilators, such as salbutamol
• sterile saline solutions
• certain antibiotics
• selected antifungal medicines in specialist care

Only use medication or sterile solutions specifically prescribed or recommended for your nebuliser. Do not add tap water, essential oils or other substances.

Nebulisers in chronic lung disease

Types of nebulisers

Jet nebulisers

Jet nebulisers use compressed gas, usually air, to turn liquid medication into an aerosol. Oxygen-driven nebulisers are used in selected clinical circumstances and require appropriate supervision.

Jet nebuliser systems may be:

• Continuous-output: producing aerosol throughout treatment, including during exhalation.
• Breath-enhanced or breath-actuated: designed to reduce wasted medication or improve delivery during inhalation.

Vibrating mesh nebulisers

These use a vibrating mesh containing microscopic openings to produce an aerosol. They can be compact and quiet, but require careful cleaning and may not be suitable for every medication.

Ultrasonic nebulisers

Ultrasonic nebulisers use high-frequency vibrations to produce aerosol droplets. They are not suitable for all medicines because the way they generate aerosol can affect certain formulations.

Cleaning and maintenance

Correct nebuliser hygiene is especially important for people with bronchiectasis or other chronic lung disease. Poorly maintained equipment can become contaminated with bacteria or fungi.

• Follow the manufacturer’s instructions and any additional guidance provided by your respiratory team. Cleaning methods differ between devices.
• Clean the reusable medication chamber and other washable parts after use as instructed. Some equipment also requires regular disinfection.
• Use the recommended method of disinfection. Heat, steam or chemical disinfectants may be suitable for some components but can damage others.
• Allow parts to dry thoroughly before storage, using the method recommended for your equipment. Avoid storing damp parts in closed containers.
• Use sterile medication and solutions as prescribed. Do not use tap water to prepare or dilute nebulised medicines.
• Replace components at the intervals specified by the manufacturer or respiratory service. Do not assume that all masks, tubing and chambers have the same replacement schedule.
• Check filters, tubing and the compressor according to the device instructions.

Some nebuliser parts should not be immersed in water, while others may require disinfection after every treatment. Your respiratory team can demonstrate the correct procedure for your specific equipment.

If you notice persistent moisture, visible contamination, damage or a change in how the nebuliser operates, seek advice before continuing to use it.

Common questions

Which is better: an inhaler or a nebuliser?

Neither is automatically better. The best choice depends on the medicine, the condition being treated and whether you can use the device correctly. Many people obtain effective treatment from a hand-held inhaler, sometimes with a spacer.

Why might my doctor prescribe a nebuliser?

A nebuliser may be needed because a medicine is only available in nebulised form, because a particular treatment requires this method of delivery, or because you cannot use a suitable hand-held inhaler effectively.

Why has my inhaler been changed?

Your inhaler may be changed because of updated prescribing guidance, medicine availability, treatment needs or environmental considerations. You should receive instruction in using the new device and have your technique checked.

Do nebulisers deliver medication deeper into the lungs?

Not necessarily. How much medication reaches different parts of the lungs depends on several factors, including aerosol particle size, the device, breathing pattern and the condition of the airways. A correctly used inhaler can deliver medication effectively to the lungs.

How often should nebuliser equipment be replaced?

Replacement schedules vary by manufacturer, device and component. Follow the instructions supplied with your equipment and any advice from your respiratory service rather than relying on a single replacement interval.

Can I use a nebuliser if I have aspergillosis?

Yes, if your respiratory team has prescribed one for a specific purpose. Nebulisers may help deliver saline, bronchodilators or other selected treatments, but they do not themselves treat the underlying fungal disease. Nebulised antifungal medicines require specialist assessment and supervision.

Further information

For demonstrations of inhaler technique:

Asthma + Lung UK: Inhaler technique videos

For information about nebulisers:

Asthma + Lung UK: Nebulisers

For advice on newer asthma inhaler treatment:

Blue Inhalers, Combination Inhalers and Aspergillosis

Your respiratory specialist team can provide personalised advice, check inhaler technique and explain how to clean and maintain prescribed nebuliser equipment.

Author and review information