What can and cannot be added to a nebulizer: list of medications and solutions

Nebulizer therapy is a method of delivering medications into the lower respiratory tract in the form of a fine aerosol. However, for the procedure to be effective and provide the expected result, it is important to know what can be added to the nebulizer and how to use the device properly.

Important! This article is for informational purposes only. All medications must be prescribed exclusively by a physician, taking into account the patient’s age characteristics, concomitant diseases, and allergy history. Self-medication without consulting a healthcare professional may lead to serious complications.

Classification of solutions for nebulizer therapy

According to the mechanism of action, several types of solutions are distinguished:

• Bronchodilators – “first aid” for obstruction, dilate the bronchi, relieve spasms, and facilitate breathing.
• Mucolytics and expectorants – liquefy sputum and facilitate its elimination.
• Inhaled corticosteroids – hormonal agents with a powerful anti-inflammatory effect that reduce mucosal edema and bronchial hyperreactivity.
• Antiseptics and antibacterial agents – used to fight bacterial infections directly at the inflammation site.
• Isotonic solutions – moisturize mucous membranes and are used to dilute other medications.
• Hypertonic solutions – draw fluid into the lumen and promote active sputum clearance.

Saline solution (NaCl 0.9%) as a base: role and rules of use

The most universal remedy is sterile isotonic sodium chloride solution 0.9%. It contains no pharmacological components, and its osmolarity is identical to blood plasma. Therefore, it is mainly used as a basic solvent for most medications (mucolytics and bronchodilators). Saline solution for inhalation, usually dosed at 2–4 ml per procedure, may also be used independently. Although it does not treat disease or eliminate inflammation, it moisturizes the mucous membrane, maintains its elasticity, and facilitates natural mucus elimination. The solution is completely safe for adults and children even with frequent use.

Pure saline solution may also be used for preventive moisturizing of the respiratory tract in dry indoor air conditions.

Hypertonic solutions: when a concentration above 3% is required (Lorde Hyal)

For wet cough with thick sputum, hypertonic solutions such as Lorde Hyal 3% or 7% are prescribed. Due to the high salt concentration, they liquefy and remove sputum.

Indications for the use of hypertonic solutions are various diseases of the respiratory system (obstructive bronchitis, cystic fibrosis, nasopharyngitis, laryngotracheobronchitis), which are accompanied by viscous sputum.

According to methodological recommendations of the Institute of Phthisiology and Pulmonology, hypertonic solutions may be used as an adjunctive treatment in children over 2 years old with diseases accompanied by viscous sputum.

Important! According to the instructions, Lorde Hyal inhalations should only be used for productive cough. In dry cough, they may increase mucosal irritation and provoke bronchospasm.

Ectoine: anti-inflammatory protection and moisturizing

For dry irritating cough without signs of obstruction, ectoine-based solutions are recommended. Ectoine is a natural osmoregulatory substance produced by certain halophilic bacteria. Unlike ordinary saline solution, ectoine combines intensive moisturizing with a mild anti-inflammatory effect, thereby reducing irritation of a “dry” throat. It stabilizes cell membrane structure and forms a protective moisturizing layer on the mucosal surface that prevents contact with allergens and irritants.

Ectoine is recommended for:

• persistent dryness of respiratory mucosa;
• dry irritating cough without obstruction;
• atrophic mucosal changes in elderly people;
• recovery after viral infections.

Mucolytics and expectorants: Lazolvan for inhalation

Mucolytic therapy is aimed at changing the rheological properties of sputum by reducing its viscosity.

Mechanism of action on sputum and mixing rules with the base

The active substance of Lazolvan is ambroxol, which:

• timulates surfactant production;
• reduces sputum viscosity and mucus surface tension;
• activates ciliated epithelium to remove sputum;
• provides mild anti-inflammatory and antioxidant effects.

Unlike expectorants (agents that increase secretion), mucolytics change the very structure of mucus (reduce its viscosity).

To achieve optimal humidification, saline solution is mixed with Lazolvan in a 1:1 ratio immediately before filling the nebulizer chamber.

Important! Only 0.9% saline solution should be used as a solvent.

Mucolytics are not recommended immediately before bedtime because they stimulate active sputum secretion, which may interfere with rest.

Lazolvan for inhalation is usually used 1–2 times daily during active cough. Treatment duration (5–10 days) is determined by a physician.

Fighting infections: Decasan and antiseptics

If a bacterial origin of the disease is suspected, a physician may add antiseptics to the treatment regimen.

Features of the use of Decasan for bacterial complications

Decasan is a topical broad-spectrum antiseptic based on decamethoxin. It acts locally on mucous membranes, destroying bacteria, viruses, and fungi, but does not penetrate lung parenchyma and does not achieve concentrations required for systemic action.

Indications for Decasan inhalation:

• acute tracheitis with bacterial microflora;
• exacerbation of chronic bronchitis with purulent sputum;
• prevention of secondary infection during viral respiratory infections;
• aspiration complications with bacterial colonization risk.

When using Decasan for inhalation, proportions must be determined by a physician. Adults are often prescribed the drug undiluted (2–5 ml), while children are advised to dilute it with saline solution in a 1:1 or 1:2 ratio depending on age and severity.

Important! Antiseptics are used as adjunctive therapy only. They cannot replace systemic antibiotics if infection has spread deeply into tissues or caused systemic intoxication.

Hormonal and bronchodilator drugs: Pulmicort and Berodual

Pulmicort is a glucocorticosteroid used to control inflammation and prevent asthma attacks. Berodual is a combined bronchodilator that rapidly dilates the bronchi during obstruction. These nebulizer medications require strict medical supervision and are prescription-only.

Why are these medications used only as prescribed by a physician?

Pulmicort and Berodual are prescription-only:

• They require precise dosing, taking into account the patient’s age and weight, the degree of obstruction, and concomitant diseases. An underdose will not give the expected effect, and an overdose may be toxic to the body.
• They often provoke adverse reactions. When using them, the general condition should be constantly monitored. Particular attention should be paid to children, since long-term hormone therapy can affect growth and the functioning of the adrenal cortex.
• They interact with other drugs. They potentiate the effects of cardiovascular medications, antidepressants, and other stimulants.

Uncontrolled use of Berodual for inhalation (especially in patients with hypertension, tachyarrhythmias, glaucoma) can cause serious problems: tachycardia, arrhythmias, increased blood pressure, tremors, headaches.

Self-administration of Pulmicort for inhalation can disrupt local immunity and cause the development of oral candidiasis and dysphonia. Therefore, before prescribing the drug, the doctor must assess the cause of the obstruction and the general condition of the patient.

Table: Comparative characteristics of popular drugs (action, dosage, age restrictions)

Technical limitations: why a nebulizer is not a steam inhaler

A nebulizer and a steam inhaler are different devices that differ in their operating principle, technical capabilities and purpose. The main difference is that a steam inhaler works by evaporating a liquid when heated, while a nebulizer creates a cold aerosol (fine mist). The high temperature generated by a steam inhaler can pose risks: most medications (antibiotics, hormones, mucolytics) lose their properties due to structural destruction. In a nebulizer, the medications remain cold, so their chemical structure does not change. Another significant difference is in the size of the particles. A steam inhaler forms large particles that settle only in the upper respiratory tract (nose, throat), while a nebulizer breaks substances into microscopic particles that can penetrate deep into the bronchi and alveoli.

A steam inhaler is intended primarily for essential oils, herbal decoctions and mineral water. The nebulizer uses sterile aqueous solutions and specially designed nebulized forms (nebules) that contain saline, hormonal drugs, and bronchodilators.

Prohibition of oils, herbal decoctions, and syrups (risks for lungs and device)

Using substances not intended for them in a nebulizer causes irreparable damage to the device, worsens the course of the underlying disease, and provokes the development of aspiration pneumonia.

Why you shouldn’t pour oils into a nebulizer:

• For the device. Oils have a much higher viscosity than water. They settle on the nebulizer membrane, blocking microscopic holes and causing the device to malfunction.
• For the lungs. Oil particles (especially larger than 10 microns) do not pass through the upper respiratory tract and settle in the bronchioles, provoking oil pneumonia, which can lead to severe inflammatory damage to the lungs.

When inhaling herbs, there is a possible danger:

• For the device. The complex molecular structures of plant extracts (polysaccharides, tannins, glycerides) change the viscosity and surface tension of the liquid, as a result of which the spray becomes uneven and the membrane becomes clogged.
• For the lungs. The unpredictable size of the particles and the high concentration of organic compounds create a risk of allergic reactions and contribute to the reproduction of microbes.

Why syrups are prohibited:

• For the device. The viscosity of saccharides and thickeners (sorbitol, glucose syrup) is hundreds of times higher than water, as a result of which the nozzles of the nebulizer chamber become clogged, which disables the device.
• For the lungs. Sticky particles remain in the respiratory tract and clog them. In addition, saccharides contribute to the excessive reproduction of pathogenic microflora, as they serve as a nutrient base for bacteria.

How to prepare the solution and fill the nebulizer chamber

The procedure includes several stages:

• Preparation of components

Make sure that all medications are approved for inhalation use and are within their expiration dates. Check the temperature of the solution – it should not be lower than 18°C ​​and not higher than 25°C. If the medication was stored in the refrigerator, it should be kept at room temperature for some time to warm up.

• Mixing the solution (for combination therapy)

Prepare a sterile container (you can take a clean glass) and pour the required amount of saline into it according to the doctor’s instructions. Add the drug, observing the indicated proportions. Gently mix the mixture by rotating the container (do not shake to prevent foaming). Check the homogeneity of the solution (it should not contain visible particles).

• Filling the nebulizer chamber

Disassemble the device according to the manufacturer’s instructions. Place the chamber on a hard, flat surface and open the lid. Fill the chamber with solution and close tightly. Attach the mouthpiece or mask to the top of the device.

• Preparing for inhalation

Connect the compressor to the power supply. Connect the tube from the compressor to the appropriate inlet of the chamber.

• Performing inhalation

To make the procedure as effective as possible, breathe calmly and evenly, without holding your breath. When using the mask, make sure that it fits snugly to your face.

Duration of inhalation – 5-15 minutes – until the solution in the chamber is completely used up.

• Cleaning the device

Turn off the compressor and unplug it. Disassemble the chamber and mouthpiece (the compressor cannot be disassembled). Pour out the remaining medication that makes up the remaining capacity of the chamber.

Wash all parts with warm water and baby soap, rinse under running water. Dry on a clean towel without wiping.

Safety measures

To make inhalation completely safe and as effective as possible, you should follow these rules:

• Use only officially approved drugs in nebulizer form.
• Check the expiration date. Using expired drugs is dangerous – the active substance is destabilized, which can cause side effects.
• Follow medical recommendations. All inhalations with medications (except pure saline and ectoine) are carried out exclusively as prescribed by a doctor.
• Observe the duration of the procedure. Usually inhalation takes 5–10 minutes.
• Follow the specified doses. Even a slight deviation in dosage can be harmful to health.
• Avoid contact with eyes. If the aerosol accidentally gets into your eyes, rinse them with clean water for 10–15 minutes.
• Do not use the device in bed. Inhalation should be carried out in an upright position to ensure optimal distribution of the aerosol.
• If side effects occur or the condition worsens, consult a doctor immediately.

Remember! A nebulizer is a medical device, not a substitute for medical advice. Its proper use under the supervision of a doctor provides the greatest benefit and minimizes risks.

How to choose the right nebulizer? For stationary home use, reliable models such as Ulaizer Home are suitable, and for active people or children who are afraid of noise, it is advisable to use compact and quiet Ulaizer Air+ models, the sound level of which is significantly lower than the standard 60 dB.

When preparing the material, recommendations from the methodological manual of the State Educational Service “F.G. Yanovsky Institute of Physiotherapy of the National Academy of Medical Sciences of Ukraine” (2025) were used.