First treatment should be performed under the guidance of a Physiotherapist or Respiratory therapist to ensure proper technique and correct use of equipment.

A mouthpiece should be tried first, regardless of age. The mouthpiece must be placed well into the mouth, on top of the tongue, to avoid deposition of aerosol in the mouth. If, for some reason, a mouth piece cannot not be used (for example in a young child) a mask may be used.

1. Wash your hands thoroughly with soap and water before preparing the medication. This helps prevent infection.
2. Place the compressor on a clean surface and connect to power supply.
3. Attach the long connecting tubing to the air out port of the compressor.
4. Take out your nebulizer and remove the nebulizer top from the nebulizer cup. Place the nebulizer top on a clean surface.
5. Check the expiration date of the medication you will be nebulizing.
6. Empty the medication into the nebulizer cup. It is very important that you use the full dose of the drug. Screw or snap the cap onto the nebulizer cup.
7. Connect the mouthpiece to the nebulizer.
8. Connect the free end of the long tubing to the port on the bottom of the nebulizer, being careful not to tilt the nebulizer. Keep nebulizer upright so not to spill any of the medication out of the nebulizer.
9. Turn on the compressor and check to see that mist is coming out of the nebulizer.

1. Sitting upright in a chair, place the mouthpiece between your teeth and on top of your tongue. Be sure not to block the airflow with your tongue. Breathe normally by inhaling and exhaling through your mouth. Do not breathe through your nose. Every 1 –2 minutes take a couple of deep breaths through the mouthpiece to enhance more peripheral distribution of the medication to the airways. If you have difficulty breathing through your mouth, use a nose clip.
2. Do not be concerned if condensation collects in the long connecting tube during treatment. When the nebulizer begins “spitting”, gently tap the nebulizer cup and continue breathing until the nebulizer cup is empty, or stops producing mist. If you are interrupted or begin coughing during treatment, turn off the compressor, taking care not to spill any of the drug. To resume treatment, turn on the compressor and continue.
3. It is important to inhale the full dose of your treatment. If you detect a leak or feel any moisture coming from the nebulizer during treatment, turn off the compressor and check to be sure the nebulizer cap is sealed correctly =before continuing.

This is based on the manufacturer’s recommendations and from the Infection control census document from the Cystic Fibrosis Foundation.

1. Wash your nebulizer with soap and water as soon as possible after use
2. Disinfect your nebulizer with one of the following methods if acceptable according to manufacturers’ recommendations:
   1. Boil in water for 5 minutes, (manufacturer says 10 minutes)
   2. Immerse in one of the following:
      1. 1:50 dilution of 5.25% to 6.15% household bleach for 3 minutes
      2. 70% to 90% ethyl or isopropyl alcohol for 5 minutes
      3. 3% hydrogen peroxide for 30 minutes
   3. If immersed in one of the above solutions, rinse with sterile or filtered water
3. Use a standard cycle dishwasher, if the water temperature is 700 or higher and maintained for at least 30 minutes
4. Microwave for 5 minutes
5. Finally, air dry all equipment.
6. Clean outside of compressor with detergent and water.

It is not advisable to use vinegar as it does not kill all bacteria effectively.

1. Fink JB. Aerosol device selection: evidence to practice. Respir Care 2000;45:874-5.
2. Rubin BK, Fink JB. The delivery of inhaled medication to the young child. Pediatr Clin North Am 2003;50:717-31
3. Boe J, Dennis JH, O’Driscoll BR, et al. European Repiratory Society Task Force on the use of nebulizers. European Respiratory Society Guidelines on the use of nebulizers. Eur Respir J 2001;18:228-42.
4. Infection Control Consensus Conference Document. Consensus Conferences, Cystic Fibrosis Foundation. 2003; Vol X