The great advantage of inhalation therapy is that the active agents are directly delivered to the airways e.g. the lungs. However, this only works if you use the right inhalation technique. This article will explain the key points.
To make sure that the active agents directly reach the airways, it is important to use the right inhalation technique. The first step is selecting an appropriate inhalation device. The second step is using this inhalation device properly.
The main advantage of inhalation therapy is that the active agents reach where they are needed. Transporting active substances into the nose calls for a different inhalation device than the treatment of a lung disease such as asthma or COPD. Just distinguishing of the mouth and throat area, the nose and the paranasal sinuses, while the lower airways consist of the windpipe, the bronchi, the bronchioles and the alveoli.
At PARI, we are specialists in inhalation therapy – and have been for over 100 years. See below for detailed information on targeted inhalation techniques for different diseases:
Not all inhalation devices are suitable for all active agents. Certain medications are, for example, destroyed by ultrasound. In these cases, only compressor-nozzle nebulisers or vibrating membrane nebulisers are an option.
You can only inhale saline solution with a nebuliser. The commonly lauded method of inhaling over a cooking pot or inhaling steam does not work. This is because the salt does not evaporate, otherwise obtaining sea salt by evaporating the water would be impossible. Read more about inhaling saline solution.
These inhalers contain certain medications or formulations of medications that are only prescribed by doctors. They are available as a powder (dry powder inhalation) or as a spray (metered dose inhaler). They are used for diseases affecting the lungs, such as asthma or COPD. They should only be used after training is given by medical professionals.
The advantage of these two procedures is that they are compact and can be carried everywhere. The inhalation session is very short. The disadvantage is that they are prone to user errors. Metered dose aerosols require good coordination between breathing in and triggering the spray. A holding chamber (e.g. VORTEX) can help with this difficulty. Dry powder inhalers require a certain inspiratory flow - the speed you inhale with - , which some older or very unwell patients and children are unable to do.
The most versatile procedure is inhalation therapy with a nebuliser. A nebuliser creates a fine mist from an inhalation solution. This fine mist is called aerosol. As described above, the particle size should be adjusted to the goal of the therapy. When inhaling with a nebuliser, it is enough to just breathe naturally. No special inhalation technique is required. This means that user errors are very uncommon.
For inhalation therapy for the lower airways, you should switch from the mask to the mouthpiece as soon as possible. In children, this should generally be after the age of three.
It takes about five minutes to inhale 2.5 millilitres of inhalation solution properly with the PARI BOY Classic. With the PARI BOY free it only takes about three minutes for the same amount. The inhalation time essentially depends on a range of factors:
For the treatment of lung diseases, the droplets that are generated have to be sufficiently small. In the case of particles smaller than 5 microns (< 5 µm), we therefore refer to respirable droplets. The smaller the droplets, the longer the inhalation takes with the same performance of the inhalation device. This is why efficiency is so important and also how much active ingredient reaches the lungs in how much time. PARI nebuliser systems rank highly in terms of efficiency.
You take a bowl with hot water, put a towel over your head and breathe in the steam. Something that has been going for so long must be good, mustn’t it? Unfortunately, that does not hold true in this case. While the warm water may make you feel better, there is no sustainable and proven positive effect. A Cochrane Review – a systematic overview that summarises research results – concluded in 2017 that inhalation therapy with warm steam has no effect on a cold1. Another study even warns against it, because of the risk of scalding in babies and children2,3.
How about adding other ingredients to hot water? Sometimes we are also advised to inhale a salt solution over a cooking pot. But because of the high boiling temperature of the salt compared to the water, that does not work at all. The water evaporates and the salt stays behind in the pot. Inhaling salt over a cooking pot is a remedy that is just a myth. Caution is advised for essential oils, as not everyone tolerates them well. There is also the risk of scalding yourself.
Inhalation therapy over a cooking pot – a myth that is still going strong
Medications are, as a matter of principle, prescribed by the doctor. You should never discontinue or change these medications of your own accord. Please always consult closely with your doctor. You can inhale isotonic saline solutions with your prescribed drugs, as they do not have any interactions.
You can also inhale saline solutions as a stand-alone therapy to loosen mucus or to protect the airways. Read more about inhalation with saline solutions here.
The proper technique in inhalation therapy can help against a host of respiratory diseases. The choice of the right inhalation method depends on the goal of the treatment. The claim that an inhalation device is equally suited for the upper and lower airways is an empty promise. Different areas of the airways need different devices. Steam inhalation is also rarely helpful and inhaling salt over a cooking pot is a myth that continues to endure. To inhale saline solutions for mucus clearance for example, you need to use a nebuliser.
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