Editing Nebulizer (section)

==Medical uses==
[[File:Nebulizer.JPG|thumb|Another form of nebulization]]

===Guidelines===
Various asthma guidelines, such as the Global Initiative for Asthma Guidelines [GINA], the British Guidelines on the management of Asthma, The Canadian Pediatric Asthma Consensus Guidelines, and United States Guidelines for Diagnosis and Treatment of Asthma each recommend [[metered dose inhalers]] in place of nebulizer-delivered therapies.<ref name=Clark2010>{{cite journal |vauthors=Clark NM, Houle C, Partridge MR, Leo HL, Paton JY |title=The puzzle of continued use of nebulized therapy by those with asthma |journal=Chron Respir Dis |volume=7 |issue=1 |pages=3–7 |year=2010 |pmid=20103617 |doi=10.1177/1479972309357496 |doi-access=free }}</ref>
The European Respiratory Society acknowledge that although nebulizers are used in hospitals and at home they suggest much of this use may not be evidence-based.<ref name=Boe2001>{{cite journal  |vauthors=Boe J, Dennis JH, O'Driscoll BR, etal |title=European Respiratory Society Guidelines on the use of nebulizers |journal=Eur. Respir. J. |volume=18 |issue=1 |pages=228–42 |date=July 2001 |pmid=11510796 |doi=10.1183/09031936.01.00220001|doi-access=free }}</ref>

===Effectiveness===
Recent evidence shows that nebulizers are no more effective than [[metered-dose inhaler]]s (MDIs) with spacers.<ref name=Cates2013>{{Cite journal|last1=Cates|first1=Christopher J.|last2=Welsh|first2=Emma J.|last3=Rowe|first3=Brian H.|date=2013-09-13|title=Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma|journal=The Cochrane Database of Systematic Reviews|volume=2013 |issue=9|pages=CD000052|doi=10.1002/14651858.CD000052.pub3|issn=1469-493X|pmid=24037768|pmc=7032675}}</ref>  An MDI with a spacer may offer advantages to children who have acute asthma.<ref name=Clark2010/><ref>{{cite journal |vauthors=Epling J, Chang MH |title=Are metered-dose inhalers with holding chambers better than nebulizers for treating acute asthma? |journal=Am Fam Physician |volume=67 |issue=1 |pages=62–4 |date=January 2003 |pmid=12537167 |url=http://www.aafp.org/link_out?pmid=12537167}}</ref><ref name=Cates2013 /> Those findings refer specifically to the treatment of asthma and not to the efficacy of nebulisers generally, as for COPD for example.<ref name=Cates2013 /> For COPD, especially when assessing exacerbations or lung attacks, there is no evidence to indicate that MDI (with a spacer) delivered medicine is more effective than administration of the same medicine with a nebulizer.<ref>{{Cite journal|last1=van Geffen|first1=Wouter H.|last2=Douma|first2=W. R.|last3=Slebos|first3=Dirk Jan|last4=Kerstjens|first4=Huib A. M.|date=2016-08-29|title=Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD|journal=The Cochrane Database of Systematic Reviews|volume=2016|issue=8|pages=CD011826|doi=10.1002/14651858.CD011826.pub2|issn=1469-493X|pmid=27569680|pmc=8487315|url=https://pure.rug.nl/ws/files/36833530/Geffen_et_al_2016_The_Cochrane_Library.pdf}}</ref>

The [[European Respiratory Society]] highlighted a risk relating to droplet size reproducibility caused by selling nebulizer devices separately from nebulized solution. They found this practice could vary droplet size 10-fold or more by changing from an inefficient nebulizer system to a highly efficient one.<ref name=Boe2001/><ref name=Cates2013 />
Two advantages attributed to nebulizers, compared to MDIs with spacers (inhalers), are their ability to deliver larger dosages at a faster rate, especially in acute asthma; however, recent data suggests actual lung deposition rates are the same. In addition, another trial found that a MDI (with spacer) had a lower required dose for clinical result compared to a nebulizer.<ref name=Clark2010/>

Beyond use in chronic lung disease, nebulizers may also be used to treat acute issues like the inhalation of toxic substances. One such example is the treatment of inhalation of toxic [[hydrofluoric acid]] (HF) vapors.<ref>{{cite journal |last1=Kono |first1=K |title=Successful treatments of lung injury and skin burn due to hydrofluoric acid exposure. |journal=International Archives of Occupational and Environmental Health |volume=73 Suppl |pages=S93-7 |pmid=10968568 |year=2000 |issue=S1 |doi=10.1007/pl00014634 |bibcode=2000IAOEH..73S..93K |s2cid=37322396 }}</ref> [[Calcium gluconate]] is a first-line treatment for HF exposure to the skin. By using a nebulizer, calcium gluconate is delivered to the lungs as an aerosol to counteract the toxicity of inhaled HF vapors.