Nursing care
Nebuliser Therapy: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Nebuliser therapy delivers aerosolised medication directly to the airways for faster local effect than oral dosing. Nursing management covers pre-treatment assessment, correct equipment setup with a mouthpiece preferred over a mask for anyone who can hold one, monitoring for tachycardia or tremor during treatment, and teaching correct technique before discharge.
What the procedure achieves
Nebuliser therapy converts a liquid medication, usually a bronchodilator such as salbutamol or ipratropium, or occasionally a corticosteroid or mucolytic, into a fine mist the patient inhales over several minutes. The aim is direct deposition of drug onto airway mucosa, which achieves therapeutic effect faster and at a lower systemic dose than the equivalent oral medication, while producing fewer systemic side effects than an oral or intravenous route for the same bronchodilator response.
It is used where a patient cannot generate the inspiratory effort or coordination needed for a metered-dose inhaler, during acute exacerbations of asthma or COPD, or when higher doses than an inhaler can deliver are clinically indicated. The nurse's management spans the full episode: confirming the order and patient readiness beforehand, running the treatment safely, and consolidating the patient's own technique so the effect is reproducible without supervision.
Pre-procedure nursing responsibilities
Before starting, verify the medication order against the patient, confirm allergy status, and take a baseline respiratory assessment: respiratory rate, oxygen saturation, auscultation for wheeze or diminished air entry, and baseline heart rate, since beta-agonist bronchodilators commonly cause tachycardia that needs a pre-treatment reference point. Check the patient is sitting upright or in high Fowler's position, which allows full lung expansion and better drug distribution than lying flat.
Confirm the correct nebuliser chamber, driving gas flow rate as prescribed (typically six to eight litres per minute for a jet nebuliser), and that the medication is drawn up and diluted correctly if dilution is required. Assess the patient's ability to hold and use a mouthpiece independently, since this determines the interface choice made at equipment setup, and explain the procedure so the patient understands they need to breathe normally through the device rather than hyperventilating to finish faster.
Equipment and positioning
A mouthpiece achieves better drug deposition in the lower airways than a mask in any patient who can hold one steady between the lips, because it avoids the loss of aerosol around the mask seal and reduces deposition on facial skin and in the eyes. Reserve a mask for patients who are unable to maintain lip seal on a mouthpiece: young children, patients who are drowsy or confused, or those with significant facial weakness.
Position the patient upright with the nebuliser chamber held vertically so the medication chamber drains correctly and does not spill. Attach the device to the oxygen or air flow source at the prescribed flow rate and confirm visible misting before the patient begins breathing through it. If the patient is on supplemental oxygen and the nebuliser is oxygen-driven, monitor total oxygen delivery so it does not exceed what is appropriate for a patient with chronic hypercapnic risk, such as some COPD patients, where compressed air rather than oxygen may be the specified driving gas.
Complications and early signs
The most common adverse effects are tachycardia, tremor, and occasionally palpitations from beta-agonist bronchodilators, and dry mouth or a bitter taste with ipratropium. Monitor heart rate during treatment and stop or slow the session if the patient develops significant tachycardia, chest pain, or dysrhythmia symptoms, reporting to the prescriber before continuing.
Paradoxical bronchospasm is an uncommon but recognised complication where the patient's wheeze or breathlessness worsens during or immediately after treatment rather than improving; this requires stopping the nebuliser and reassessing rather than continuing on the assumption more medication will help. In patients with narrow-angle glaucoma, ipratropium mist reaching the eyes can precipitate acute angle closure, so a mask that allows aerosol contact with the eyes should be avoided in this group and a mouthpiece used instead wherever possible.
Post-procedure care
After the treatment, which typically ends when misting stops (around ten to fifteen minutes), reassess respiratory rate, oxygen saturation, air entry on auscultation, and heart rate, and compare against the pre-treatment baseline to document response to therapy. Ask the patient to rinse their mouth with water after inhaled corticosteroid nebulisation specifically, to reduce the risk of oral candidiasis.
Clean or replace the nebuliser chamber and tubing per facility policy, since residual medication and moisture in the chamber support bacterial growth if reused without cleaning. Document the medication given, the response, any adverse effects, and the interface used, and notify the prescriber if the expected improvement in wheeze or oxygenation did not occur, since this may prompt escalation to a different bronchodilator strategy.
What to teach before discharge
Teach the patient to breathe normally and slowly through the mouthpiece rather than taking rapid deep breaths, which does not improve deposition and can cause dizziness from hyperventilation. Reinforce that a mouthpiece is the preferred interface for them if they are able to hold it, since it delivers more medication to the airways than a mask and avoids facial and eye exposure.
Confirm they know how to assemble, clean, and store the device at home, including air-drying the chamber fully between uses to prevent mould or bacterial contamination, and how to recognise when their inhaler or nebuliser is not controlling symptoms and they need to seek urgent care rather than repeating doses. If the patient is going home on a portable compressor, confirm they can access replacement chambers and know the expected lifespan of the equipment.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
Is a mouthpiece or mask better for nebuliser therapy?
A mouthpiece gives better drug deposition in the airways than a mask in any patient who can hold it steady, because it avoids aerosol loss around a mask seal. Reserve a mask for patients unable to maintain a lip seal, such as young children or the drowsy or confused.
What position should a patient be in for nebuliser treatment?
Upright or in high Fowler's position, which allows full lung expansion and improves drug distribution compared with lying flat. The nebuliser chamber itself should also be held or set upright so it drains and mists correctly.
What are early signs of a complication during nebuliser therapy?
Watch for tachycardia, tremor, or palpitations from beta-agonist bronchodilators, and for paradoxical bronchospasm where wheeze worsens rather than improves. Either finding warrants stopping the treatment and reassessing rather than continuing as scheduled.
Why should a nebulised mask be avoided in patients with glaucoma?
Ipratropium mist reaching the eyes through a mask can precipitate acute angle-closure glaucoma in susceptible patients. A mouthpiece keeps the aerosol away from the eyes and is the safer interface choice when the patient can use one.
Should a patient rinse their mouth after using a nebuliser?
Yes, if the medication was an inhaled corticosteroid, rinsing with water afterwards reduces the risk of oral candidiasis. It is not required after a bronchodilator-only treatment, though dry mouth from ipratropium can make it comfortable regardless.