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Nebulizing on
the rise

In the beginning, we had to nebulize the teddy bear. Our Olivia, then 3,
was horrified by the hissing sound the new machine made as it misted
medication to calm her coughing. And breathe through a mask? Her shrieks
made it clear: NO WAY! So we went to the mouthpiece instead. But teddy
still had to take a turn.
Even then it wasn’t fun to get a resistant toddler to sit still for
10-minute home treatments. And on those occasions when the nebulizer had to
be used every four hours through the night, well, let’s just say, welcome
to one of the grueling chapters of parenthood. But the fact is, the
treatments worked. Three years later, they still do.
While most of the year she is not on medication, Olivia has airways that
can react to a combination of upper-respiratory colds and dry, cold
So, when we head North in the wintertime, we pack along inhalers and her
nebulizer, which is about the size and weight of a large hand vacuum and
delivers a mixture of Albuterol and bronchial saline.
And here in Florida, when late October or early November brings a chilly
spell and upper-respiratory problems, we have learned to pay attention if
Olivia develops a persistent cough. Then it is time for her preventives:
Zyrtec syrup and inhaler-administered Flovent and Albuterol. But the
inhalers can’t stop airway-related coughing that is already in progress.
Then it’s time for Nebby.
On the playground, I hear other mothers talking about their own nights of
nebulizing. One friend spent a weekend coordinating treatments for her two
children, ages 2 and 5.
So I got to thinking: Why do so many families these days seem to have
nebulizers? Was I just aware of them because I am around other parents with
little kids? Why hadn’t the use of nebulizers come up when my adult
daughter, Rebecca, was little? She is 15 years older than Olivia, had
asthma as a child, and used Albuterol syrup and inhalers through elementary
I made an appointment to talk with Dr. Elaine Waters, a Bradenton allergist
trained in pediatrics who had seen both Olivia and my husband, Dozier.
Waters had impressed me with her personable and relaxed manner, and her
ability to communicate.
I also spoke by telephone with Dr. William Berger, a former staff allergist
with the U.S. Olympic swim team whose books, co-written with track star
Jackie Joyner-Kersee, include “Asthma for Dummies” (For Dummies,
2004). Berger also is past president of the American College of Allergy,
Asthma & Immunology.
They said I was right. The use of nebulizers is on the increase, and they
tend to be used mostly for little children and the elderly because the
mechanics of administering medication through inhalers can be difficult.
Nebulizers have been around since the 1970s, Berger says, first as those
“big, bulky things” used in hospitals for “rescue medicine.” In the 1980s,
they started to come into home use.
Their use is also on the rise, Waters and Berger say, because doctors are
getting better at diagnosing patients at a younger age. With parents having
access to nebulizers, Waters says, “One of the biggest changes I’ve seen
with kids is we don’t hospitalize them as much.”
The down side is we are seeing more asthma and nobody knows why. Berger
leans toward the “hygiene hypothesis,” which maintains that several
factors, including the availability of life-saving vaccines, the increased
use of germ-fighting antibacterial products and improved public health
measures, have given our immune systems less infection fighting to do. As a
result, many people’s systems, out of “boredom,” are overreacting to
usually harmless substances. Berger expects medicine in the next 20 to 30
years to find ways to prevent the rise of asthma.
As for now, parents need to remember to use nebulizers correctly. A common
mistake both allergists report is the “blow-by” tactic, spraying the mist
at a child’s face rather than using the mouthpiece or mask. Berger
describes that approach as worthless.
The good news is that two-thirds of infants and toddlers who get treated
early for infection-induced asthma will not develop adult asthma. And most
children can expect to stop using nebulizers during their grade school
years, either because their situations resolve themselves or they become
competent enough to use inhalers.
At this point, it looks like that is how it will be for us. Olivia, now in
kindergarten, still doesn’t love the nebulizer. “I hate it,” she says, even
though she knows it helps her. But Nebby may soon be part of our past.