Nebulizer vs. Inhaler: Why Patients Use One Over the Other

What leads a patient to choose a nebulizer to deliver their respiratory medications over a handheld inhaler?

U.S. researchers asked that question in a study that followed 2,973 adults taking part in the SPIROMICS study. The investigators examined the characteristics of people who use nebulizers, how they use them, and the factors that led some to switch to these devices over time. Participants in the study, who were followed for up to seven years, had smoking histories with or without spirometrically defined COPD.

Results showed:

• Nebulizer utilization was highest in patients with advanced COPD, with 49% of GOLD Group D participants using these devices at baseline.
• Nebulizer treatments were primarily used for short-acting bronchodilators as needed rather than for long-acting nebulized medications.
• Baseline nebulizer use was associated with respiratory exacerbations in the prior year, as well as lower FEV1, COPD Assessment Test (CAT) scores, and six-minute walk distances. A history of asthma was also associated with baseline nebulizer use.
• Longitudinal uptake was associated with exacerbations, asthma, and lower FEV1 and CAT scores.
• Patterns were consistent between tobacco-exposed participants with preserved spirometry and those with COPD.

By identifying patient characteristics associated with nebulizer use, the authors hope their study will provide a stronger foundation for future investigations to help clinicians make more informed decisions for their patients.

“Although our observational study design precludes assessment of causality, these findings argue for randomized controlled trials to compare directly the efficacy of nebulized versus hand-held devices, particularly in patients with advanced COPD with high symptom burden and frequent exacerbations,” they wrote.

The study was published in Chronic Obstructive Pulmonary Disease. 

Highlighted in RC Buzz, May 11, 2026