Inhalers Versus Nebulizers, The Key Differences

If you have a respiratory condition, such as COPD, you may be prescribed inhaled medication. Inhalation is an excellent delivery route for medications for pulmonary conditions since it often offers quick onset of the drug.

The two ways inhaled respiratory medications are used are in a nebulizer and an inhaler. Both nebulizers and inhalers deliver medication into the lungs. In many cases, the same medication is available in both. But there are several differences between nebulizers and inhalers.

Learning about each device and making sure you use it correctly is vital for an effective treatment. Below is more information on each type of device.


Inhalers are small handheld devices that deliver a dose of medication into the lungs. Common classifications of medications include fast-bronchodilators, corticosteroids, and long-acting bronchodilators. Several types of inhalers are on the market including the following:

Metered Dose Inhalers: A metered dose inhaler is a small pressurized canister that delivers a measured dose of medication in the form of an aerosol spray. Metered dose inhalers were redesigned in the late 1990s due to environmental concerns. The propellant used in metered dose inhalers was changed from chlorofluorocarbons (CFC) to hydrofluoroalkane (HFA). 

Metered dose inhalers are more effective if used with a spacer. A spacer is a small tube-like device that holds the MDI. It makes it easier to coordinate using the inhaler and allows you to inhale slower.

Dry Powder Inhalers: A dry powder inhaler delivers medication in the form of powder instead of an aerosol. Dry powder inhalers are not used with a spacer.

Soft Mist Inhalers: Slow mist inhalers are relatively new. The inhaler delivers a pre-measured dose of medication in the form of a slow-moving mist. Soft mist inhalers also are not used with a spacer.

It’s helpful to understand that inhalers are not all taken the same way. For example, some inhalers, such as HFAs, require a slow inhalation. Other inhalers require a stronger and faster inhalation.

Instructions on priming an inhaler also vary by the type of inhaler and medication. Priming refers to the instructions for getting the inhaler ready to use.


A nebulizer is a device that turns liquid medication into an aerosol or mist, which you inhale into your lungs. Although a nebulizer may come in different sizes, many of them consist of the same parts. Nebulizers have a small cup that holds liquid medication, a mouthpiece or mask, and an air compressor. Some types of nebulizers also have tubing that connects the nebulizer cup to the air compressor.

Air from the compressor moves through the device and turns the medication into an aerosol or mist.

Liquid respiratory medication for a nebulizer comes in a premeasured vial. Although it’s essential to follow the manufacturer’s instructions, most nebulizers work similarly. To use a nebulizer:

·       Open the vial and place the medication into the nebulizer cup.

·       Attach the mouthpiece or mask to the nebulizer.

·       Turn the nebulizer on.

·       Seal your lips tightly around the mouthpiece.

·       Inhale slowly and deeply through your mouth.

·       Continue to breathe in through the device until all the medication is gone.

The length of time it takes to do a treatment using a nebulizer may vary based on the amount of medication you are using.

Should you use a nebulizer or an inhaler?

When it comes down to whether a nebulizer or inhaler is best to treat your respiratory condition, it may depend on the medication you need. For example, there might be instances in which the medication prescribed by your doctor is only available through an inhaler. In other cases, the drug may be available in both a liquid for a nebulizer and an inhaler.

In theory, both inhalers and nebulizers should deliver the same dosage of medication. But getting a good treatment and the correct dose of medication with an inhaler is largely dependent on the user’s technique.

Misusing an inhaler may prevent the medication from being deposited into the lungs. It may also increase the side effects. Unfortunately, many people do not use their inhaler correctly. Common mistakes include forgetting to prime the inhaler, not using a spacer with an MDI, and inhaling too slowly or too fast.

It’s also important to follow the manufacturer’s instructions when using a nebulizer. But a nebulizer is very user-friendly. Typically, fewer mistakes are made using a nebulizer. For instance, a nebulizer is not dependent on inhalation technique as much as an inhaler.

Another advantage of using a nebulizer is it allows for a passive treatment. There are instances when a person is too sleepy or weak to use an inhaler correctly. A nebulizer with a mask can be used even if a person is asleep or you are giving a treatment to a young child.

In the past, nebulizers usually required an AC power source, which made them less convenient than an inhaler. But today’s nebulizers are available in battery operated models. Small, portable nebulizers are also available that fit in your pocket and can go anywhere.  

Certain nebulizers are now designed to deliver smaller particles than in the past. Smaller particles are delivered deeper into the lungs. The more medication that is deposited into the respiratory tract, the more effective it may be.

The bottom-line is both inhalers and nebulizers may play a role in your treatment plan. But nebulizers are still the gold standard when it comes to treating COPD and asthma. Nebulizers are often easier to use than an inhaler, which means you get a more effective treatment.

MaryAnn DePietro is a licensed respiratory therapist working part-time at a trauma center in California for the past 14 years. Additionally, she is a former EMT and ACE certified personal trainer.