In patients with COPD, do oxygen driven jet nebulisers deliver the recommended 5mg dose of salbutamol when limited to a 6-minute treatment window?

February 4, 2026

February 4, 2026

Brent Glassford, Research Paramedic (Yorkshire Ambulance Service)

Christopher von Mickwitz, Advanced Paramedic Clinical Lead

In [Adults presenting to the ambulance service with exacerbation of COPD] do [oxygen driven jet-style nebulisers] effectively [deliver the expected 5mg dose of salbutamol within the 6-minute treatment window as advised in British Thoracic Society guidance]

A 71-year-old female presents to the ambulance service with exacerbation of COPD. She is short of breath and has a significant expiratory wheeze. You treat the patient with nebulised salbutamol, but only have the oxygen driven jet nebuliser available. Following advice from the British Thoracic Society, an oxygen driven nebuliser should be limited to 6 minutes in patients with COPD to limit the risk of hypercapnic respiratory failure. You wonder if the oxygen driven jet nebuliser can deliver the recommended 5mg dose of salbutamol within this 6-minute period.

To find appropriate publications, a database search of MEDLINE and CINAHL was conducted using the following search terms:

(nebuli#er) AND (oxygen-driven OR oxygen driven OR oxygen-powered OR oxygen powered OR jet OR jet-style OR jet style) AND (salbutamol or saba or short acting beta 2 agonist or ventolin or albuterol) AND (delivery OR output OR dose) AND (Chronic Obstructive Pulmonary Disease OR COPD OR Chronic Obstructive Lung Disease OR Chronic Obstructive Airway Disease OR Emphysema)

Where relevant, search terms were modified with truncations and then combined with Boolean operators. No further restrictions were applied. The titles and abstracts of the resulting studies were screened for relevance. Finally, the full text of all publications deemed relevant were critically appraised.

The initial search resulted in 21 papers; 1 duplicate was identified and removed. Title and abstracts were then screened for relevance; 12 papers were excluded leaving 8 for full text review. After full text review and critical appraisal, a further 2 papers were excluded based on quality and non-English language, leaving 6 for final inclusion. Of these 6 papers there are 5 RCTs and 1 systematic review.

Each of the included studies demonstrates consistent evidence that oxygen driven jet nebulisers (JN) are inefficient at delivering the nominal dose of salbutamol to the lungs, particularly when compared with vibrating mesh nebulisers (VMN).
In vitro, ex vivo and in vivo studies showed that a substantial proportion of the nominal dose remains as residual volume within the nebuliser, is lost to the circuit, or is deposited in the upper airways before reaching the lungs. One study using radioisotope scintigraphy during non-invasive ventilation found that only 12.51% (± 6.31%) of the nominal dose was inhaled and only 3.14% (± 1.71%) was deposited in the lungs when delivered by JN. Although this study used a mixed bronchodilator solution rather than salbutamol alone, it provides evidence of poor pulmonary deposition with jet nebulisation. These findings are supported by the included systematic review, which reports that up to 50% of the nominal dose may remain as residual volume when using jet nebulisers.
Two studies reported clinical outcome measures such as FEV₁, dyspnoea scores and respiratory rate. While only one of these demonstrated statistically greater improvements with VMN compared to JN, this may still indicate that the inefficiency of a JN can be clinically relevant. However, further research would be required to confirm this effect.
Additionally, urinary salbutamol excretion was consistently lower following administration via JN compared with VMN when the same nominal dose was used. As early urinary salbutamol excretion is a surrogate marker of pulmonary drug absorption, this supports the in vitro and scintigraphy findings that a JN delivers a smaller biologically absorbed dose to the patient.
Importantly, none of the included studies were designed to replicate a prehospital 6-minute nebulisation strategy. Nebulisation was generally continued to completion (until sputtering) under controlled conditions, meaning that the reported findings are likely to represent an upper estimate of drug delivery with a JN. As such, while the available evidence cannot confirm whether a full 5 mg dose is delivered within a 6-minute window, it demonstrates that the effective dose delivered to the lungs by a JN is substantially lower than the nominal dose.
A number of limitations should be acknowledged when interpreting these findings. Many of the included studies were single centre crossover designs with relatively small sample sizes, which may limit generalisability. Several studies also relied on surrogate markers of drug delivery, such as urinary salbutamol excretion or filter deposition, rather than direct clinical endpoints. In addition, three of the included studies originated from the same research group, raising the likelihood of potential bias, despite consistency in their findings.

In adults presenting with an exacerbation of COPD, oxygen driven jet nebulisers do not reliably deliver an effective pulmonary dose equivalent to 5 mg of salbutamol within a 6-minute treatment window. Evidence demonstrates substantial drug loss and low lung deposition, even when nebulisation is continued to completion. As prehospital practice limits oxygen driven nebulisation to 6 minutes, the effective dose delivered to the lungs is likely to be lower still.

Level 1: Recent well-done systematic review was considered or a study of high quality is available

1. Zhouzhou Feng, Zhengcai Han, Yaqin Wang, Hong Guo and Jian Liu. Comparison of the Application of Vibrating Mesh Nebulizer and Jet Nebulizer in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis.
2. Muhammad H.E. ElHansy, Marina E. Boules, Assem Fouad Mohamed El Essawy, Mohamed Bakry Al-Kholy, Maha M. Abdelrahman, Amira S.A. Said, Raghda R.S. Hussein and Mohamed E. Abdelrahim. Inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during invasive mechanical ventilation.
3. Yasmin M. Madney, Maha Fathy, Ahmed A. Elberry, Hoda Rabea, Mohamed E.A. Abdelrahim. Aerosol Delivery Through an Adult High-Flow Nasal Cannula Circuit Using Low-Flow Oxygen.
4. Ahmed Hassan, Randa Salah Eldin, Maha M. Abdelrahman and Mohamed E. Abdelrahim. In-vitro/in-vivo comparison of inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during non-invasive ventilation.
5. Valdecir Castor Galindo-Filho, Luciana Alcoforado, Catarina Rattes, Dulciane Nunes Paiva, Simone Cristina Soares Brandão, James B. Fink, Armèle Dornelas de Andrade. A mesh nebulizer is more effective than jet nebulizer to nebulize bronchodilators during non-invasive ventilation of subjects with COPD: A randomized controlled trial with radiolabeled aerosols.
6. Sergey N. Avdeev, Galia S. Nuralieva, Aung Kyaw Soe, Viliya V. Gainitdinova and James B. Fink. Comparison of Vibrating Mesh and Jet Nebulizers During Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.