Possible Problems



Nebulizer usage



How to Use a Nebulizer – And Other Pulmonary Solutions

One of the challenges of being a laryngectomee is how to do things like use a nebulizer, and inhaler, to promote better pulmonary health, and we often get questions about how to take a pulmonary function test (PFT). I recently had a PFT and in the process (with a little experimentation) learned a few things that might be helpful to some of you.
My primary concern was how to effectively use the nebulizer so let’s start with that.
At first I was given a pediatric mask to go over my stoma, which was hooked up to the nebulizer. While this worked there was also quite a bit of leakage around the edges so it was replaced with a trach mask. That was big improvement with less leakage but for the best results you need a direct, sealed shot into your stoma. Something like a face breather taking the medication directly into the mouth, but actually better since in our case the medication doesn’t have to travel through the mouth and throat before it reaches the trachea.

There are basically 3 ways to get a direct shot into the trachea although other variations may be possible.

1. A nebulizer can be connected directly to a lary button/tube like the Barton Mayo or the Atos Lary Button if you have a Hudson RCI, Multi-Adapter (H1422) as pictured in the illustration. You can purchase these at numerous places for about $2.50 with an internet search. I got mine at www.DirectHomeMedical.com. One end of the connector goes into the flex hose of the nebulizer kit, and the other plugs into the lary button/tube. (See Pictures below)


2. If you use an HME base plate then you can also plug the adapter into them just like above. In my case the base plate works a lot better because the connector sits deeper into it than with the lary button/tube. The base plate holds it more firmly whereas with the button or tube you have to hold it perfectly in place or it will slip out.

3. The third option, which I haven’t tried, is a special HME that has an oxygen port built into the side of it. In this case you don’t need the flex hose or the adapter. You use a trach mask set-up and plug the oxygen tube directly into the HME port. These special HMEs were available from Boston Medical. I can not find them on the site, so I am not sure they are still available.

Trach Mask Configuration



Base Plate/Stoma Button-Tube Configuration



This last picture is a Symbicort inhaler that is plugged into an extender, then the Hudson adapter is plugged into the extender, and then a baby bottle nipple with the tip cut off, is attached to the end. The nipple is then inserted into the stoma and you spray whatever medication you use into the extender. Some medica-tions work best when the spray has a chance to “mist” before it reaches the trachea, so the extender allows space for it to mist. The above set-up does a great job of this but it had to be modified a bit, and there are many types of extenders out there that this may not work with. So this is just something to help you visualize what may work in your case.

Finally, we get back to the elusive Pulmonary Function Test that many of you have been told can’t be done on a laryngectomee, or that the respiratory specialist doesn’t know how to do it. But rather than me trying to ex-plain it all I will refer you to a great video made by our own Bill Cross that shows you how to do it. So watch the video at https://www.youtube.com/watch?v=5KzuMLB6WrA, then order yourself a Hudson Adapter, get a base plate or stoma button, and educate your respiratory specialist if you ever need to do the test.


Jack Henslee




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