Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
Discuss whether a change in controller medication or decrease in the dose or strength of the inhalant would be an option. Some health experts have reported a reduction in hoarseness after backing down the dose, but this is not always effective. There is a particular inhaled steroid which is inactive until it reaches the surface of the lung (after inhalation). It seems to be an ideal inhalant for people who have adverse effects which are localized to the throat or tongue. The brand name of this unique inhaled steroid is Alvesco. It is only available by prescription. Unfortunately no currently available steroid based inhaler, (including Alvesco) eliminates the risk of dysphonia. One study referenced below suggested reduced risk with some dry powder inhalers.
Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine , selegiline , guanethidine, and ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants ( desipramine , amitriptyline , doxepin , and imipramine ) may block the effect of ephedrine. The carbonic anhydrase inhibitors acetazolamide and dichlorphenamide may increase ephedrine blood levels and the risk of side effects from ephedrine. Patients taking any medications should consult with their physician or pharmacist before starting OTC ephedrine.