Nebulised Therapy

What nebulised therapy is for

Nebulised therapy has three main jobs in cardiorespiratory care:¹

• Airway hydration and mucus clearance — saline and hypertonic saline draw water into the airways and thin sticky mucus, making your airway clearance more productive.
• Opening the airways — nebulised relievers (bronchodilators) can be used before clearance or during a flare-up.
• Treating or suppressing infection — some people with chronic conditions such as bronchiectasis or cystic fibrosis use nebulised antibiotics long-term.

Medicines commonly nebulised at home

Only nebulise medicines that have been specifically prescribed for nebulising. Never put a medicine into a nebuliser unless your prescriber has told you to.²

Is there a difference between ordinary and hypertonic saline?

Most people have met isotonic saline — 0.9% sodium chloride. Its salt content is about the same as that already found in your cells and body fluids, so inhaling it mainly moistens the airways.

Hypertonic saline has a higher salt content than isotonic saline. That higher concentration draws water out of the airway wall and into the mucus itself, which thins and loosens it — helping to clear the lungs when mucus has built up.¹

MucoClear® 3% versus 6% — what is the difference?

Both strengths are sterile salt-water solutions that draw water into the airway surface to hydrate and loosen thick mucus so it is easier to clear; the only difference is the salt concentration. MucoClear® 3% is the gentler, lower-concentration option — it tends to cause less coughing, throat irritation and chest tightness, so it is often the starting strength, the choice for people who are more sensitive or reactive, and the usual step when 6% is not tolerated. MucoClear® 6% is more concentrated, so it pulls more water into the airways and is generally the more effective mucus-thinner — but it is more likely to trigger coughing or a feeling of tightness, particularly in people with twitchy airways.³

Because the stronger solution can provoke bronchospasm (a sudden tightening of the airways), a reliever (bronchodilator) is usually taken first, and your physiotherapist may trial 6% under supervision before you use it at home. Which strength suits you is decided individually, based on how thick your secretions are, how well you tolerate it, and your response over time — so always use the strength you have been prescribed.

Where it fits in your day

When you use several therapies, order matters. A typical sequence is:⁴

Nebulised therapy usually sits within a set morning and evening routine alongside your reliever, airway clearance and inhalers. See your plan for managing your condition for the full daily sequence.

Using a nebuliser safely

• Wash and dry your hands, and use a clean, dry medication cup each time.
• Sit upright and relaxed; breathe normally with an occasional slow, deep breath. A session usually takes about 5–10 minutes, until the misting stops or sputters.
• Rinse your mouth after steroid or antibiotic medicines.
• Hygiene is essential — a dirty nebuliser can grow bacteria and cause a chest infection. Rinse and dry all medication parts after every use, and clean thoroughly as the manufacturer directs.

References & evidence base

1. Elkins MR, Bye PTP. Mechanisms and applications of hypertonic saline. J R Soc Med 2011;104(Suppl 1):S2–S5.
2. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2026.
3. Wark P, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev 2018;(9):CD001506.
4. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1–69.

References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use. For drug-specific detail, including full product information, consult MedsInfo.