Our understanding of albuterol nebulization driven by helium-oxygen mixture (heliox) has matured with recent advances in clinical therapy, delivery systems, and understanding of dosing; this has led to substantial improvements in delivery as well as refinements of research protocols for asthma exacerbations. This review begins with heliox inhalation therapy and then addresses heliox as a driving gas for nebulization. Technical considerations are reviewed, including optimal gas mixtures, flow-rate adjustment factors, and nebulizer setup.