In the 24 years since first being marketed, the mesh nebulizer has been developed by five main manufacturers into a viable solution for the delivery of high-value nebulized drugs. Mesh nebulizers provide increased portability, convenience and energy efficiency along with similar lung deposition and increased ease of use compared with jet nebulizers. An analysis of EU and US clinical trial databases has shown that mesh nebulizers are now preferred over jet nebulizers for clinical trials sponsored by pharmaceutical companies. The results show a strong preference for the use of mesh nebulizers in trials involving high cost and niche therapy areas. Built-in capability to optimize the way patients use their mesh nebulizer and manage their disease will further increase uptake. [Formula: see text]
Spacers and valved holding chambers (VHCs) are pressurized metered dose inhaler (pMDI) accessory devices, designed to overcome problems that patients commonly experience when administering aerosol via a pMDI. Spacers were developed in direct response to patient-related issues with pMDI technique, particularly, poor coordination between actuation and inhalation, and local side-effects arising from oropharyngeal deposition. Current clinical guidelines indicate the need for widespread prescription and use of spacers, but, despite their apparent ubiquity, the devices themselves are, unfortunately, all too commonly "disused" by patients. An understanding of the background from which spacers developed, and the key factors influencing the optimization of the spacer and the later VHC, is crucial to developing an appreciation of the potential of these devices, both contemporary and future, for improving the delivery of pressurized aerosols to patients. This review, informed by a full patent search and an extensive scientific literature review, takes into account the clinical and laboratory evidence, commercial developments, and the sometimes serendipitous details of scientific anecdotes to form a comprehensive perspective on the evolution of spacers, from their origins, in the early days of the pMDI, up to the present day.
Conventional aerosol delivery systems and the availability of new technologies have led to the development of ''intelligent'' nebulizers such as the I-neb Adaptive Aerosol Delivery (AAD) System. Based on the AAD technology, the I-neb AAD System has been designed to continuously adapt to changes in the patient's breathing pattern, and to pulse aerosol only during the inspiratory part of the breathing cycle. This eliminates waste of aerosol during exhalation, and creates a foundation for precise aerosol (dose) delivery. To facilitate the delivery of precise metered doses of aerosol to the patient, a unique metering chamber design has been developed. Through the vibrating mesh technology, the metering chamber design, and the AAD Disc function, the aerosol output rate and metered (delivered) dose can be tailored to the demands of the specific drug to be delivered. In the I-neb AAD System, aerosol delivery is guided through two algorithms, one for the Tidal Breathing Mode (TBM), and one for slow and deep inhalations, the Target Inhalation Mode (TIM). The aim of TIM is to reduce the treatment time by increasing the total inhalation time per minute, and to increase lung deposition by reducing impaction in the upper airways through slow and deep inhalations. A key feature of the AAD technology is the patient feedback mechanisms that are provided to guide the patient on delivery performance. These feedback signals, which include visual, audible, and tactile forms, are configured in a feedback cascade that leads to a high level of compliance with the use of the I-neb AAD System. The I-neb Insight and the Patient Logging System facilitate a further degree of sophistication to the feedback mechanisms, by providing information on long term adherence and compliance data. These can be assessed by patients and clinicians via a Webbased delivery of information in the form of customized graphical analyses.
C Co om mp pa ar ri is so on n o of f t tw we en nt ty y t th hr re ee e n ne eb bu ul li iz ze er r/ /c co om mp pr re es ss so or r c co om mb bi in na at ti io on ns s f fo or r d do om mi ic ci il li ia ar ry y u us se e The combinations were evaluated in terms of pressure-flow characteristics, aerosol mass distribution, volume output, electrical costs, and sound level. In addition, we determined the effect of nebulizer fill volume on aerosol mass distribution and volume output. One nebulizer was used with six different compressors, and four compressors were tested with three different nebulizers.The pressure-flow relationships showed a wide variation between models, as did flow-rate at the nebulizer (range 3.0-8.0 L·min -1 ). The mean±SD volume nebulized after 10 min using an initial fill volume of 2.5 and 5.0 mL was 46±9 and 34±12%, respectively. The mass median aerodynamic diameter (MMAD) over a 5 min nebulization ranged 2.6 to 10.2 µm. Nine of the nebulizations produced an MMAD of less than 5 µm at both fill volumes. Changing nebulizer/compressor combinations affected flow rate, MMAD and volume output. Sound levels varied between models. Running costs were low, with all using less than 74 kilowatt hours of energy per year.We conclude that there is a wide variation in performance of nebulizer/compressor combinations for use with nebulized bronchodilators. Correct matching of the nebulizer/compressor is seen to be important to ensure optimum performance. We recommend that: 1) manufacturers of nebulizers provide information on the required flow rate at the nebulizer to produce the required MMAD, and the percentage of aerosol/mass contained in particles under 5 µm; and 2) suppliers of nebulizer/compressor systems match the combinations more carefully to achieve optimal delivery of the nebulized drug to the patient, and that users should use recommended combinations.
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