Jet, Ultrasonic, and Mesh Nebulizers: An Evaluation of Nebulizers for Better Clinical Outcomes

Abstract

For over a century, nebulizers have been commonly used to deliver aerosolized medications in the treatment of patients with pulmonary diseases. They are the aerosol device of choice when patients can not coordinate inhalation and actuation needed for the use of the pressurized metered-dose inhalers (pMDIs) or are not able to provide the necessary inspiratory flow required by the dry powder inhaler (DPI) for effective aerosol drug delivery. Three types of nebulizers exist: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. The purpose of this paper is to explain the types of nebulizers available on the market and to evaluate their efficiencies in aerosol drug delivery while suggesting strategies for the optimal treatment of patients with pulmonary diseases. Keywords: Nebulizers, aerosols, inhalation therapyDelivery of aerosolized drugs was revolutionized in the 1950s with the development of nebulizers and pressurized metered-dose inhalers. Nebulizers transform liquid formulations and suspension into medical aerosol. In the past few years, there have been advances in the development of new nebulizers that hold the promise to improve aerosol drug delivery to patients with pulmonary diseases. Nebulizers are divided into three categories: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. While jet nebulizers are commonly used for the treatment of patients with pulmonary diseases, they are bulky and require a power source. Due to aerosolized droplets and solvent vapor that saturates the outgoing air, jet nebulizers cool the drug solution in the nebulizer and increase solute concentration in the residual volume. Although ultrasonic nebulizers are more efficient and compact than jet nebulizers, they can not be used to deliver proteins or suspensions. With the development of mesh nebulizers that use lower-frequency waves, heating issues that denature proteins during aerosol therapy are eliminated. Also, it has been shown that mesh nebulizers are suitable for delivery of suspensions, liposomes, and nucleic acids (1-5). Since there is a large number of nebulizers in each category that have been introduced to the market, the purpose of this paper is to explain the types of nebulizers available and to evaluate their efficiencies in aerosol drug delivery. In addition, strategies for optimal inhalation treatment of patients with pulmonary diseases will be investigated. JET NEBULIZERSTraditionally, jet nebulizers have been used for the treatment of pulmonary diseases. These nebulizers require 2 to 10 L/min of pressurized gas to draw medication up through a capillary tube from the nebulizer reservoir in order to generate a wide range of particle sizes that are blasted into one or more baffles, which take larger particles out of suspension and return them to the reservoir.Jet nebulizers are effective in delivering formulations that can not be delivered with pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). For instance, antibiotics, mucolytics, liposomal f...

Deposition pattern of aerosolized Legionella using an ex vivo human-porcine respiratory model

“…The main advantages of vibrating-mesh nebulizers include consistent aerosol generation efficiency, a high fine particle fraction reaching the peripheral lung and a low residual volume in the reservoir. In addition, inhaled fractions are more important with mesh nebulizers than with jet nebulizers and can provide higher drug doses to patients (Ari, 2014). To secure the experimenters and prevent them from inhaling Legionella during nebulization, the model was placed in a glove box (815-PGB "LA PETITE" GLOVE BOX, Fisher Scientific).…”

Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

“…Jet and mesh nebulizers are commonly used for aerosol drug delivery to children. Jet nebulizers (JN) are traditional nebulizers generating aerosols throughout the subject's respiratory cycle, wasting aerosol during expiration . There are several issues associated with JNs during aerosol therapy.…”

Current options in aerosolised drug therapy for children receiving respiratory support

“…Although inexpensive, jet nebulisers may increase the pressure delivered to the lungs, are relatively noisy and can inactivate proteins within the drug. Vibrating mesh nebulisers are now considered by many to be the nebuliser of choice for ventilator circuits because they do not significantly alter airway pressures, are quiet and generate smaller droplets . If it is not a single‐use mesh, it needs to be cleaned carefully in order to prolong the lifespan of the device, because it has a tendency to become clogged after prolonged use, particularly when using drugs in suspension .…”