ABSTRACT
This chapter discusses the history, types, advantages, features, performance, opportunities for, and future development of nebulisation technology used for the delivery of therapeutic aerosols to the lungs. The principles of operation of the main types (jet, ultrasonic, and mesh) and sub-types (constant output, open vent, breath-enhanced, breath-activated, passive, and active) of nebulisers are explained. The advantages of the different types in terms of: aerosol delivery into tidal breathing, portability, residual drug, efficiency, speed, and ability to nebulise different drug formulations are described. Features such as breath activation, feedback, automatic end of treatment detection, dose control, electronic monitoring of adherence to prescribed regimen, and compliance to correct use/technique are discussed. Faster, quieter, more efficient mesh nebulisers with the option of built-in e-health capability are also changing the drug development paradigm, with nebulisation chosen increasingly for commercialisation of new drug entities. Future aerosol generation technologies (disposable mesh, multi-layer mesh, flat plate, and acoustic wave) that offer increased convenience, output rates, broader liquid viscosity ranges, and less cleaning and maintenance will be supplemented with connectivity and physiological parameter monitoring to provide self-management and disease management benefits to patients and clinicians. These developments explain the recent resurgence and popularity of nebulised therapy for inhaled medication delivery.
