Conference Proceedings
December 2002 / Volume 47 / Number 12 / Page 1459
The Future of Nebulization
IntroductionCurrently available nebulizers are inefficient, bulky, noisy, and take longer to use than other inhalation devices. Use of nebulizers is increasingly confined to patients who cannot use other devices or who require therapies not available in another form. In the future, nebulizers will be smaller and more efficient. "Smart" nebulizers that can monitor patient use and provide feedback to the patient and the caregiver will be developed. Critical study will be needed to determine whether these innovations improve patient compliance with therapy. Nebulizers will also be refined for delivering complex molecules for both pulmonary and systemic disease. One example is in the use of gene therapy, in which issues such as the best gene vector are unresolved. Nebulizing these complex molecules without damaging them may be difficult, and nebulizers of the future will have to be more efficient to avoid wasting expensive drugs. For the delivery of widely used, less expensive medications, such as some bronchodilators, these innovations will not be cost-effective, so cheaper, less efficient nebulizers will continue to be used.
Compliance and Adherence
Size
Appearance
Fashion
Noise
Power Source
Administration Time
End of Treatment/Dose-Remaining Indicators
Interaction with Patient/Patient and Physician Feedback
Multiple Doses
Effectiveness
The Future
Using Complex or Expensive Drugs to Treat Lung Disease
Persistent Pulmonary Hypertension of the Newborn
Delivery of Drugs for Gene Therapy
Gene Therapy in the Treatment of PPHN
Oligonucleotides and Inhalation
Summary
Introduction
Looking into the future is an attractive pastime for a number of reasons: you can champion causes that are dear to your heart; other people cannot contradict you, at least not in the present; and, as long as you predict far enough into the future, you are unlikely to be around to hear the opprobrium of your successors that the predictions were wrong. However, prediction is also a difficult pastime, with many potential outcomes and areas to be covered. In this review I will concentrate on a small number of clinical situations to illustrate some areas in which nebulizer therapy may be developed.
Our path to the future is influenced by our starting point in the past and by how we have traveled to get to our present. Inhalational therapy has a long history, with vapors and smokes being used in the treatment of respiratory disease and other ailments more than 4,000 years ago. In the modern era, Sir Alexander Crichton described the use of the vapors of boiling tar in the treatment of tuberculosis, a practice continued in Berlin in the first half of the nineteenth century. In 1859 a portable device was marketed in France that generated an aerosol of liquid tar for medicinal use. Many types of nebulizer have since been developed, but the commonest type in use today remains similar in principle to the Collinson nebulizer, a jet nebulizer constructed of ebonite with a plate baffle to filter out large drug particles. Until recently, improvements in nebulizer therapy have been made by modifications of that type of device.
Other reviews in this and the previous issue of RESPIRATORY CARE have documented the characteristics of the main nebulizer types and described various approaches to improve the efficiency of the jet nebulizer, as well as new approaches to nebulization that are being developed. This review will use examples from clinical practice to speculate on how nebulizers may be used in the future, to address 3 issues:
- Patient compliance with inhaled medication therapy
- Using complex or expensive drugs to treat lung disease
- Delivering complex molecules for gene therapy
