Recent Recommendation For Nasal
Monika V. Pawar
M.Pharm – I
Guided by : Dr.Indira Parab.
Nebulization is means of administering drugs by inhalation.
Liquid Nebulisation is a common method of medical aerosol
A nebuliser is a device that converts liquid into aerosol droplets
(fine mist) suitable for inhalation.
Nebulisers use oxygen, compressed air or ultrasonic power to
break up medication solutions and deliver a therapeutic dose
of Aerosol particles directly to the lungs.
Indications of Nebulization
Delivery of bronchodilator drugs :
On acute attack of asthma Nebulization is the most common
means of delivery.
Administration of antibiotics and anti antifungal agents:
In some cases of resistant chest infections for eg.cystic fibrosis
antibiotics may be prescribed to be inhaled directly into the lung.
To aid expectoration :
Inhalation of hypertonic saline has been found to increase
clearance of bronchial secretions.
To relieve dyspnea in patients such as those suffering from
alveolar carcinoma. 3
In some cases, nebulization is restricted or avoided due to
possible untoward results or rather decreased effectiveness
Patients with unstable and increased blood pressure
Individuals with cardiac irritability (may result to
Persons with increased pulses
Unconscious patients (inhalation may be done via mask but the
therapeutic effect may be significantly low)
1858- First Pressurised inhaler ,invented in France by Sales
Girons,it used pressure to atomize the liquid medication.
1864-First steam driven nebulizer,invented in Germany known
as “Siegles steam spray inhaler”,it used the venturi principle to
atomize liquid medication.
1930-First electric nebulizer called a Pneumostat,it used a
medical fluid was made to aerosol by the power from an
1956- A technology competing against nebulizer launched by
Riker Laboratory it used pressurised metered dose inhalers.
1964- New type of electronic nebulizer was introduced called
the ultrasonic wave nebulizer.
A minimum residual volume(< 0.5 ml)
Aerosol delivered only during inhalation.
No waste aerosol released to the environment.
Small and portable.
Aerosol delivered with a droplet size distribution suitable for
Rapid treatment time,quite and unobtrusive in use.
Finally,perhaps also a means to monitor patient compliance.
1. Large and bulky 1.Smaller in size
2.Plain on the ouside (white
2.Does not look like a machine
(Design /Patterned exterior)
3.Long cords in the way. 3.Rectangular tubing
4.Large face mask and tube 4.Redesigned mouthpiece that
mixes medicine instead of
5.Noisy 5.Less noise
6.Runs on battery
7. Shut off machine by itself
Mass median aerodynamic diameter
≤ 1μm : Reach up to the alveoli,
0.5-5μm: Beyond the 10th generation
of bronchi (respirable particles),
≥ 5 μm : oropharynx
Solution or suspensions can be nebulized by ultrasonics or an air
jet and administered via a mouthpiece, ventilation mask or
Types of nebulizers :
Ultrasonic wave nebulizer
Vibrating mesh Nebulizers
Siegle Steam Spray Nebulizer
A spirit burner in the base boils water in the reservoir which
passes across the top of a tube suspended in the medication
The passage of the steam draws the medication into the
The patient inhales the vapour
through the glass mouthpiece.
Silbe Atomizer : A hand held nebulizer with a bulb syringe
that had to be squeezed
Colossol Nebulizer : A glass nebulizer with a rubber squeeze
This took a lot of time, coordination, and even muscle strength
to get an adequate amount of medicine to be aerosolized.
Air jet Nebulizer
• In air jet nebulizer compessed air is
forced through an orifice,an area of low
pressure is formed where the air jet exists.
• A liquid may be withdrawn from a
perpendicular nozzle (the Bernoulli effect)
to mix with the air jet to form droplets.
• A baffle within the nebulizer is often
used to facilitate the formation of the
• Carrier gas (oxygen) can be used to
generate the “air jet”.
• Jet nebulizers are the most commonly prescribed because they are
easy to use and inexpensive.
Less portable than inhalers
Delivery may take 5 to 10 mins or
Require power sources,
Traditional jet nebulizers are often
bulky and require an electrical source, which can be a problem in
PARI Breath-Enhanced Jet Nebulizers
Continuous gas flow to neb chamber combined with patients
Exhaled air does not mix with aerosol, amount of solution
wasted is minimized
High output ,short treatments. Cannot be used in ventilator
Higher dose than T-Neb or MDI
Not cost effective for short term
Multiple one –way valve reduce
Not readily adaptable to
Dishwasher safe, may be boiled
Cost effective for long -term
PARI LCPlus Jet Reusable Nebulizer
The only Reusable Nebulizer approved for use with TOBI.
Breath – enhanced delivery
Balance of fast treatment time and
optional treatment efficiency
PARI LC SPRINT Reusable Nebulizer
10-20% Faster treatment times than PARI LC PLUS.
Higher aerosol output.
Inspiratory valve cap cantbe lost.
Design prevent medication from spilling.
Easy view medication level indicator.
Robust ,flexible nozzle construction.
Medication cup self-drains when
Breath Actuated Nebulizer
Breath-actuated devices produce aerosol when the patient
inhales and do not when the patient exhales.
Because the drug is not constantly being aerosolized, delivery
is more efficient and less of the drug is wasted.
Bottom Load Aerosol Mask
• Does not directs aerosol towards
• Inefficient because of impaction
of aerosol onto bridge of mask
PARI Aerosol Mask
Adult and Pediatric Masks
Polyvinylchloride (PVC) soft Plastic
Efficient and effective
Directs aerosol to mouth
Prevent impaction of aerosol.
Minimizes eye and face deposition.
Elongated mass “snout” create a “reservoir” where the aerosol
velocity slows down and congregated before inhalation by the
patients which increases “respirable” dose.
Ultrasound waves are formed in an ultrasonic nebulizer
chamber by a ceramic piezoelectric crystal that vibrate when
These set up high-energy waves in the solution,within the
device chamber ,of a precise frequency that generates an
aerosol cloud at the solution surface.
Ultrasonic nebulisers (i.e. aerosonic nebulisers) are
characterised by fast nebulisation of medicine particles into
extra small size for enhanced absorption in the very depth of
the respiratory system, helping to increase the effects of
Ultrasonic nebulisers are fast and discreet with reduced noise
They can be used at home and during travel as many modern
ultrasonic nebulisers are not only mains powered, but also
battery powered for convenience.
Car adaptors are also used for nebulisation on the move or for
The only drawback is medication restrictions because heat is
transferred to the medication
Vibrating Mesh Nebulizer
In this technology a mesh/membrane with
1000-7000 laser drilled holes vibrates at the
top of the liquid reservoir, and thereby
pressures out a mist of very fine droplets
through the holes.
This technology is more efficient than having
a vibrating piezoelectric element at the bottom
of the liquid reservoir, and thereby shorter
treatment times are also achieved.
The high nebulization capacity (>0.25 ml/min)
device offers short inhalation time.
The old problems found with the ultrasonic wave
nebulizer, having too much liquid waste and undesired
heating of the medical liquid, have also been solved by
the new Vibrating Mesh nebulizers.
A partial list of available VMT nebulizers includes: Pari
eFlow, Respironics i-Neb,Omron,Beurer Nebulizer IH50,
and Aerogen Aeroneb.
PARI eFlow nebulizer
A high respirable fraction due to the precisely defined
High liquid output rate combine to produce a highly efficient
and fast administration of inhaled medications.
Portability, ease of handling and noiseless operation have a
positive effect on patient compliance,
Reduction of residual drug volumes left in the nebulizer,
creating possible cost savings when administering expensive
Aerosonic MicroMesh Nebulizer HL100 features :
Portable, pocket sized and easy to carry
Battery operated with low power consumption
One touch, simple to operate, noiseless and discreet
Can nebulise effectively for up to 10 seconds in all directions
(i.e. upside down or rotated to any angle)
Automatically shuts down at the end of
Beurer IH 50 Ultrasonic Nebulizer
Beurer IH50 ultrasonic nebulizer is effective and versatile and
can be used at home and during travel, when access to mains
power supply is not possible.
Low levels of noise generated by the Beurer IH 50 ultrasonic
nebulizer make it pleasant and discreet in use.
It is a perfect nebuliser for
adults as well as children.
Schill Mobil Aerosonic Nebulizer
Schill Mobil Aerosonic Nebulizer utilises innovative advanced
electronic technology to deliver effective and safe inhalation
therapy to adults and children.
It can be powered directly from the mains or by rechargeable
effective with optimum droplet size.
suitable for a broad spectrum of medicines
comfortable, simple, quick and quiet
light and mobile for use anywhere
DigiO2 Micro Nebulizer
Vibrating Mesh Technology
Creates mist-like droplets for better absorption and reduces
Light and easy to clean
USB Power Supply
Allows easy charging in cars or traveling
One Button Operation
Start and stop medicine delivery
with just one button
Unique Capsule Design
Stops automatically when
delivery is complete
New Generation Nebulizer
Advantages of the AERx System
• Small hand-held devices
• Very short administration time
(typically 1-2 breaths)
• Highly efficient, precise aerosol delivery
• Breath control to ensure reliable
drug delivery to lung
• Simple to use.
Nebulizer Solution Formulations
Nebulizers are designed primarily for use with aqueous
solution or suspension.
Drug suspension use primary particles in the range of 2-5
Nebulizer solutions are usually formulated in water, although
other cosolvent for eg. Glycerin, propylene glycol,and ethanol
may be used.
Nebulizer solution pH be greater than 5.0 to show that
bronchoconstriction is a function of hydrogen ion
Method of Administration
Nebulized aerosol is introduced to the patient by compressed
air from a device known as positive pressure ventilator.
A mouthpiece may be inserted in the mouth may be attached
tightly to the face.
A face tent fits more loosely around the patients
A tracheostomy mask may be fitted to the patients
tracheostomy tube directly and require T shaped adapter.
• Face masks should be avoided or sealed very tightly when
anticholinergic drugs are administered to patients with
• Face masks should ideally also be avoided for delivery of
nebulized corticosteroids, to prevent contact with the
surrounding facial skin and eyes.
Present induction pneumatic nebulizer designs fit into 5
1. Concentric:Concentric Nebulizers have a central capillary
with the liquid and an outer capillary with the gas.
2. Cross Flow: Gas flow at right angles to the Liquid flow;
3. Entrained: Gas and Liquid mixed in the system and emitted as
a combined flow.
4. Babington and V Groove: Liquid is spread over a surface to
decrease the surface tension, and passed over a gas orifice;
5. Parallel Path: Liquid is delivered beside a gas orifice and
induction pulls the liquid into the gas stream.
Enhanced parallel path nebulizers :
This allows the gas and liquid to interact in the center of the
gas flow where the gas flow speed is highest, producing a
better transfer of energy from the gas to the liquid, and
producing a finer droplet size.
List of Medication
Brand Name Generic Name Category
Proventil Albuterol Bronchodilator
Ventolin Albuterol Bronchodilator
Atrovent Ipratropium bromide Bronchodilator
DuoNeb Ipratropium and
Mucosil Acetyl Cysteine Mucolytics
Intal Cromolyn Sodium Anti-inflammatory
Nebulizers should be cleaned daily in regular usage and after each
use in intermittent use.
The mask, mouthpiece and chamber should be disconnected,
disassembled and washed in a warm detergent and water solution.
The components should be left to dry overnight.
Before reuse, the nebuliser should be run for a few seconds before
Disposable components such as the mouthpiece, mask, tubing and
nebulizer chamber should be changed every three to four months.
Compressors require annual servicing by manufacturer or local
Physicochemical Aspects and Efficiency of Albuterol
Nebulization: Comparison of Three Aerosol Types in an
In Vitro Pediatric Model
The following nebulizers were tested: Sidestream Disposable
jet nebulizer, Multisonic Infra Control ultrasonic nebulizer, and
the Aerogen Pro and Aerogen Solo vibrating mesh nebulizers.
Aerosol duration, temperature, and drug solution osmolality
were measured during nebulization.
Albuterol delivery was measured by a high-performance liquid
chromatography system with fluorometric detection.
The droplet size distribution was analyzed with a laser
The ultrasonic nebulizer was the fastest device based on the
duration of nebulization; the jet nebulizer was the slowest.
Solution temperature decreased during nebulization when the
jet nebulizer and vibrating mesh nebulizers were used, but it
increased with the ultrasonic nebulizer.
Osmolality was stable during nebulization with the vibrating
mesh nebulizers, but increased with the jet nebulizer and
ultrasonic nebulizer, indicating solvent evaporation.
Albuterol delivery was 1.6 and 2.3 times higher with the
ultrasonic nebulizer and vibrating mesh nebulizers devices,
respectively, than with the jet nebulizer.
Particle size was significantly higher with the ultrasonic
The in vitro model was effective for comparing nebulizer
types, demonstrating important differences between nebulizer
The new devices, both the ultrasonic nebulizers and vibrating
mesh nebulizers, delivered more aerosolized drug than
traditional jet nebulizers.
Different nebulizer/compressor combinations have markedly
different performance characteristics which could result in
different efficacy and safety profiles of the medications being
administered via these devices
Anthony J. Hickey,Pharmaceutical Inhalation
Aerosol Technology,Second edition,Vol 134,pp-280-291.
K.Nikandar,M.Sanders,The early evolution of nebulizers,pp: 1-7
Ruben D Restrepo,Effect of Face Mask Design on Inhaled Mass
of Nebulized Albuterol, Using a Pediatric Breathing
Evaluation and Design of
Mark Sanders,Inhalation therapy : an historical review,
Primary care Respiratory Journal(2007),pp: 71-81
LeBrun PP, de Beor AH A review of the technical aspects of
Pyung heum yeon, young min cho, and yong-nam
pak,development of an ultrasonic nebulizer using a domestic
humidifier,bull. Korean chem. Soc. 1999, vol. 20, pp:1-4
C.J. Harvey,m.J. O'doherty,comparison of jet and ultrasonic
nebulizer pulmonary aerosol deposition during mechanical
Siraj Shaikh,recent advances in pulmonary drug
delivery system,International journal of Applied
P.W. Barry,Drug output from nebulizers is dependent on the
method of measurement ,pp:1-4