Nebulizers – The preferable aerosol delivery device:

For more than one hundred years, nebulizers have been used to deliver aerosolized medications; especially after respiratory and pulmonary diseases spread around the world, the use of nebulizers has been further reinforced. Currently, nebulizers have become the aerosol device of the first choice in the two cases below:

• When patients are not able to coordinate between inhalation and actuation, especially when patients experience problems using pressurized metered-dose inhalers.
• When patients do not have the necessary inspiratory flow rate that can meet the requirement of a powder inhaler that is used to deliver aerosol medication.

Market forecast:

According to research, the global nebulizer market in 2022 was valued at more than 1.12 Billion dollars; and due to the rising prevalence of chronic respiratory disorders and diseases, the worldwide market is expected to reach more than 2 billion dollars before 2030, and grow at a rate of 7.6% during the forecast period. For example, early in 2018, WHO published a related report – in the world, more than 200 million people were diagnosed with asthma. And this has significantly driven the growth of the nebulizer market. However, the lack of awareness regarding nebulizers and the high costs associated with nebulizers still hinder the market growth of nebulizers to some extent.

Regional Market Analysis:

• North America:

In the global nebulizer market, North America accounts for the largest revenue share than other regions; besides the rising prevalence of chronic respiratory disorders and diseases, there are another 2 major conditions driving the market growth in this region – the significantly increasing demand of well-established healthcare facilities with advanced infrastructures, and the impact of rising urbanization on air quality; in particular, in North America, there is an extremely high rate of chronic obstructive pulmonary diseases.

• Asia Pacific:

And let’s talk about the region where the market growth rate increases most notably; research found the Asia Pacific region registers the most significant growth rate within the forecast period. In this region, the prevalence of respiratory conditions is also obviously rising, governments increase investments in healthcare product development, and more and more companies set foot in the medical device manufacturing industry; moreover, the region also has to deal with the long-term impact posed by the rapid population aging; and the growing elderly population with the focus on awareness of preventative health care is another factor driving the market growth.

• Europe:

By comparison, the Europe market is estimated to keep a relatively steady growth rate during the next years; the major factor driving the market growth in this region is the steadily growing investment – Europe never stops increasing investments for research and design of innovative respiratory devices. In the healthcare sector, the increasing demand for mesh nebulizers has something to do with the wide prevalence of COPD (chronic obstructive pulmonary disease).

Do you need portable nebulizers or tabletop nebulizers?

• Portable nebulizers:

Generally, a portable nebulizer usually means a small-sized and battery-operated nebulizer; this is convenient for customers who need to use nebulizers on the go. Although portable nebulizers are not as powerful as table-top nebulizer machines, for users who don’t have enough space or who need occasional treatments, this is a more practical option.

• Tabletop nebulizers:

Tabletop nebulizers are usually large and powerful units that are plugged into an outlet. More often than not, tabletop nebulizers are more effective than portable nebulizers; although tabletop nebulizers are much less convenient than portable nebulizers, they are still widely used by patients who need regular, multiple treatments in daily life.

 

Pros and cons of using nebulizers:

Cons: the biggest disadvantage of using nebulizers is that if nebulizers are used regularly, the cost can be expensive. Traditional nebulizers can be somewhat noisy. This can be disruptive for both caregivers and patients. Moreover, nebulizers require regular cleaning and maintenance to prevent the excess build-up of microorganisms and bacteria.

Pros: nebulizers are portable and simple to use; and they can be used on the majority of patients, regardless of the age group; in addition, various medications can be used in a nebulizer form, such as bronchodilators, pain medications, and anti-inflammatory drugs.

 

Common types of nebulizers:

According to the functional principle, nebulizers can generally be divided into three types: ultrasonic, membrane (mesh), and nozzle (compressor) nebulizers.

• The ultrasonic nebulizer uses a piezo vibrator that can continuously and rapidly generate high-frequency vibrations(2~3 million/sec), this type of mechanical wave belongs to ultrasonic waves; the waves are transmitted to the medication through the water tank; and during the process, water act as a cooling agent; such a strong vibration can generate columns of liquid medication; and a large amount of tiny particles are formed under the ultrasonic waves.

Features: ultrasonic nebulizers create the aerosol by using ultrasonic vibrations. This type is typically cheap and small in size. Ultrasonic nebulizers are not very effective; but for people who just need a single treatment instead of regular treatments, ultrasonic nebulizers are acceptable.

• The compressor nebulizer runs by a nozzle that generates compressed air. By this means, the medicine solution is atomized into tiny droplets under high air pressure.

Features: this type of nebulizer uses compressed gas to generate medicated mist – it delivers gas through a pressurized air stream, down a narrow channel or tube, and through a small opening to create a powerful jet. During the process, the air movement creates a vacuum that forces the liquid medication into a fine mist.

If you can think of a traditional nebulizer machine with a lot of tubes and parts, you are picturing a jet nebulizer. This type of nebulizer is the most commonly used and has been used for a long time in the past; compared with traditional metered dose inhalers, jet nebulizers were cost-effective for patients who need to receive inhalation treatment daily, aerosol waste was reduced greatly during the exhalation phase, and it was relatively easy to receive respiratory treatment for patients on the go. A jet nebulizer could be more suitable when a discreet treatment was needed. However, jet nebulizers are loud and cumbersome when in use, and there is still some inconvenience (and as nebulization technology advances rapidly, mesh nebulizers have come to the market as an innovation of nebulizer machines).

• Mesh nebulizers utilize a thin, vibrating membrane with a multitude of microscopic holes (A piezo element is also used to vibrate the mesh). The vibrating element pushes liquid medication through the fine holes. During this process, small aerosol droplets are generated.

Features: this type of nebulizer utilizes compressed air to generate the aerosol through a fine mesh; typically, compared with other types of nebulizer, the particle size of the generated aerosol droplets is small enough to meet the requirement for a wide range of pulmonary treatments; as we all know, to make the atomized droplets reach the deepest part of the lung, the particle size is required to be less than 5 um; although mesh nebulizers just have low volume, they are effective, and they are portable and light in weight; so they are preferred by people with chronic respiratory conditions, and are widely used for multiple treatments per day.

 

Frequently asked questions about nebulizer types:

1. Is a jet nebulizer the same as a compressor nebulizer?

The terms (jet nebulizers and compressor nebulizers) have been used interchangeably. Currently, jet nebulizers are the most common in the global market; in different regions, people may name them in different ways.

 

2. How to tell the difference between mesh nebulizers and ultrasonic nebulizers?

Some users confuse vibrating mesh nebulizers with ultrasonic nebulizers (vibrating mesh nebulizers are also known as ultrasonic mesh nebulizers). But there are significant differences between the two. Although ultrasonic nebulizers are also driven by a piezo-electric element, they utilize high-frequency ultrasonic waves to vaporize the liquid medicine; by contrast, as the liquid medicine passes through holes in the mesh of a vibrating mesh nebulizer, it generates medicated aerosol by resorting to the vibrating action; in other words, ultrasonic nebulizers just emit ultrasonic waves into the solution directly, then aerosol is only generated upon the surface of the liquid;

 

3. Do ultrasonic mesh nebulizers belong to ultrasonic or mesh nebulizers?

A mesh nebulizer makes full use of a piezo-electric element that acts as an ultrasonic transducer; on applications of electric current, such an element contract and expand rapidly; this can vibrate a precisely drilled mesh which is in contact with liquid medicine; during this process, an aerosol is generated. By contrast, ultrasonic nebulizers send ultrasonic waves into the solution directly, which causes aerosol to be generated at the surface of the liquid medicine. Confusion between ultrasonic nebulizers and mesh nebulizers is quite common; after all, both two types of nebulizers use ultrasonic technology; an example can make this point more clear: as we all know, ultrasonic nebulizers can not deliver suspension formulations like budesonide, such a perception of inability to deliver suspension formulations is often incorrectly assumed to the same for mesh nebulizers. In fact, mesh nebulizers can effectively deliver budesonide.

 

Pros and cons of mesh, ultrasonic, and compressor nebulizers:

• Pros and cons of Vibrating mesh nebulizers:

Pros: mesh nebulizers present many competitive advantages; typically, mesh nebulizers generate consistent aerosol particles that can reach deeper into the lungs; mesh nebulizers are more customizable – they allow for more custom adjustments to improve the delivery efficiency of a specific medicine. For example, the majority of respiratory patients may prefer mesh nebulizers over ultrasonic nebulizers and compressor nebulizers; after all, mesh nebulizers work fast and quietly; moreover, they are more portable and easy to use. In particular, mesh nebulizers have a self-contained power source.

Mesh nebulizers are suitable for individuals of all ages, especially for those young children who have difficulty using inhalers;  this type of nebulizer can be easily used without requiring much operation experience, even for Children. A mesh nebulizer is very efficient at delivering any type of liquid medication in the form of a fine mist. Mesh nebulizers can greatly reduce the time of performing a respiratory treatment. The majority of mesh nebulizers are light in weight, small, easy to clean, and easy to carry.

Compared with jet nebulizers, most mesh nebulizers work relatively quietly; by the way, a lot of mesh nebulizers also offer battery power options so that they can go on to work without an external source of power.

 

Cons: Although using mesh nebulizers is one of the most efficient nebulization methods, mesh nebulizers are not suitable for all types of medications (they are often applicable to common respiratory medications); in addition, compared with other 2 types of mesh nebulizers, a mesh nebulizer may fail relatively frequently if used for a long time. And it is necessary to point out another common drawback of mesh nebulizers: although mesh nebulizers are able to handle thick liquid medicines better than ultrasonic nebulizers; the mesh nebulizers may unexpectedly log when nebulizing viscous solutions, especially if they have not been maintained or cleaned properly; therefore, to prevent any clogging, you had better follow the instruction manual of a mesh nebulizer.

 

Ultrasonic nebulizers VS mesh nebulizers VS Jet nebulizers:

Although jet nebulizers are often preferred as a method of treating respiratory and pulmonary diseases, they are large in size, and they also require a power source to function. By contrast, ultrasonic nebulizers and jet nebulizers have a small volume container, they are small, and they are light and convenient to carry.

Compared with jet nebulizers, ultrasonic nebulizers have a lot of limitations; ultrasonic nebulizers are poor at delivering suspensions and proteins; and if suspension/protein drug formulations are used for treatment, jet nebulizers are preferable. Although mesh nebulizers can also be used to nebulize suspensions, there can be a significant decrease in performance in terms of inhaled mass and output rate during use.

 

 

Advantages of jet nebulizers:

• Jet nebulizers are insensitive to changes in osmolality. And compared with other types of nebulizers, jet nebulizers are also relatively insensitive to changes in surface/viscosity tension.
• Compared with ultrasonic and mesh nebulizers, jet nebulizers are relatively cheap.
• Almost all the jet nebulizers are applicable for general-purpose drugs, such as corticosteroids and short-acting β2

 

Disadvantages of jet nebulizers:

• Jet nebulizers are relatively bulky and heavy, they need to be connected to a compressor through a tube.
• When jet nebulizers are operating, they are noisy.
• With Jet nebulizers, the treatment time is typically long (6~15 min).
• Due to evaporation, the concentration of liquid medication can increase over time.
• Jet nebulizers need to have a large residual volume, otherwise they can not aerosolize; in other words, jet nebulizers can not function properly with small fill volumes.
• The nebulization performance is easily impacted by the tube and compressor that is paired with a jet nebulizer.
• There is relatively large variability in dose delivery.
• The task of cleaning and maintaining is relatively tedious; you have to carefully clean the nebulizer, air filter, and tube after usage.
• A source of compressed oxygen or air is required to run a jet nebulizer.
• Among the three types of nebulizers, jet nebulizers have the lowest efficiency.
• The liquid drug will be sucked by a jet of compressed air passing through the orifice. During the process, a polydispersed aerosol is produced, but only approximately 5% of the aerosol can be respirable, and the remainder of the drug is removed by impaction and sent back to the reservoir; such a multi-cycle generation process is inherently not efficient, and baffles are required to aid droplet breakup.
• Generally, after each use, it is required to rinse and boil wash. And jet nebulizers are typically replaced after 6 months (durable) and 30 days (disposable).

 

 

Advantages of mesh nebulizers:

• No need to use driving gas.
• Normally 100% of the aerosol generated by the mesh can be respirable.
• The aerosolized particles are more respirable and uniform.
• There are no baffles because the aerosol generates on the first pass.
• The required minimum fill volume is relatively low, 0.3~2ml is OK.
• Compared with jet nebulizers, the cleaning regime is not complicated; but typically, it is always necessary to rinse after use, wash, and boil weekly using distilled water. And the mesh needs to be replaced after half to one year.
• Mesh nebulizers are more efficient than jet nebulizers; with mesh nebulizers, drug waste can be minimized.
• Shorter medicine delivery time than Jet nebulizers.
• Mesh nebulizers are portable (mesh nebulizers feature small size, compact design, and lightweight); the majority of mesh nebulizers on the market are alsobattery-powered;

With mesh nebulizers, one set of batteries is enough to accomplish a lot of treatments; mesh nebulizers work faster than jet nebulizers; generally, due to their high output rate, the treatment can be done within 3 to 10 minutes. And the possible residual volume is also low – generally, it ranges from 0.1 to 1.25 ml;

• Mesh nebulizers work quietly; when they are working, the sound level is so low that patients rarely complain about the generated noise.
• Mesh nebulizers can generate aerosol stably.
• Vibrating mesh nebulizers provide greater lung deposition than jet nebulizers – the diameter of the generated particles is less than 5um, and tiny particles can easily penetrate to the deep part of a lung;
• Drug can be subjected to low shear as well as single pass through the mess, therefore the biological activity of macromolecules is retained to the largest degree.
• Mesh nebulizers are more customizable:

In terms of design; mesh nebulizers allow the inclusion of advanced medicine delivery features, like breath adherence/feedback/activated.

 

The size of the aerosol chamber, the reservoir, and the mesh pores can be adjusted according to the features of a specific drug formulation. As we all know, the requirement for the delivery speed of aerosol medications to patients can vary greatly; with mesh nebulizers, the output rate can be easily adjusted for a variety of drugs.

 

When used for aerosol delivery to ventilated patients, mesh nebulizers confer particular advantages; through mesh nebulizers, the aerosol is generated and introduced into the ventilation system without additional pressures and flows that can arise during the use of jet nebulizers. When combined with breath-activated systems like the pulmonary drug delivery system, mesh nebulizers allow aerosol generation that is synchronized with the ventilator, so the maximum delivery efficiency can be achieved; these features allow the mesh nebulizers to be easily adapted to various ventilator support circuits, enabling a mesh nebulizer can be inserted into an inhalation arm of volume ventilators; in noninvasive ventilation circuits and applications of continuous positive airway pressure, a mesh nebulizer is usually positioned after a ventilator’s leak port. Due to the flexibility of altering the position in a ventilator’s circuit, mesh nebulizers allow significant improvements in dose delivery for both neonatal patients and adult patients. Compared with pMDIs (pressurized meter-dosed inhalers), mesh nebulizers can delivery more types of medicine (e.g. mucolytics, prostaglandins, surfactants, and antibiotics) to ventilated patients.

 

Disadvantages of mesh nebulizers:

• Mesh nebulizers are not available for all kinds of drugs; although mesh nebulizers can also be used to nebulize suspensions, this easily leads to an inadequate cleaning regime, and thereby the performance may decline.
• Mesh nebulizers are relatively expensive.
• After each use, disassembly and cleaning are required.