Abstract:
An improved nebulizer places a venturi in close proximity to or inside a patient&#39;s oral cavity. One or more medicine feed lines feeds the medicine to a location proximate to a venturi. A plurality of medicines may be administered simultaneously to the patient, with preferably each medicine vial being shape-keyed to a medicine receiver of corresponding shape. The medicine vial or vials may contain a standard unit dose of medication. A portable gas canister can be utilized to supply air pressure to the venturi when a press open release closed type valve is actuated.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
   This is a continuation-in-part of application Ser. No. 10/783,442, entitled, “Apparatus For Evaluating A Patient&#39;s Laryngeal Cough Reflex And Associated Methods”, filed Feb. 20, 2004 now abandoned, by W. Robert Addington and Stuart Miller. This application is hereby incorporated by reference into this specification in its entirety. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The invention is directed to nebulizers and, more particularly to an intra-oral nebulizer. 
   2. Description of the Prior Art 
   Inhalation is a very old method of drug delivery. In the twentieth century it became a mainstay of respiratory care and was known as aerosol therapy. Use of inhaled epinephrine for relief of asthma was reported as early as 1929, in England. Dry powder inhalers have been utilized to administer penicillin dust to treat respiratory infections. In 1956, the first metered dosed inhaler was approved for clinical use. 
   The scientific basis for aerosol therapy developed relatively late, following the 1974 Sugar Loaf conference on the scientific basis of respiratory therapy. 
   A more complete history of the development of aerosol therapy and the modern nebulizer is described in the 2004 Phillip Kitridge Memorial Lecture entitled, “The Inhalation of Drugs: Advantages and Problems by Joseph L. Row; printed in the March 2005 issue of Respiratory Care, vol. 50, no. 3. 
   The typically used modern nebulizer is delivered as a kit of seven plastic pieces which are assembled prior to use to provide for delivery of the medication to a patient via inhalation. An exploded view of the seven pieces showing their relationship for assembly is given in  FIG. 1 . There is a mouthpiece  100  that is force fit onto one end of a T connector  110 . Similarly, the other end of the T connector  110  is attached to a flex tube  120 , also by force fit. The parts are such that the components can be assembled and disassembled with a simple twisting action. Nevertheless, when engaged and pressed together, the pieces form a substantially airtight seal. The bottom part of the T connector  110  is connected to a cup cover  130 . That, too, is connected by pushing the cup cover onto the bottom part of the T connector in such a way that the airtight seal is formed. The cup cover  130  has a screen  135  that screens the material going into the T connector. There is a cup  150  for receiving the medicine to be nebulized. The cup also has a venturi projecting through the bottom. 
   In a typical use, a vial containing the medication for administration through the nebulizer is opened and poured into the cup  150  where it accumulates at the edges of the rounded bottom of the cup. The venturi is surrounded by a conical plastic piece through which it passes. The shape of the conical piece of the medicine cup  150  matches substantially the shape of the venturi cover  140 . Once the medicine is poured into the cup, the venturi cover  140  is placed over the venturi and the filled medicine cup is screwed, using threaded portions on each piece, onto the cup cover  130 . In this way, the medicine is held in place ready for administration. 
   In use, the bottom of the airline feeding the venturi in the medicine cup is attached to an air hose  160 , to which is applied to a source of air pressure thus activating airflow through the venturi. By venturi action, the exhaust of the air flow through the small opening of the venturi results in a reduction in pressure on the downstream side of the airflow so that the medicine from the medicine cup is fed under positive pressure up in the interstices between the conical shape of the medicine cup and the venturi cover and is exhausted then through the screen  135  into the bottom of the T connector  110 . 
   A patient is asked to inhale the aerosol mist provided through the cup cover screen into the airflow channel between the mouthpiece  100  and the flex tube  120 . As a patient takes the mouthpiece  100  in their mouth, and inhales, air flows through the open end of the flex tube  120 , through the T connector  110 , picking up the aerosol medication and into the patients&#39; air passages through the mouthpiece  100 . 
   PROBLEMS OF THE PRIOR ART 
   Table 8 of the Respiratory Care article, referred to above, page 381, lists the characteristics of an ideal aerosol inhaler as follows: 
   
     
       
             
           
         
             
               TABLE 8 
             
             
                 
             
           
           
             
               Dose reliability and reproducibility 
             
             
               High lung-deposition efficiency (target lung deposition of 100% of 
             
             
               nominal dose) 
             
             
               Production of the fine particles ≦5 μm diameter, with correspondingly 
             
             
               low mass median diameter 
             
             
               Simple to use and handle 
             
             
               Short treatment time 
             
             
               Small size and easy to carry 
             
             
               Multiple-dose capability 
             
             
               Resistance to bacterial contamination 
             
             
               Durable 
             
             
               Cost-effective 
             
             
               No drug released to ambient-air 
             
             
               Efficient (small particle size, high lung deposition) for the specific 
             
             
               drug being aerosolized 
             
             
               Liked by patients and health care personnel 
             
             
                 
             
           
        
       
     
   
   The standard nebulizer shown in  FIG. 1 , fails to achieve a number of these characteristics. Specifically, the nebulizer of  FIG. 1  wastes medication during exhalation. Further, the particle size is often too large to reach the bottom of the lungs where the medication may be most needed. There is difficulty in estimating the dose of the drug being given to a patient and there is difficulty in reproducing that dose. There is a possibility of contamination when opening the initially sterile kit, poring medication into the cup, and assembling the pieces for use by a patient. There is also considerable inefficiency in the medication delivery, with much of it being deposited in the throat, rather than in the lungs. 
   BRIEF DESCRIPTION OF THE INVENTION 
   The invention is directed to an intra-oral or near intra-oral nebulizer that overcomes the problems of the prior art. 
   This is achieved in one embodiment by placing the venturi that creates the atomized medication preferably inside the mouth of the patient. Close proximity to the lips of a patient is also an alternative. 
   The invention will be described in more detail with reference to the following drawings. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
       FIG. 1  is an exploded view of a nebulizer kit of the prior art. 
       FIG. 2  is a perspective view of an improved nebulizer in accordance with one aspect of the invention. 
       FIG. 3  is a sectional view of the nebulizer of  FIG. 2 , cut along the centerline of the longitudinal axis. 
       FIG. 4  is a sectional view of the nebulizer of  FIG. 2  showing a cut along the transverse axis at the air line. 
       FIG. 5  is an exploded view of the nebulizer of  FIG. 2  in accordance with one aspect of the invention. 
       FIG. 6  is an assembled view of the nebulizer of  FIG. 2  with a medicine vial in place for use. 
       FIG. 7  is a perspective view of a portion of the nebulizer shown in  FIG. 2 , showing an air line connection. 
       FIG. 8  is an embodiment of a nebulizer that has a pressurized gas canister connected to selectively activate the venturi of the nebulizer. 
       FIG. 9  is a view of the nebulizer of  FIG. 8 , showing insertion of another type of medicine dispenser. 
       FIG. 10  is a perspective view of the open end of the fluid/air channel section of the nebulizer which interfaces with a fluid combiner and nozzle section and the distal diffuser end piece. 
       FIG. 11  shows a detailed side sectional view of the venturi, the mixing chamber and a diffuser. 
       FIG. 12  shows a detailed perspective view of the venturi, mixing chamber and diffuser shown in  FIG. 11 . 
       FIG. 13  shows one form of fluid feed from the medicine reservoir to the venturi and mixing chamber. 
       FIG. 14  shows an alternative form of fluid feed from the medicine reservoir to the mixing chamber. 
       FIG. 15  shows an improved nebulizer in accordance with one aspect of the invention which utilizes four shape-keyed medicine sources with individual medicine feeds to the venturi and mixing chamber. 
       FIG. 16  shows an exemplary fluid/air channel section of the nebulizer of  FIG. 15 . 
   

   DETAILED DESCRIPTION OF THE INVENTION 
     FIG. 2  is a perspective view of an improved nebulizer in accordance with one aspect of the invention. The nebulizer comprises a main body  200  which has a medicine receiver  210 . Extending from the main body is a fluid air channel section  230 . The fluid combiner and nozzle section  240  then mates the fluid air channel section  230  with the diffuser  250  as described more hereinafter. A rubber mouthpiece  260 , the position of which can be adjusted, surrounds the nebulizer. The medicine receiver  210  is shaped to correspond to the shape of a medication vial or other medication container which, in this embodiment, can be punctured using the medicine puncture tubes  220  which are hollow and which permit the medication then to reach the venturi, discussed more hereinafter, utilizing, in most embodiments, a gravity feed, possibly supplemented with the venturi pressure differential. 
     FIG. 3  is a sectional view of the nebulizer of  FIG. 2 , cut along the centerline of the longitudinal axis. Here one can see the path of the air from the air line  300  as it goes toward venturi  310 . The medicine puncture tube  220  communicates with the medicine feed line  320  allowing the medication to flow from the medication reservoir into the medicine feed line into the mixing chamber  330  where it can be atomized by action of the venturi  310 . 
     FIG. 4  is a sectional view of the nebulizer of  FIG. 2  showing a cut along the transverse axis at the air line. This view shows the upper half of the nebulizer of  FIG. 2  and again shows the air line  300  as it traverses the length of the nebulizer up to the venturi. 
     FIG. 5  is an exploded view of the nebulizer of  FIG. 2  in accordance with one aspect of the invention. The nebulizer, as discussed previously, comprises a main body  200 . On the main body is a medicine receiver  210  which is shaped to allow the medicine cartridge  500  to fit into the receiver. As the medicine cartridge  500  is inserted in the receiver, the medicine puncture tubes  220  in the medicine receiver  210  will puncture the medicine cartridge  500  allowing the medication to flow into the nebulizer for atomization in the mixing chamber, discussed hereinafter. The medicine puncture tubes  220  can either be a portion of a  22  gauge hollow needle which is press fit into the main body or plastic cast into the main body  200 . The far end of the needle communicates with a medicine feed line discussed hereinafter. On either side of the main body  200  are one way reed valves  270 , or openings which communicate with air passages in the fluid air channel section  230  to allow inhalation and exhalation by the patient. A fluid air channel section  230  communicates with the main body in such a way as to align with the air passages feeding the inlet and exhaust to openings or one-way reed valves  270 . In addition, the fluid air channel section  230  communicates with the air line which is feeding the air to the venturi and with the medicine feed line or lines which bring medicine from the medicine cartridge or reservoir  500 . The fluid combiner and nozzle section  240 , interfaces between the fluid air channel section  230  in the diffuser  250  as described more in detail hereinafter. 
     FIG. 6  is an assembled view of a nebulizer of  FIG. 2  with the medicine vial in place for use. 
     FIG. 7  is a perspective view of a portion of the nebulizer shown in  FIG. 2 , showing an air line connection. 
     FIG. 8  is an embodiment of a nebulizer that has a pressurized gas canister connected to selectively activate the venturi of the nebulizer. Replacing an air line, which requires connection to a fixed source of air pressure, such as an oxygen tank or an air tank, is a gas canister  800  which is totally portable. The gas canister connects to the main body of the nebulizer, preferably with a screw on type connection. The passage from the exhaust of the gas canister to the venturi is through a press on release off type of valve which can be selectively activated, using the valve actuator  810  to provide the appropriate level of gas pressure to the venturi for mixing with the medication coming in from medication reservoir  500 . In this particular embodiment the air inlet exhaust valves for inhalation and exhalation by the patient, instead of being positioned on each side of the nebulizer, are positioned on the top of the fluid air channel section  230 . 
     FIG. 9  is a view of the nebulizer of  FIG. 8  showing insertion of another type of medicine container. In this case, the medicine container is shaped to be received by the medicine receiver, previously discussed, in the form of a small button, approximately the size of an antacid tablet, which contains an individual dose of the medication to be utilized. This permits a user to carry with him or her a number of such individual dose containers, optionally packed in a roll, which can be placed into the medicine receiver  210  to dispense the unit dose of medication for the particular patient utilizing the nebulizer. With the medicine in place, a patient can place the distal end of the nebulizer in his mouth, sealing his lips around the rubber mouthpiece  260  and synchronize inhalation with the activation of the valve actuator  810  which then activates the flow of gas from the pressurized gas container  800  through the venturi and the mixing chamber where the medicine from the medicine container is atomized by the action of the venturi and the diffuser plate as described more hereinafter. 
     FIG. 10  is a perspective view of the open end of the fluid/air channel section of the nebulizer which interfaces with a fluid combiner and nozzle section and the distal diffuser end piece. As one can see in  FIG. 10 , the venturi  310  protrudes slightly beyond the end of the main body  200  into a mixing chamber to be shown hereinafter. Proximal to the venturi  310  is a medicine feed line  320 . 
     FIG. 11  shows a detailed side sectional view of the venturi, the mixing chamber and a diffuser. The venturi  310  extends into the mixing chamber  1100 . The flow of air from the venturi is applied to a spherical diffuser element causing the medication entering the mixing chamber as shown hereinafter to be atomized by the action of the venturi flow. 
     FIG. 12  shows a detailed perspective view of the venturi, mixing chamber and diffuser shown in  FIG. 11 . In this sectional view, one can see a plurality of tiny apertures  1200   i  through which droplets atomized in the mixing chamber by action of the venturi can pass, ensuring some maximum size of the droplets into the area through which the patient inhales and exhales. Since this is a cross section view, only one air passage  1210  is shown. However, there is a corresponding airflow aperture located symmetrically about the cut line. The one-way valves  270  are constructed so that the patient can inhale and exhale through one of the appropriate air passages  1210 . 
     FIG. 13  shows one form of fluid feed from the medicine reservoir to the venturi and mixing chamber. In this particular embodiment, the medicine from the medicine feed line, which in this embodiment runs parallel to the air line feeding the venturi, ends at the fluid combiner and nozzle section  240 . That piece fits over the nozzle, but is designed to allow flow of medication from the medicine feed line down into the proximity of the end of the venturi, exhausting in close proximity to the exhaust point of the venturi itself. The venturi action is such that the high speed flow of the air as it exits the venturi tip results in a considerably decreased pressure vis a vis the surrounding air pressure, which allows a partial vacuum to form which causes the medicine from the medicine feed line to enter into the mixing chamber by virtue of not only gravity feed, but of the pressure differential which results from the venturi action. The turbulence of the venturi feed interacting with the diffuser in close proximity with the medicine fed from the medicine feed line, results in atomization of the medicine in the mixing chamber. 
     FIG. 14  shows an alternative form of fluid feed from the medicine reservoir to the mixing chamber. In this case, the medicine feed line enters the mixing chamber at a distance somewhat removed from the tip of the venturi. Nevertheless, the action of the venturi and the fuser in the mixing chamber is sufficient to atomize the medication for delivery to the patient. 
     FIG. 15  shows an improved nebulizer in accordance with one aspect of the invention which uses four shape-keyed medicine sources with individual medicine feeds to the venturi and mixing chamber. It is highly desirable to avoid a situation in which a patient might be given the incorrect medication. To insure the correct medicine is fed to the patient, each of the medicine containers or reservoirs are shaped having a unique shape that is specific for the medication to be administered. This provides a ready mechanism by which medical personal can visually confirm the correct medication being given to the patient. Each medication would be keyed to a particular shape and the shapes would become readily recognizable to medical personal resulting in fewer errors in administration. 
   It is also the case, that sometimes a plurality of medications would be administered simultaneously. In the case shown in  FIG. 15 , up to four medications can be administered simultaneously to a patient in the appropriate dosages. As noted above, each medicine container or reservoir can be configured to contain a unit dose of medication, each shaped according to its unique shape. As a result, the correct dosage can be applied to the patient and the dosage is reproducible. Three of the four medication feed lines are shown in  FIG. 15 , the fourth one not being visible by virtue of the manner of the depiction obscuring the fourth medicine feed line. 
     FIG. 16  shows an exemplary fluid air channel section of the nebulizer of  FIG. 15 . In the view shown in  FIG. 16 , there are four medicine feed lines, one from each of the key-shaped medicine receivers. There are also two larger ports which handle the inlet and exhaust from the patients breathing. In the version shown, the inlet and exhaust passages, the larger holes, feed respective inlet and output ports located behind the rubber mouthpiece shown in  FIG. 16 . The location of the inlet and outlet exhaust ports can be relocated as convenient without doing violence to the functioning of the nebulizer. For example, it is in some embodiments preferred to have the medicine feed lines located closer to the center line of the longitudinal axis of the nebulizer and have the air inlet/exhaust ports be located on either side of the four medicine feed lines. The latter configuration would be more appropriate where the air inlet/exhaust valves  217  are located on the side of the nebulizer, as shown, for example in  FIG. 5 , whereas the configuration shown in  FIG. 16  might be preferable when the air inlet/exhaust ports are shown on the top of the fluid air channel section  230  as shown in  FIG. 8 . 
   Returning again to Table 8 of the Respiratory Care article, discussed above, one can see that the invention has many of the characteristics of an ideal aerosol inhaler system as described there. 
   Dose reliability and reproducibility is enhanced by using unit dose medicine containers. High lung-deposition efficiency is vastly improved over the prior art because the venturi is located near or preferably inside the oral cavity. Very fine particles can be produced in accordance with the invention. The simplicity of use is enhanced by the use of a portable pressurized gas container and value actuation mechanism. The short treatment time is enhanced because the assembly of a seven-piece kit is not required. All that is required is that the medication be inserted into the medicine receiver and the actuator valve for the pressurized gas container is activated to deliver the medication. The nebulizer in accordance with the invention is a smaller size and easier to carry than the seven piece kit. The nebulizer of the invention has multiple dose capabilities, depending on the size of the medicine reservoir. The nebulizer of the invention is resistant to bacterial contamination, because the medication vials do not need to be opened and poured into an open cup as in the prior art. Nevertheless, it is possible to configure the nebulizer of the invention to utilize a cup that can be opened and to pour the medication into the cup as has been done in the past by simply making the medication reservoir with a screw off or pressure fit lid which will allow the medication to be put into the cup as it has been done in the past with the seven piece plastic kit. The nebulizer of the invention is durable and cost effective. Much less of the medication is released to the ambient air by virtue of the positioning of the venturi well within the oral cavity. 
   Thus, a much improved nebulizer has been disclosed which overcomes the problems of the prior art. 
   While various embodiments of the present invention have been illustrated herein in detail, it should be apparent that modifications and adaptations to those embodiments may occur to those skilled in the art without departing from the scope of the present invention as set forth in the following claims.