Patent Publication Number: US-2022218919-A1

Title: Breath-actuated nebulizer for medicine inhalation

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 14/957,449, entitled BREATH-ACTUATED NEBULIZER FOR MEDICINE INHALATION, filed on Dec. 2, 2015, which claims priority to U.S. Provisional Patent Application No. 62/087,730, entitled BREATH-ACTUATED NEBULIZER FOR MEDICINE INHALATION, filed on Dec. 4, 2014, the disclosure of each of which is incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     Field 
     The present disclosure is related to an apparatus and method for generating an aerosol for delivery to a patient. More particularly, the present disclosure is related to a breath-actuated nebulizer configured to generate an aerosol in coordination with a patient&#39;s breathing. 
     Description of Related Art 
     Nebulizers for providing aerosolized medicine to a patient are commonly used in the healthcare industry. In many instances, it is desirable that the nebulizer provides automatic delivery to the patient, as the patient inhales. Some nebulizers deliver medication to the patient only when the patient inhales, reducing or ceasing delivery of medication when the patient is not breathing or when the patient exhales. These nebulizers provide a higher certainty that the patient actually received the intended medication. 
     SUMMARY 
     Described herein are embodiments of breath-actuated nebulizers that deliver medication to a patient when the patient inhales and reducing or ceases delivery of medication to the patient when the patient is not breathing or when the patient exhales. The breath-actuated feature of the nebulizers reduces the exposure of caregivers to aerosolized medication otherwise prevalent in many continuous nebulizers. Some nebulizers that automatically cease medicine delivery include moving components that adapt to pressure and volume variations produced by the patient&#39;s breathing. The devices are configured so the moving components, which include membranes and deformable pieces made of resilient materials, actuate a nebulizing mechanism that provides aerosolized medicine to the patient. A drawback of such devices is a reduced reliability due to wear of the moving components. Another problem typically encountered with moving components is the longer response time associated with mechanical motion. Also, use of adequate resilient materials is expensive and imposes certain requirements for the rigid components of the device. For example, attaching a moving membrane to a rigid plastic piece imposes restrictions on the materials and method of fabrication that are difficult to implement on a mass production configuration. 
     Some embodiments described herein include a breath-actuated nebulizer for delivering medicine, comprising: a medicine cup configured to hold medicine and comprising (i) an ambient gas inlet configured to permit ambient gas into the medicine cup, (ii) a pressurized gas inlet configured to conduct pressurized gas into the medicine cup, and (iii) an outlet configured to direct gas out of the medicine cup; a venturi passage comprising a throat, the passage being configured to conduct the ambient gas from the inlet to within the medicine cup; a jet nozzle configured to receive the pressurized gas and comprising a jet orifice configured to produce a jet stream of the pressurized gas within the medicine cup; and a pressure passage comprising (i) a first portion comprising a venturi hole that provides fluid communication with the venturi passage throat, (ii) a second portion comprising a medicine inlet that provides fluid communication with the medicine cup, and (iii) a third portion, between the first and second portions, comprising a conducting opening that is configured to conduct medicine from the second portion toward the jet stream; wherein when ambient gas is drawn into the medicine cup through the venturi passage, a pressure within the pressure passage is reduced such that medicine is drawn up through the second portion until the medicine is conducted to the jet stream via the conducting opening. 
     In some embodiments, a breath-actuated nebulizer for delivering medicine is provided, including: a medicine cup configured to hold medicine and comprising (i) a first gas inlet, (ii) a second gas inlet configured to conduct pressurized gas into the medicine cup, and (iii) an outlet that directs gas out of the medicine cup; a jet nozzle, in fluid communication with the second gas inlet, comprising a jet orifice configured to produce a jet stream of the pressurized gas; a venturi passage comprising a throat in fluid communication with the first gas inlet and, via a passage, the medicine cup; wherein, without moving parts of the nebulizer, the passage changes from a first high pressure, when gas is not drawn into the medicine cup through the venturi passage and medicine is not conducted from the medicine cup through the venturi passage, to a second low pressure, when gas is drawn into the medicine cup through the venturi passage and medicine is conducted from the medicine cup toward the jet stream. 
     In some embodiments, a breath-actuated nebulizer for delivering medicine includes an outlet port, an opening, and a medicine cup coupled to the opening through a venturi tube. The medicine cup is configured to receive a medicine to be delivered through the outlet port, and is fluidically coupled to the outlet port. The nebulizer further includes a jet nozzle configured to be coupled to a pressurized gas source and to deliver the pressurized gas into the medicine cup, a sleeve in the medicine cup, the sleeve fluidically coupling the venturi tube to the medicine cup and forming a capillary volume with the jet nozzle, and a rib formed on the sleeve and supporting a diverter disposed above a nozzle tip. The diverter is configured to form a radial flow of the pressurized gas away from a nozzle axis. 
     Some methods include forming a medicine cup having an upper chamber and a lower chamber coupled by a fluid channel, and forming an outlet port on a cap that fits the medicine cup. The method further includes forming a sleeve that fits onto a jet nozzle, slide fitting the sleeve onto the jet nozzle in the medicine cup, welding together a venturi tube and the sleeve; and assembling the cap to the sleeve and the venturi. 
     Some methods provided herein include removing a cap from a medicine cup in a nebulizer; providing medicine to the medicine cup; and coupling the nebulizer to a pressurized gas source such that a jet stream is created; wherein, without moving parts of the nebulizer, the nebulizer switches from a first state, when gas is being evacuated from the medicine cup and medicine is drawn from the medicine cup toward the jet stream, to a second state, when gas is not evacuated from the medicine cup and medicine is not drawn from the medicine cup toward the jet stream. 
     Some methods include removing a cap from a medicine cup in a nebulizer, providing medicine to the medicine cup, adjusting a sleeve supporting a venturi tube on a jet nozzle, coupling the nebulizer to a pressurized gas source, and coupling an outlet port in the nebulizer to a patient&#39;s respiratory channel. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates a perspective view of a cross section of a breath-actuated nebulizer, according to some embodiments. 
         FIG. 2  illustrates a cross section of a breath-actuated nebulizer, according to some embodiments. 
         FIG. 3  illustrates a breath-actuated nebulizer used in a healthcare facility, according to some embodiments. 
         FIG. 4  illustrates a cross section of a breath-actuated nebulizer, according to some embodiments. 
         FIG. 5  illustrates a flowchart in a method for assembling a breath-actuated nebulizer, according to some embodiments. 
         FIG. 6  illustrates a flowchart in a method for providing a medicine to a patient, according to some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     In healthcare facilities it is often desired to deliver aerosolized medication to patients through respiratory channels. This is typically done with nebulizers that are continuously running units. It is desirable to provide a nebulizer that operates automatically, even when patients are unconscious, semi-conscious, or otherwise unable to actuate the device. Such a device would deliver aerosol only while a patient inhales, thereby ensuring that the patient receives the medication. Also, a breath actuated device reduces substantially the exposure of a caregiver to “second hand” aerosolized medications. Some breath actuated nebulizers currently available include mechanical actuators having moving parts. However, it is desirable that these devices have few or no moving parts so they are inexpensive, easily manufactured on a large scale, and durable. Some embodiments disclosed herein include a breath-actuated nebulizer with no moving parts. The patient&#39;s inhalation is directed through a venturi tube, generating a vacuum, or low pressure, that is used directly to pull medicine into a nebulizing position near a jet nozzle tip inside the device. As used herein, the term vacuum is a broad term, and is meant to refer to, among other things, a reduced pressure zone when compared with ambient pressure or a pressure in an area surrounding the reduced pressure zone. 
     Some embodiments include a venturi tube configured such that one end of the venturi tube is open to ambient air (at about atmospheric pressure), and the opposite end of the venturi tube is fluidically coupled to an outlet port, which can be coupled to an artificial airway of a breathing patient or can be accessed directly by a patient. The venturi tube has a region of reduced diameter (‘pinched’ region, or ‘throat’) that accelerates flow, thus generating a vacuum or a relatively low pressure. A port, aperture, hole, or passageway at the venturi throat is fluidically coupled to a reservoir of liquid medication. Accordingly, the vacuum or low pressure generated by the venturi tube is used to draw or pull medication upward, beyond its resting position. Some embodiments include a nozzle assembly including a jet orifice to direct a constant stream of gas from a pressurized gas source (compressed air or oxygen) to flow against a diverting surface or pin. The diverting surface causes a radial wall jet flowing out of an axis defined by the jet nozzle. The radial wall jet flows over a capillary volume at a high speed. This radial wall jet generates a continuous vacuum or low pressure within the capillary volume. The radial wall jet also impinges upon medicine emerging from the capillary volume and aerosolizes or atomizes the medicine in preparation for the medicine to exit the outlet or outlet port in an aerosolized form. 
     In some embodiments, the capillary volume is fluidically coupled, or “teed,” to a medicine tube and to the venturi throat  103 , through a nozzle feed tube or conduit. The assembly is configured in such a way that when no patient inhalation occurs, the medicine drains at a distance from the nozzle feed tube, thus preventing the medicine to be drawn into the capillary volume to be aerosolized by the radial wall jet. When a patient inhales, or when gas is drawn from the medicine cup through the outlet, the vacuum, or pressure drop, generated by the venturi tube pulls the medicine into proximity of the nozzle feed tube, and the radial wall jet draws the liquid medicine out of the capillary volume to be aerosolized in the radial jet stream. Accordingly, embodiments consistent with the present disclosure provide a mechanism to bring a liquid medication up to a nebulizing position within the device using fluidic forces rather than mechanically actuated moving parts. 
       FIG. 1  illustrates a perspective view of a cross section of a breath-actuated nebulizer  100 , according to some embodiments. Breath-actuated nebulizer  100  for delivering medicine can include an outlet port  111 ; an opening  105 , and a medicine cup  135  coupled to opening  105  through a venturi tube  101 . Outlet port  111  protrudes from a cap  110  that snap fits to an upper chamber  120  of medicine cup  135 , by pressure. Some embodiments may optionally include a mouth piece that couples the patient&#39;s mouth to outlet port  111 . Further according to some embodiments, outlet port  111  may be configured to attach to a mask that fits onto the patient&#39;s face, fixing outlet port  111  relative to the patient&#39;s respiratory channels. In some embodiments, cap  110  is secured to medicine cup  135  through tongue  117 . Accordingly, tongue  117  may be configured as a quarter turn fastener. Further according to some embodiments, cap  110  may be secured to medicine cup  135  by threads formed on the inside of cap  110  and the outside of the rim in upper chamber  120 . Upper chamber  120  is configured to receive liquid medicine and is separated by a jet nozzle  126  from a bottom chamber  130 . Bottom chamber  130  is coupled to the pressurized gas source through a pressurized gas port  133 . 
     Medicine cup  135  is fluidically coupled to outlet port  111 . Jet nozzle  126  is configured to be coupled to a pressurized gas source (not shown) and, in the illustrated embodiments, protrudes into medicine cup  135 . A sleeve  102  fluidically couples venturi tube  101  to medicine cup  135 . In some embodiments, sleeve  102  is pressure fit onto jet nozzle  126  and forms a capillary volume  121  with jet nozzle  126 . Capillary volume  121  is formed between the tip of nozzle  126  and sleeve  102 . Accordingly, in some embodiments capillary volume  121  is a conical passageway for the liquid medicine. In some embodiments, capillary volume  121  is a frusto-conical passageway for the liquid medicine. 
     A rib  107  formed on sleeve  102  supports a diverter  122  disposed above the tip or orifice of the jet nozzle  126 . Diverter  122 , which can be a cylindrical member having a generally flat surface that faces the jet nozzle  126 , is configured to form a radial flow of the pressurized gas away from a nozzle axis. Sleeve  102  comprises a pressure passage  114  that includes a vent tube  115 . Vent tube  115  is coupled to a throat of venturi tube  101  through a first hole  112 , or a venturi hole, having a first diameter. Vent tube  115  is coupled to capillary volume  121  through a second hole  123 , or conducting opening, of the pressure passage  114  having a second diameter and a nozzle feed tube  125 . The diameter of first hole  112  and the diameter of second hole  123  are selected such that a patient breath pulls the medicine up to the level of second hole  123 , where the medicine fluidically contacts nozzle feed tube  125 . In some embodiments, nozzle feed tube  125  is generally horizontal. The jet nozzle flow pulls the medicine through capillary volume  121  and into the radially outward gas flow. Sleeve  102  includes a lip  127  coupled to a bottom portion of the upper chamber  120  in medicine cup  135  to hermetically seal capillary volume  121  from medicine cup  135 . Lip  127  forms a gap fluidically coupling medicine cup  135  to vent tube  115 . In some embodiments, the pressure passage  114  of the sleeve  102  includes a medicine tube  129  fluidically coupling vent tube  115  to medicine cup  135 . 
     When a patient inhales through the outlet, or outlet port  111 , or when gas is drawn through the outlet port or outlet, a vacuum, or low pressure zone, is formed in vent tube  115  and medicine is pulled up from the bottom of upper chamber  120  through medicine tube  129 . The liquid medicine is aerosolized into small particles that flow through the outlet or outlet port  111  into the patient&#39;s respiratory channel by the radial gas flow or jet formed at the tip of jet nozzle  126  after the flow of pressurized gas from the nozzle encounters diverter  122 . In some embodiments, the pressurized gas source runs continuously through jet nozzle  126 , creating a vacuum in capillary volume  121 . Nozzle feed tube  125  runs across to capillary volume  121  at the junction of vent tube  115  and medicine tube  129 . Medicine is raised high enough by the patient created vacuum in vent tube  115  to reach nozzle feed tube  125 . In operation, when a patient created vacuum is formed in vent tube  115 , medicine is prevented to flow up to venturi tube  101  by the vacuum created by jet nozzle  126  in capillary volume  121 . In some embodiments, inadvertently actuating the medicine nebulizer by tilting the container may be prevented by the air pressure in vent tube  115  when the patient is not breathing through outlet port  111 . Accordingly, nebulizing actuation in breath-actuated nebulizer  100  is ‘binary’ (on/off) based on patient respiration or the action of drawing gas through the venturi tube or passageway. 
     A thin rib  107  in sleeve  102  supports diverter  122 . Diverter  122  may be a cylinder just above the jet orifice in jet nozzle  126 . Accordingly, pressurized gas from jet nozzle  126  impinges on diverter  122  and spreads radially outward, relative to the axis of jet nozzle  126 . Medicine is atomized at the nozzle by the high velocity air flowing radially out. Liquid medicine is “sheared off” by the radial flow created between nozzle tip and diverter. Diverter  122  may be flat or have an angle, or a semi-circular dome to change the angle of the spray coming out of the nozzle. Different designs of a specific shape of diverter  122  may be used to increase output. In some embodiments, capillary volume  121  forms a concentric gap around the jet orifice of jet nozzle  126 . Accordingly, the pressurized gas exiting jet nozzle  126  hits diverter  122  first and then engage the fluid out of capillary volume  121 . In some embodiments, diverter  122  is fixed relative to jet nozzle  126 , and there is no need to move the diverter in and out of position to actuate the medicine nebulizer. According to some embodiments, capillary volume  121  is a medicine pathway forming a 0.010″ gap between sleeve  102  and jet nozzle  126 . Lip  127  at the end of sleeve  102  interferes with a chamfer at the bottom of upper chamber  120  forming a liquid tight seal to avoid medicine leaks into capillary volume  121  from medicine cup  135 . 
     In embodiments consistent with the present disclosure, parts and components in a breath-actuated nebulizer as disclosed herein are fixed with respect to one another in a relatively rigid configuration. Embodiments consistent with the present disclosure include carefully adjusted diameters of first hole  112  and of second hole  123 , so as to form a vacuum in capillary volume  121  that brings the medicine from nozzle feed tube  125  in contact with the radial flow generated by jet nozzle  126  and diverter  122 . Accordingly, the vacuum in capillary volume  121  created by the radial jet flow is not too high to automatically pull medicine from medicine cup  135 , without patient respiration. 
       FIG. 2  illustrates a cross section of breath-actuated nebulizer  100 , according to some embodiments. In that regard,  FIG. 2  illustrates a cross-sectional view of breath-actuated nebulizer  100  looking from the side opposite outlet port  111 . Elements in  FIG. 2  having the same numeral reference as an element in  FIG. 1  are the same in both figures, and therefore their description will not be repeated here, unless otherwise indicated. Medicine  201  sits in the bottom of upper chamber  120  waiting for the next patient breath to occur. In some embodiments, outlet port  111 , sleeve  102 , venturi tube  101 , medicine cup  135 , and jet nozzle  125  are formed of a rigid material such as plastic. For example, medicine cup  135 , venturi tube  101 , and sleeve  102  may all be made by injection molded plastic. The breath-actuated nebulizer  100  can include a rib that supports a diverter above and in close proximity to the tip of j et nozzle  126 . Also,  FIG. 2  shows that, in some embodiments, pressurized gas coming from jet nozzle  126  may exit nebulizer  100  through outlet port  111  and also through venturi tube  101  when the patient is not inhaling. 
       FIG. 3  illustrates a breath-actuated nebulizer  100  used in a healthcare facility  300 , according to some embodiments. Accordingly, the pressurized gas source coupled to breath-actuated nebulizer  100  may be a canister  310  containing pressurized gas. In some embodiments, the pressurized gas source is a hose  311  coupled to a gas pipeline  320  running on the wall of healthcare facility  300 , through an outlet  321 . 
     Gases used in canister  310  or in hose  311  may include air, oxygen, nitrogen, or any other gas used in healthcare facility  300  in connection with a patient&#39;s care. In some embodiments, the gases may include inert gases such as argon (Ar) or helium (He), or other gases such as CO 2 , and the like. Further, in some embodiments healthcare facility  300  is a surgical room, and breath-actuated nebulizer  100  is used to deliver an anesthetic drug to patient  301 . In that regard, the pressurized gas provided by canister  310  or by hose  311  may be an anesthetic component. 
       FIG. 4  illustrates a cross section of a breath-actuated nebulizer  400 , according to some embodiments. Elements of nebulizer  400  that are common to elements of nebulizer  100  have the same numeral reference and are described in detail above (cf.  FIG. 1 ). Therefore, the description of the common elements between nebulizer  400  and nebulizer  100  will not be repeated here, unless otherwise indicated. Nebulizer  400  further comprises a manual override including a push button  401  to actuate a medicine dispenser, bypassing venturi tube  101 . Nebulizer  400  including a manual override may be desirable for use with frail or weak patients that are unable to actuate the nebulizer via their own breath. In such configurations, a manual override provided by push button  401  and actuated by either the patient or healthcare personnel activating nebulizer  400  by manually creating a vacuum in vent tube  115 , at a desired time. The vacuum is created when a force is applied in the direction of arrow  410 , as illustrated. 
       FIG. 5  illustrates a flowchart in a method  500  for assembling a breath-actuated nebulizer, according to some embodiments. Steps in  FIG. 5  may be performed at least partially by an automated machine having a computer including a memory circuit and a processor circuit. The memory circuit may store commands which, when executed by the processor circuit, cause the machine to perform the steps in method  500 . Steps in methods consistent with method  500  may be performed in any order, and the sequence illustrated in  FIG. 5  is not limiting of embodiments consistent with the scope of the present disclosure. Further, some steps in method  500  may be performed overlapping in time. Moreover, some steps in method  500  may be performed simultaneously, or quasi-simultaneously, without departing from the scope of the present disclosure. Methods consistent with the present disclosure may include at least one, but not all of the steps in method  500 . 
     Step  502  includes forming a medicine cup having an upper chamber and a lower chamber coupled by a fluid channel. The medicine cup, the upper chamber, and the lower chamber may be as described in detail above (e.g., medicine cup  135 , upper chamber  120  and lower chamber  130 , cf.  FIG. 1 ). In some embodiments, step  502  may include forming a jet nozzle on a side of the fluid channel protruding into the upper chamber; and forming a pressurized gas port on a side of the fluid channel protruding into the lower chamber (e.g., jet nozzle  126  and pressurized gas port  133 , cf.  FIG. 1 ). 
     Step  504  includes forming an outlet port on a cap that fits the medicine cup. The outlet port and the cap may be as described in detail above (e.g., outlet port  111  and cap  110 , cf. FIG.  1 ). In some embodiments, the outlet port may be configured to directly enter the mouth of a patient. In some embodiments, the outlet port is configured to couple with a device that enters the mouth of the patient, such as an artificial airway. 
     Step  506  includes forming a sleeve that fits onto a jet nozzle. The sleeve and the jet nozzle may be as described in detail above (e.g., sleeve  102  and jet nozzle  126 , cf.  FIG. 1 ). Step  506  may include forming a rib over the tip of the nozzle in the sleeve, the rib supporting a diverter over the tip of the nozzle (e.g., rib  107  and diverter  122 , cf.  FIG. 1 ). Step  508  includes slide fitting the sleeve onto the jet nozzle in the medicine cup. In some embodiments, step  508  may include pressure fitting the sleeve onto the jet nozzle in the medicine cup. In some embodiments, step  508  may include forming a capillary volume between the sleeve and the jet nozzle (e.g., capillary volume  121 ,  FIG. 1 ). Moreover, in some embodiments step  508  may include hermetically sealing the capillary volume from the upper chamber, except for a small gap coupling a medicine tube in the sleeve to the upper chamber (e.g., medicine tube  129 , cf.  FIG. 1 ). In some embodiments, step  508  includes forming a lip on the sleeve that contacts the upper chamber (e.g., lip  127 , cf.  FIG. 1 ). 
     Step  510  includes welding together a venturi tube and the sleeve. In some embodiments, step  510  may include pressure fitting the venturi tube onto the sleeve. The venturi tube may be as described in detail above (e.g., venturi tube  101 , cf.  FIG. 1 ). Step  510  may include aligning a hole in the throat of the venturi tube with an opening of a vent tube in the sleeve (e.g., hole  112  and vent tube  115 , cf.  FIG. 1 ). 
     Step  512  includes assembling the cap to the sleeve and the venturi in the upper chamber of the medicine cup. In some embodiments, step  512  may include permanently assembling the cap to the sleeve and the venturi. In some embodiments, step  512  may include snap fitting the cap onto the upper chamber in the medicine cap. The cap has a rim forming the opening, the rim is pressure fit onto an inlet of the venturi tube. Step  512  may include coupling an assembly including the cap, the sleeve, the venturi tube and the medicine cup onto a pressurized gas source. In some embodiments, step  512  includes turning the cap around the medicine cup. For example, in some embodiments step  512  may include making a ¼ turn so that a tongue fixes the cap onto the medicine cup (e.g., tongue  117 , cf.  FIG. 1 ). In some embodiments, step  512  may include threading the cap onto the medicine cup. 
     Method  500  may be performed in the context of a high volume production of inexpensive, disposable assemblies for breath-actuated nebulizers. In some embodiments the assemblies are rigid and have no flexible parts and no moving parts, which may make the assemblies more rugged and durable. Each or at least one of the forming steps  502  through  506  in method  500  may include at least one of injection molding or three-dimensional (3D) printing of the parts and components described in the steps. 
       FIG. 6  illustrates a flowchart in a method  600  for providing a medicine to a patient, according to some embodiments. In some embodiments, steps in method  600  may be performed at least partially by healthcare personnel at a healthcare facility. In some embodiments, steps in method  600  may be performed at least partially by a user performing a self-medication procedure, or providing medication to another person. Steps in  FIG. 6  may be performed at least partially by an automated machine having a computer including a memory circuit and a processor circuit. The memory circuit may store commands which, when executed by the processor circuit, cause the machine to perform the steps in method  600 . Steps in methods consistent with method  600  may be performed in any order, and the sequence illustrated in  FIG. 6  is not limiting of embodiments consistent with the scope of the present disclosure. Further, some steps in method  600  may be performed overlapping in time. Moreover, some steps in method  600  may be performed simultaneously, or quasi-simultaneously, without departing from the scope of the present disclosure. Methods consistent with the present disclosure may include at least one, but not all of the steps in method  600 . 
     Method  600  may be performed in connection with a breath-actuated nebulizer having an outlet port protruding from a cap that fits onto a medicine cup. The medicine cup may include an upper chamber and a lower chamber, the lower chamber including a pressurized gas port (e.g., breath-actuated nebulizer  100 , outlet port  111 , cap  110 , medicine cup  135 , upper chamber  120 , lower chamber  130  and pressurized gas port  133 , cf.  FIG. 1 ). The breath-actuated nebulizer in method  600  may be coupled to a pressurized gas source such as a liquefied gas canister or a wall pipeline in a healthcare facility, the wall pipeline having a wall outlet (e.g., healthcare facility  300 , canister  310 , wall pipeline  320  and wall outlet  321 , cf.  FIG. 3 ). 
     Step  602  includes removing the cap from the medicine cup in the nebulizer. In some embodiments, step  602  includes pressing the cap to snap it apart from the medicine cup. In some embodiments, step  602  may include twisting the cap by a quarter turn or a partial turn around the medicine cup to disengage a tongue link. Step  604  includes providing medicine to the medicine cup. Step  606  includes adjusting a sleeve supporting a venturi tube on a jet nozzle (e.g., venturi tube  101 , cf.  FIG. 1 ). The jet nozzle may be configured to provide a pressurized gas flow through a nozzle tip. Step  606  may include forming a capillary volume between the jet nozzle and the sleeve (e.g., capillary volume  121 , cf.  FIG. 1 ). Accordingly, step  606  may include carefully positioning the nozzle tip in the proximity of a diverter formed on a rib in the sleeve. Step  608  includes coupling the nebulizer to the pressurized gas source. In some embodiments, step  608  includes coupling the nebulizer to the wall pipeline containing a pressurized gas flow and turning on the wall outlet of the wall pipeline. In some embodiments, step  608  includes coupling the nebulizer to the liquefied gas canister. Step  608  may include inserting the pressurized gas port in the lower chamber of the medicine cup to an outlet fixture of the pressurized gas source. Step  610  includes coupling the outlet port in the nebulizer to a patient&#39;s respiratory channel or an artificial airway. 
     The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology. 
     There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology. 
     As used herein, the phrase “at least one of” preceding a series of items, with the term “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” does not require selection of at least one of each item listed; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C. 
     Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim. The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. 
     A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” The term “some” refers to one or more. All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description. 
     While certain aspects and embodiments of the subject technology have been described, these have been presented by way of example only, and are not intended to limit the scope of the subject technology. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms without departing from the spirit thereof. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the subject technology.