Overview of nebuliser treatment
Authors: M. F. Muers
Journal: Thorax (1997)

Historical perspectivetal were not introduced until the 1960s. 3 More recently, equipment development has focused The word "nebuliser (from the Latin "nebula", mist) was first used in 1872 and was defined on breath assisted chambers which generate an even higher percentage of respirable particles in 1874 as "an instrument for converting a liquid into a fine spray, especially for medical and can facilitate aerosol treatment with a wide variety of drugs, drug suspensions, and so-purposes". 1 The idea of producing a vapour or aerosol for the treatment of lung disease was lutions with different physicochemical properties (fig 4).Progress towards the matching of by no means new even then since smoke and steam had been used in this way for centuries.specific equipment to particular types of drug delivery is likely to continue.Future treatment Inhalation devices depending on mouth suction to draw air through a liquid were produced for may well include a greater use of the products of recombinant gene technology -for example, essential oil treatment in the 18th century and similar devices were employed when antiseptic rhDNase, 1 -antitrypsin -as well as specific anti-inflammatory mediator drugs for both inhalations were advocated for the treatment of tuberculosis. 2Although early inhalation devices interstitial lung disease and obstructive air flow disease, and possibly cytokines and cell surface depended on steam (fig 1), mechanical pumps to generate the gas flow for nebulisation were receptors for the treatment of endobronchial neoplasia.made in the 19th century and these were eventually supplanted by electrical compressors in Despite this expanding range of nebuliser therapies, there is a need for physicians to the 1930s.Early nebuliser chambers were essentially simple atomisers -like the glass and recognise that, for the foreseeable future, the principal use worldwide will be for broncho-hand bulb atomisers first introduced for asthma treatment in the 1930s (fig 2).These generated dilatation.By extrapolation from a regional study 5 it is possible to estimate that there are an aerosol with a wide range of particle sizes and much of the output was non-respirable.currently about 40 000 compressors in use for adult domiciliary treatment in the UK with an Modern jet nebuliser chambers use a combination of high gas flow, precise Venturi ori-associated drug cost of approximately £40 million annually.A recent audit of a large fices, and baffles to restrict the size of the particles emitted more closely to those of res-Scottish teaching hospital revealed an annual use of 32 000 daily doses of nebulised broncho-pirable size (1-5 m diameter) and thereby increase lung deposition and treatment efficacy.dilators. 6 Elsewhere in Europe usage may be even higher.Brandli 7 has reported a figure of These designs depend upon the availability of precision engineering, originally of ebonite and 215 nebulisers per 10 5 population in Swit-Killingbeck Hospital, perspex -for example, the Wright nebuliser of zerland compared with 70 per 10 5 in the UK York Road, Leeds the 1950s (fig 3) -and now injection moulded survey.Nevertheless, as so often happens with LS14 6UQ, UK M F Muers plastics.By contrast, ultrasonic nebulisers physical treatments in medicine, widespread use has preceded much needed, more fun-which rely on high frequency sound waves