Editing Nebulizer (section)

==Types==
[[File:Jet nebulizer.jpg|thumb|A modern jet nebulizer]]
[[File:Albuterol Sulfate (1).JPG|thumb|A vial of 0.5% [[albuterol]] sulfate inhalation solution for nebulizing]]

===Pneumatic===
====Jet nebulizer====
The most commonly used nebulizers are jet nebulizers, which are also called "atomizers".<ref name=Finlay>{{cite book |author=Finlay, W.H. |title=The Mechanics of Inhaled Pharmaceutical Aerosols: An Introduction |publisher=Academic Press |year=2001 }}</ref> Jet nebulizers are connected by tubing to a supply of compressed gas, usually [[compressed air]] or [[oxygen]] to flow at high velocity through a liquid medicine to turn it into an [[aerosol]] that is inhaled by the patient. Currently there seems to be a tendency among physicians to prefer prescription of a [[pressurized Metered Dose Inhaler]] (pMDI) for their patients, instead of a jet nebulizer that generates a lot more noise (often 60&nbsp;dB during use) and is less portable due to a greater weight. However, jet nebulizers are commonly used in hospitals for patients who have difficulty using inhalers, such as in serious cases of respiratory disease, or severe asthma attacks.<ref name=Hickey>{{cite book |author=Hickey, A.J. |title=Pharmaceutical Inhalation Aerosol Technology |url=https://archive.org/details/pharmaceuticalin134anth |url-access=registration |publisher=Marcel Dekker |location=New York |year=2004 |isbn=978-0-8247-4253-9 |edition=2nd}}</ref> The main advantage of the jet nebulizer is related to its low operational cost. If the patient needs to inhale medicine on a daily basis the use of a pMDI can be rather expensive. Today several manufacturers have also managed to lower the weight of the jet nebulizer to just over half a kilogram (just under one and a half pounds), and therefore started to label it as a portable device. Compared to all the competing inhalers and nebulizers, the noise and heavy weight is still the biggest draw back of the jet nebulizer.<ref>{{Cite journal
 |author1=J. Jendle |author2=B. E. Karlberg |author3=J. Persliden |author4=L. Franzen |author5=M. Jr Arborelius | title = Delivery and retention of an insulin aerosol produced by a new jet nebulizer
 | journal = Journal of Aerosol Medicine
 | volume = 8
 | issue = 3
 | pages = 243–254
 | date = Fall 1995
 | doi =10.1089/jam.1995.8.243
 | pmid = 10155650
}}</ref>

===Mechanical===

====Soft mist inhaler====
The medical company [[Boehringer Ingelheim]] also invented a device named [[Respimat]] Soft Mist Inhaler in 1997. This new technology provides a metered dose to the user, as the liquid bottom of the inhaler is rotated clockwise 180 degrees by hand, adding a buildup tension into a spring around the flexible liquid container. When the user activates the bottom of the inhaler, the energy from the spring is released and imposes pressure on the flexible liquid container, causing liquid to spray out of 2 nozzles, thus forming a soft mist to be inhaled. The device features no gas propellant and no need for battery/power to operate. The average droplet size in the mist was measured to 5.8 micrometers, which could indicate some potential efficiency problems for the inhaled medicine to reach the lungs. Subsequent trials have proven this was not the case. Due to the very low velocity of the mist, the Soft Mist Inhaler in fact has a higher efficiency compared to a conventional pMDI.<ref name="Soft Mist Inhaler">{{cite web|url=http://www.respimat.com/com/Main/functions/howitworks/index.jsp|author=Boehringer Ingelheim|title=How it works: Respimat Soft Mist Inhaler|year=2003|access-date=2005-08-16|url-status=dead|archive-url=https://web.archive.org/web/20070527080759/http://www.respimat.com/com/Main/functions/howitworks/index.jsp|archive-date=2007-05-27}}</ref> In 2000, arguments were launched towards the European Respiratory Society (ERS) to clarify/expand their definition of a nebulizer, as the new Soft Mist Inhaler in technical terms both could be classified as a "hand driven nebulizer" and a "hand driven pMDI".<ref name="Soft Mist Inhaler definition">{{cite journal |journal=Eur Respir Rev |volume=10 |pages=187–191  |vauthors=Denyer J, etal |title=New liquid drug aerosol devices for inhalation therapy |year=2000}}</ref>

===Electrical===
====Ultrasonic wave nebulizer====
Ultrasonic wave nebulizers were invented in 1965<ref>{{cite patent|url = http://pdfpiw.uspto.gov/.piw?PageNum=0&docid=03243122|country = US|title = Ultrasonic Spray Apparatus|inventor = Snaper, Alvin A.|number = 3243122|status = patent|pubdate = 29 March 1966|fdate = 24 February 1965}} {{Webarchive|url=https://web.archive.org/web/20181029191628/http://pdfpiw.uspto.gov/.piw?PageNum=0&docid=03243122 |date=29 October 2018 }}</ref> as a new type of portable nebulizer. The technology inside an ultrasonic wave nebulizer is to have an [[electronic oscillator]] generate a high frequency [[ultrasonic wave]], which causes the mechanical vibration of a [[piezoelectric]] element. This vibrating element is in contact with a liquid reservoir and its high frequency vibration is sufficient to produce a vapor mist<ref name="Ultrasonic humidifier">{{cite web|url=http://www.airwin-luftbefeuchter.de/html/en/operating_principle.html|author=BOGA Gmbh|title=Operating principle of ultrasonic humidifier|access-date=2010-04-05|url-status=dead|archive-url=https://web.archive.org/web/20101114085152/http://www.airwin-luftbefeuchter.de/html/en/operating_principle.html|archive-date=2010-11-14}}</ref> via [[ultrasonic atomization]]. As they create aerosols from ultrasonic vibration instead of using a heavy air compressor, they only have a weight around {{convert|170|g}}. Another advantage is that the ultrasonic vibration is almost silent. Examples of these more modern type of nebulizers are: [[Omron]] NE-U17 and Beurer Nebulizer IH30.<ref>{{cite book |author1=Knoch, M. |author2=Finlay, W.H. |chapter=Ch. 71 Nebuliser Technologies |editor1=Rathbone |editor2=Hadgraft |editor3=Roberts |title=Modified-Release Drug Delivery Technology |publisher=Marcel Dekker |year=2002 |pages=849–856 }}</ref>


====Vibrating mesh technology====
A new significant innovation was made in the nebulizer market around 2005, with creation of the ultrasonic Vibrating Mesh Technology (VMT). With 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 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. Available VMT nebulizers include: Pari eFlow,<ref name="VMT1">{{cite web|url=http://www.paripharma.com/technologies1.htm|author=PARI Pharma|title=Leading aerosol therapies worldwide, delivery with eFlow|year=2008|access-date=2010-04-09|url-status=dead|archive-url=https://web.archive.org/web/20100328172026/http://www.paripharma.com/technologies1.htm|archive-date=2010-03-28}}</ref> [[Respironics]] i-Neb,<ref name="VMT2">{{cite web|url=http://ineb.respironics.com/AADHow.asp|author=Philips Respironics|title=Active Aerosol Delivery, The I-neb and Vibrating Mesh Technology|year=2010|access-date=2010-04-09|url-status=dead|archive-url=https://web.archive.org/web/20100804054557/http://ineb.respironics.com/AADHow.asp|archive-date=2010-08-04}}</ref> Beurer Nebulizer IH50,<ref name="VMT4">{{cite web|url=http://www.beurer.com/web/en/products/nebulization/nebulization/IH-50|author=Beurer|title=Product details of IH50 nebulizer, with a vibrating membrane|year=2015|access-date=2015-04-21|archive-date=2015-05-13|archive-url=https://web.archive.org/web/20150513010354/http://www.beurer.com/web/en/products/nebulization/nebulization/IH-50|url-status=dead}}</ref> and Aerogen Aeroneb.<ref name="VMT5">{{cite web|url=http://aerogen.com/technology.html|author=Aerogen|title=Micropump nebulizers, Aeroneb, Vibrating Mesh Technology|year=2009|access-date=2010-04-09|url-status=dead|archive-url=https://web.archive.org/web/20100203152617/http://aerogen.com/technology.html|archive-date=2010-02-03}}</ref> As the price of the ultrasonic VMT nebulizers is higher than models using previous technologies, most manufacturers continue to also sell the classic jet nebulizers.<ref>{{Cite web|title=Nebulizer Machine and Its Overview|url=http://www.indexofsciences.com/nebulizer-machine-and-its-overview/|last=Team|first=Editorial|date=2019-12-09|website=Index of Sciences|language=en-US|access-date=2020-05-25}}</ref>