A puff of relief

Saurabh Goyal

Unprecedented air pollution in Indian cities has triggered major health concerns. Cases of respiratory disorders like bronchial asthma, cystic fibrosis and chronic obstructive pulmonary disease are on the rise. In response to these health challenges, pulmonary drug delivery through nebulisers is gaining widespread acceptance. 

A market report published by Transparency Market Research has estimated that the Indian nebuliser market, which stood at Rs575.6 million in 2014, will reach Rs 4,703 million in 2023. Nebulisers are thus emerging as a preferred choice for the treatment of debilitating lung disorders. Considering that some medications work best with specific types of nebulisers, it is advisable to consult a doctor about the type of nebuliser suited for you, which would depend on the severity of your condition, symptoms, diagnosis and treatment regimen.

Which device best serves your purpose will also hinge on your lifestyle needs. If you spend a larger part of the day at office or school and if your job involves a lot of travelling, you should go for portable nebulisers as they are battery-operated and can be used on the go rather effortlessly.

While nebulisers enable people with lung conditions to inhale liquid-based medications into their airways to instantly relieve troublesome symptoms like wheezing and breathlessness and prevent acute attacks, the introduction of innovative technologies that enhance the efficacy is making these medical devices even more sought after.

Loss of medication in spray chamber remained a key concern in a compressor or jet nebuliser, but not any longer as now there are ultrasonic nebulisers providing efficient and faster drug delivery. The most commonly used are jet nebulisers; apart from being cost effective, they are suitable for all types of medications.

While jet nebuliser involves pressurised gas supply through a valve to assist in pushing medication toward the mouth, ultrasonic nebuliser uses electric current to produce high-frequency vibrations in a container and break up the fluid into aerosol particles. Mesh nebuliser, on the other hand, creates vibrations that enable the flow of medicine through a fine mesh so as to develop aerosol medication.

Chronic health conditions, coupled with an ageing population, have shifted the focus to personalised healthcare. This healthcare model involves adopting technologies which allow patients to manage their care on their own. Clearly, remote patient monitoring and virtual care by way of new digital technologies in portable medical devices intended for home use are now challenging the traditional healthcare model that involves frequent hospital visits and hospitalisation.

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Types of nebulisers

Compressor jet nebuliser

Working mechanism: Used at most medical facilities, it works by forcing compressed air into the medication cup at high velocity to turn liquid medicine into aerosol

Pros 

• Affordable
• Low operational cost
• Easy to use
• Suitable for a wide range of medications
• Effective in dispensing drugs which cannot be delivered with pressurised metered dose inhalers and dry powder inhalers

Cons

• Noisy
• Limited portability
• Low efficiency
• Difficult to clean
• Loss of medication in spray chamber

Ultrasonic nebuliser

Working mechanism: Piezoelectric crystal converts electric signal into high-frequency vibrations in liquid, forming aerosol using cavitation and capillary mechanisms

Pros 

• Easy to use
• More efficient than jet nebulisers
• Shorter nebulisation time (better suited for larger volumes) 
• Easier to carry
• Noise-free

Cons 

• Large residual volume
• Unable to nebulise viscous solutions
• Heats up medication, causes degradation of heat-sensitive materials, which makes it inappropriate for inhaled protein therapeutics

Mesh nebuliser

Working mechanism: A vibrating element pushes medication through microscopic holes of a membrane, generating aerosol of small droplets

Pros

• Ultra-light and portable
• Short treatment time
• Minimal residual volume
• More output efficiency
• Optimised particle size for certain drugs
• Does not add heat to solutions

Cons 

• More expensive
• Difficult to clean
• Unable to nebulise viscous liquids
• Cannot aerosolise medicines which crystallise on drying

— The writer is executive director, Nureca