Design principles of liquid nebulization devices currently in use.

Liquid nebulization is a common method of medical aerosol generation. Nebulizers are of 2 types: jet (or pneumatic) small-volume nebulizer, and ultrasonic nebulizer. Jet nebulizers are based on the venturi principle, whereas ultrasonic nebulizers use the converse piezoelectric effect to convert alternating current to high-frequency acoustic energy. Important variables for both types of nebulizer are treatment time required, particle size produced, and aerosol drug output. There are several advantages to jet nebulization, including that effective use requires only simple, tidal breathing, and that dose modification and dose compounding are possible. Disadvantages include the length of treatment time and equipment size. Design modifications to the constant-output nebulizer have resulted in breath-enhanced, open-vent nebulizers such as the Pari LC Plus and the dosimetric AeroEclipse. Ultrasonic nebulizers generally have a higher output rate than jet nebulizers, but a larger average particle size. Ultrasonic nebulizers can also substantially increase reservoir solution temperature, the opposite of jet nebulizer cooling. Drug concentration in the reservoir does not increase with ultrasonic nebulization, as it does with jet nebulization. Ultrasonic nebulizers have the same advantages as jet nebulizers. Ultrasonic nebulizers are more expensive and fragile than jet nebulizers, may cause drug degradation, and do not nebulize suspensions well. Neither type of nebulizer meets the criteria for an ideal inhaler: efficient and quick dose delivery with reproducibility, cost-effectiveness, and no ambient contamination by lost aerosol.