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Inhalation OCTOBER2016 9 Nebulizers: Past to present platforms and future possibilities A brief history of nebulizers The use of inhalation therapy for medicinal purposes was first noted in Ayurvedic medicine in India about 2,000 BC, thereby being more than 4,000 years old. At that time, a paste of Datura species and herbs were smoked through a pipe to relive lung disorders. 1 Over the follow- ing years, there are a number of examples using smoke and/or vapors to treat various respiratory disorders. 2-5 The concept of breaking up liquid into airborne droplets was first mentioned in the mid-1800s when atomizers were developed, initially in France by Dr. Auphon Euget-Les Bain in 1849. 6 This was probably a further development of the concept of splashing water onto walls that was used by Auphan in the early 1800s. 4 At that time and during most of the 19th century, the words "atom- izer" and "nebulizer" were used simultaneously to describe nebulizers. Almost ten years later, in 1858, Jean Sales-Girons pre- sented a portable nebulizer that could be operated manu- ally by using a pump to feed liquid to a nozzle, where it was ejected onto a plate and disintegrated into an aerosol (Fig- ure 1). 7 In the years to come, improvements were made and the first mention of a nebulizer based on the Venturi principle of 1738 was made by Bergson in 1862 in his "Hydrokonium" device. 8 The device was later enhanced by the introduction of a baffle system. One of the first examples was described by Evans in 1891. 9 Additional descriptions of nebulizers with baffles have been described in the literature by authors such as Waldenburg (1862), Solis-Cohen (1867) and Moeller (1882). 4, 10, 11 The use of the Venturi principle was, from there on, the predominant design pathway for jet nebulizers. Major milestones in development were introduction of the Wright nebulizer and the DeVilbiss no. 40 nebulizer. The DeVilbiss nebulizer was often operated by squeezing a rubber bulb. However, the introduction of electricity in the early 1900s made it possible to connect a nebulizer to a compressor, which made use easier for the patient. An example of a compressor nebulizer is the Pneumostat, which was manufactured in Germany in the early 1930s (Figure 2). 7 Current conventional technologies When we refer to nebulizers, we often think of the station- ary, table-top devices that are used in hospitals and domes- tic settings. While there are many nebulizer types, in this author's view, they can be divided into two general cate- gories: jet nebulizers and ultrasonic nebulizers. A jet nebulizer typically consists of a compressor and a plastic nebulizer unit. Occasionally, these are combined into an integrated unit to make them more portable. In a jet nebulizer, the aerosol is generated by compressed air. In ultrasonic nebulizers, the aerosol is generated by vibra- Brief insights into nebulizer history and technologies in use or in development, including conventional and novel approaches Ola Nerbrink, PhD Respiron Consulting AB and Medicon Valley Inhalation Consortium, MVIC AB Sales-Girons portable device (Image from The Inhalatorium) 7 Figure 1