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Inhalation JUNE2017 15 Looking toward the future of nebulized therapy Nebulized drug therapy is outpacing that of the pMDIs and DPIs, despite a limited number of new drug launches compared to those formulated for inhalers. One example of this is in the development of nebulized therapies for the treatment of common conditions such as COPD. The development of long-acting β-agonist and anti-muscarinics in recent years has been mainly restricted to pMDI and DPI inhaler formulations, 12 leaving a gap in the provision of nebulized drugs for patients discharged from the hospital with a nebulizer. Another example of a potentially missed opportunity is the use of nebulized formulations in the early stages of drug development, followed by a switch to an inhaler once proof-of-principle had been established. Contin- uing the nebulizer formulation through to launch, in parallel with inhaler development following proof-of- principle may, in many cases, have given a greater return on investment and the potential for superior out- come data in the most severe patients. Coupled with innovations in mesh technology leading to nebulizers that are more patient-friendly, there are signs of a resurgence of interest in nebulized therapies, recognizing that this is an opportunity that has been overlooked in recent years. In addition, the electronic basis on which mesh nebulizers are built provides the opportunity to integrate e-health functions into modern nebulizers to aid patient self-management in the quest for better disease control. Whereas for inhalers, the inclusion of e-health features represents significant addi- tional cost and complexity, it can fit seamlessly into mesh nebulizers. Such inclusion can provide an oppor- tunity to increase, not only the adherence to prescribed regimen and compliance with correct device use, but also overall control and management of patients, who by their very nature are vulnerable or in poor health and so most likely to benefit from such advances. References 1. Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus neb- ulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013; Sep 13; 9:CD000052. 2. Osmond MH, Gazarian M, Henry RL, Clifford TJ, Tetzlaff J. PERC Spacer Study Group. Barriers to metered-dose inhaler/spacer use in Cana- dian pediatric emergency departments: A national survey. Acad Emerg Med. 2007; Nov;14(11):1106-1113. 3. Yaxley JP. Prescribing patterns of nebulized bronchodilators: A prospec- tive chart review. J Family Med Prim Care. 2016; Apr-Jun;5(2): 501-502. 4. Salzman GA, Steele MT, Pribble JP, Elenbaas RM, Pyszczynski DR. Aerosolized metaproterenol in the treatment of asthmatics with severe air- flow obstruction. Comparison of two delivery methods. Chest. 1989;95(5):1017-1020. 5. Fink JB, Colice GL, Hodder R. Inhaler devices for patients with COPD. COPD. 2013;10(4):523-535. 6. MM&M Therapeutic Focus, Top 25 respiratory products, 2014-2015. [Cited Apr 27, 2017] Available at: http://www.mmm-online.com/com mercial/top-25-respiratory-products-2014-2015/article/485567/.