1. SMBE 4323
GROUP 4
NEBULIZER
PRESENTED BY: 1. MUHAMAD REZA NAZRIN BIN A RAHMAN 2. LAILA FADHILLAH BINTI ULTA DELESTRI 3.GOH VOON HUEH

2. WHAT IS A NEBULIZER?
A drug delivery device used to deliver medication in the form of aerosol (mist) inhaled into the lungs
Uses oxygen, compressed air or ultrasonic power to break up the liquid medications into aerosol droplets then deliver the dose directly into the lungs

3. Produce loud noise and heavy
FOCUS
Jet Nebulizer/Compressed-Air Nebulizer/Atomizer
The most common use in hospital for patients with chronic respiratory disease.
Connected to compressor, that causes compressed air flow at higher velocity through the liquid medicine then turned into aerosol.
Advantages
Low operational cost
Disadvantages
Produce loud noise and heavy

4. Schematic of typical nebulizer system.
SYSTEM DESCRIPTION
Schematic of typical nebulizer system.

5. SYSTEM DESCRIPTION Gas Source
The medication inside the medication cup.
Help patient breath normally.
Delivery System
Mouthpiece
The place where the liquid medicine turn into mist.

6. SYSTEM DESCRIPTION Aerosol Reservoir
Eg. a reservoir bag or piece of reservoir tubing.
Additional volume devoted especially to aerosol storage
Without reservoir part, 60% of the drug might loss into the air.

7. SYSTEM DESCRIPTION Flow Reservoir
To accommodate the patient’s inspiratory flow when it exceeds the source gas flow.
Give infinite air flow.
Without FR, if the patient breath too deep, the mouthpiece cannot depressurize, therefore there will be not airflow.
The tube is simply be a communication to the atmosphere, so it will not become a problem about the airflow.
Reservoir bag can inflate and deflate, so it will produce airflow into patient lung,

8. SYSTEM DESCRIPTION
Patient
Drug is inhale into respiratory pathway.

9. Presence of liquid medicine
On/Off button
Presence of liquid medicine
Medication in the cup is a must.
Either premix or mix by user.
Example:
Anti immonoglobulin E (Anti IgE)
Albuterol
Actonocholinergics
INPUT OF NEBULIZER

10. Aerosol / Mist of Medicine
OUTPUT OF NEBULIZER
Pressurized gas is supply into the medication cup through a jet.
The liquid medicine will ride along with the gas stream.
Liquid will sheared and become unstable, and break into droplets.
Baffle preventing the stream to spread into particular direction.
causing larger particles to return to the liquid reservoir.
99% particle may be returned to the liquid reservoir.
Only small particle (mist) will be transfer to patient respiratory system.
Aerosol / Mist of Medicine
3. Because of high surface tension force.

11. SYSTEM PROCESS

12. Nebulizer Working Principle Pressurized air flows into reservoir.
Pass through the small narrow opening (orifice).
Air leaves with high velocity.
Leaves jet while mixing with liquid medication.
High velocity, breaks up the liquid into tiny droplets and create mist

13. 1 2
Air Pump 3
basic forces of nature to move a liquid. As the moving pump part (impeller)begins to move, air is pushed out of the way. The movement of air creates a partial vacuum (low pressure) which can be filled up by more air. This is similar to sucking on a straw. A partial vacuum is created in your mouth when you suck on the straw. The liquid is pushed up the straw because of the pressure differences between your mouth and the atmosphere.
At sea level, mother nature exerts a pressure of 14.7 psi all around us. If one end of a tube is placed in water and a perfect vacuum is applied to the other end, that 14.7 psi could hold a column of water 33.9 feet high. This is only obtainable at sea level and with a perfect vacuum.
In nature, movement is from more dense to less dense. Weather systems are tracked as high pressures move toward low pressures. liquid under high pressure will move to an area of less pressure if a path is provided.

14. 4
Air Pump 5
4. The centrifugal pump works in the same way as sucking on the straw. As the engine starts, the impeller turns which forces the water around it out of the pump's discharge port. The partial vacuum created, allows the earth's air pressure to force water up the suction hose (straw), and into the suction (inlet) side of the pump to replace the displaced water.
5. Eg of water pump

15. Air Pump Bernoulli’s Principle
Rotating impeller to rotate the air flow
Spins the air (flow in slow in velocity, high in pressure)
Then discharge the air flow at nozzles with low pressure and high velocity.
Using turbine or motor to rotate impeller.

16. Nebulizer Air Pump

17. Exhale and Inhale

18. PERFORMANCE TESTING & MEASUREMENTS

19. Droplet size of the aerosol Amount of dose delivered
Characteristics of good performance of nebulizers : Rapid and efficient delivery of drug to the correct part of the respiratory tract
Critical factors affecting the performance of nebulizer:
Droplet size of the aerosol
Amount of dose delivered

20. TYPES OF PERFORMANCE TESTING
Provide real-time measurement of the size of droplets (average median diameter) produced
Laser Diffraction
Assessing the delivered amount of aerosol in fine-droplet fraction (%)
Cascade Impaction
Droplet size decreased with increasing compressed gas flow rate
Compressor Flow Rate
Measured the delivered dose of inhalation solution
Aerosol Output Analysis

21. 1. Laser Diffraction
Measurements can be made at varying the flow rate without affecting the accuracy of the results obtained
Analysis size distribution of droplets ranging from 0.25µm to 875µm
A 100-mm range lens: To detect the particles size
An inhaler attachment: To provide constant delivery of mist across the laser beam and also an enclosed system within the mist from the nebulizer
Air flow rate was controlled by the software (Sympatec)
The aerosol that passed across the laser beam was withdrawn by a vacuum extraction system: To avoid data error
Spraytec (Malvern Instruments)
Helos/Br Inhaler (Sympatec)

22. Results and measurements: Laser Diffraction
Figure 1 shows the effect of increasing the breathing rate on Dv50 delivered by the nebuliser
The Dv50 decreases as the bpm rate increases, especially during the mid-point of the breathing profile
Figure 2 shows changes in the median particle size (Dv50) and concentration delivered by a breath-assisted nebuliser (using 10bpm)
Initial inhalation: Low concentration delivered & Large droplet size
Midpoint inhalation: Droplet size decreases & aerosol concentration increases rapidly
Figure 1
To have different breathing profiles, use sinusoidal breath simulator to mimic different breathing pattern of person
Why need different flow rates? Changes in the air flow rate can be used to control the delivered particle size
Output of nebulizer changes in relation to inhalation profile
Measurement droplet size: Dv50 aka Median Droplet Size
Measurement breathing rate: bpm aka Breath Per Minute
Figure 2

23. 2. Cascade Impaction At a flow rate of 28.3 L/min over a 6 min period
High-pressure liquid chromatography mobile phase: To extract solution (arformoterol) from the various stages of the cascade impactor
The fine-droplet fraction is calculated: the sum of the arformoterol dose on stages 3 through “filter” divided by the sum of the arformoterol dose on “throat” through “filter” of the cascade impactor
Fine-droplet dose in nominal dose also calculated: [(delivered dose / fine-droplet fraction)/100]
Anderson Cascade Impaction
Schematic Diagram of Cascade Impaction

24. Results and measurements: Cascade Impaction
Figure 1 shows the set up of the performance testing and how amount of stages in cascade impactor can measure different sizes of aerosol (droplets)
Figure 2 shows the result of different brand of nebulizers can have different Fine-Droplet Fraction and Fine-Droplet Dose in % of Nominal Dose
The higher the % of Fine-Droplet Fraction, the smaller the size of droplets produced by the nebulizer
The higher % of Fine-Droplet Dose in Nominal Dose, the greater the amount of dose delivered through the nebulizer
Figure 1
Fine-Droplet : Size of droplets < 4.7µm
Fine Droplet Dose in Nominal Dose: Measure % of dose delivered among the dose droplet fraction
Figure 2

25. 3. Compressor Flow Rate
The air supply provides primary source of atomisation thus able in controlling droplet sizes
Flow rate measurements: Measured by using a rotameter
Rotameter is placed in line with nebulizer/compressor system
Measurements were taken at 1-minute and 6-minute intervals
Rossmax Nebulizer Tester

26. Results and measurements: Compressor Flow Rate
Figure 1 shows where the changes in droplet size distribution delivered by the nebulizer for different compressed air flow rates (using breathing rate 20bpm)
A gradual reduction in the overall droplet size distribution is observed as the gas flow rate increases
Figure 1
Measurement flow rate: L/min

27. Comparison between Laser Diffraction and Cascade Impaction

29. 4. Aerosol Output Analysis
Applied vacuum-assisted constant flow rate of 28.3 L/min
The aerosol output was collected in a glass Dreschel type apparatus
High-pressure liquid chromatography mobile phase solution: Extract solution (arformoterol) from the Dreschel-type apparatus
The amount arformoterol extracted measured via : high-pressure liquid chromatography
The residual amount of arformoterol contained in the nebulizer also extracted and measured using: high-pressure liquid chromatography
The remaining volume in the nebulizer bowl after extraction was measured: using weight

30. Results and measurements: Aerosol Output Analysis
Amount of solution (medication) delivered
Amount of residual (medication)
Remaining volume in the nebulizer