Currently available nebulizers are inefficient, bulky, noisy, and take longer to use than other inhalation devices. Use of nebulizers is increasingly confined to patients who cannot use other devices or who require therapies not available in another form. In the future, nebulizers will be smaller and more efficient. "Smart" nebulizers that can monitor patient use and provide feedback to the patient and the caregiver will be developed. Critical study will be needed to determine whether these innovations improve patient compliance with therapy. Nebulizers will also be refined for delivering complex molecules for both pulmonary and systemic disease. One example is in the use of gene therapy, in which issues such as the best gene vector are unresolved. Nebulizing these complex molecules without damaging them may be difficult, and nebulizers of the future will have to be more efficient to avoid wasting expensive drugs. For the delivery of widely used, less expensive medications, such as some bronchodilators, these innovations will not be cost-effective, so cheaper, less efficient nebulizers will continue to be used.
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