Conventional aerosol delivery systems and the availability of new technologies have led to the development of ''intelligent'' nebulizers such as the I-neb Adaptive Aerosol Delivery (AAD) System. Based on the AAD technology, the I-neb AAD System has been designed to continuously adapt to changes in the patient's breathing pattern, and to pulse aerosol only during the inspiratory part of the breathing cycle. This eliminates waste of aerosol during exhalation, and creates a foundation for precise aerosol (dose) delivery. To facilitate the delivery of precise metered doses of aerosol to the patient, a unique metering chamber design has been developed. Through the vibrating mesh technology, the metering chamber design, and the AAD Disc function, the aerosol output rate and metered (delivered) dose can be tailored to the demands of the specific drug to be delivered. In the I-neb AAD System, aerosol delivery is guided through two algorithms, one for the Tidal Breathing Mode (TBM), and one for slow and deep inhalations, the Target Inhalation Mode (TIM). The aim of TIM is to reduce the treatment time by increasing the total inhalation time per minute, and to increase lung deposition by reducing impaction in the upper airways through slow and deep inhalations. A key feature of the AAD technology is the patient feedback mechanisms that are provided to guide the patient on delivery performance. These feedback signals, which include visual, audible, and tactile forms, are configured in a feedback cascade that leads to a high level of compliance with the use of the I-neb AAD System. The I-neb Insight and the Patient Logging System facilitate a further degree of sophistication to the feedback mechanisms, by providing information on long term adherence and compliance data. These can be assessed by patients and clinicians via a Webbased delivery of information in the form of customized graphical analyses.

The results demonstrated that by using the I-neb AAD System in TIM, a 40-50% reduction of nebulizer treatment times, and a high level of compliance could be achieved. The results also showed that the patients found the I-neb AAD System easy to use.

Background: The telehealth service is one of the fastest growing healthcare segments. It is increasingly utilizing computer technology and telecommunication equipment to either provide continuous vital sign monitoring or facilitate patient care at home, rather than relying solely on in-person care. Methods: We conducted a 6-week open study in nineteen patients with cystic fibrosis enrolled from three centers, to investigate patient perception of a telehealth enabled nebulizer system (Prodose Adaptive Aerosol Delivery [AAD] System), which enabled the doorstep delivery of repeat medication. Results: The results showed that patient confidence in the device and perception of ease of use was high with no significant change between the start and end of the trial. Views on the home delivery of medication were split between 'great' and 'inconvenient.' However, if the delivery system had been more flexible and delivered all the patients' drugs, the majority of patients would have had their medication delivered in this way. Conclusions: The trial showed that it was possible to build telehealth technology into an advanced nebulizer system, and that patient acceptance of the technology was unlikely to be a barrier to the adoption of such a telehealth system.

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Introduction: Cystic Fibrosis (CF) is a chronic disease which, if left untreated, leads to colonization of the lungs by bacteria and irreversible lung damage. Whilst adherence to nebulized treatments by CF patients is typically poor, evidence suggests that electronic adherence monitoring, combined with treatment-related feedback, may aid patients' ability to adhere. [1] I-neb Insight Online is a telehealth-based patient management system, which incorporates monitoring and feedback. It is designed to support patients in taking an active role in their disease management. Conclusions: I-neb Insight Online provides patients and clinicians with remote access to treatment-related data. The handling study results indicated that the majority of patients found this system to be acceptable and were willing to engage with telehealth-based management. Data summaries and feedback were considered useful by the majority of patients and a high proportion favored continued use of the system; patients particularly valued the opportunity to monitor their own device use. The system has since been made available to all UK patients using the I-neb AAD System and will be available in Europe in the coming months. 1) Nikander, K. et al. Proceedings of Respiratory Drug Delivery. 2012;679-684. 2) Dyche, T. et al. Proceedings of Drug Delivery to the Lungs. 2010;365.