WO2003059424A1

WO2003059424A1 - Methods and systems for operating an aerosol generator

Info

Publication number: WO2003059424A1
Application number: PCT/US2003/001516
Authority: WO
Inventors: Niall Smith; John Power; James B. Fink; Michael Klimowicz
Original assignee: Aerogen, Inc.
Priority date: 2002-01-15
Filing date: 2003-01-15
Publication date: 2003-07-24
Also published as: US6968840B2; US7748377B2; US7331339B2; ES2603067T3; US20080060641A1; US20050172954A1; EP1474196B1; EP1474196A4; JP2005514991A; US20030140921A1; JP4761709B2; JP2006150093A; AU2003203043A1; EP1474196A1

Abstract

A nebule (28) having an identification marker/label (35) which is adapted to engage an aerosol generator (22). The marker/label (35) can be sensed by a sensing device (34) on the aerosol generator (22) so as to identify the contents of the nebule (28) for use by the aerosol controller (30). The controller (30) can then control the aerosol generator (22) based upon the identity of the contents of the nebule.

Description

METHODS AND SYSTEMS FOR OPERATING AN AEROSOL

GENERATOR

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is related to pending U.S. Patent Application Nos. 09/876,542, filed June 7, 2001, 09/876,402, filed June 7, 2001, and 09/812,987, filed March 20, 2001, the complete disclosures of which are incorporated herein by reference.

The present application is a continuation-in-part of U.S. Patent Application No. 09/849,194, filed May 4, 2001, which claims the benefit of Ireland patent application No. PCT/IE/00051, filed May 5, 2000, which are incorporated herein in their entirety.

The present application is a continuation-in-part of U.S. Patent Application S.N. 09/812,755, filed March 20, 2001, which is incorporated herein in its entirety.

The present application is a continuation-in-part and claims the benefit of U.S. Provisional Application 60/349,763, filed January 15, 2002, which is incorporated herein in its entirety.

The present application is a continuation-in-part and claims the benefit of U.S. Provisional Application Nos. 60/349,805, filed January 15, 2002; 60/380,655, filed May 14,

2002; 60/408,743, filed September 5, 2002; and 60/ , filed January 8, 2003, entitled

"Methods and Systems for Operating an Aerosol Generator", which are incorporated herein in their entirety.

The present application is a continuation-in-part of U.S. Patent Application No. 10/284,068, filed October 30, 2002, which claims the benefit of U.S. Provisional Application Nos. 60/344,484, filed November 1, 2001 and 60/381,830, filed May 20, 2002, which are incorporated herein in their entirety. BACKGROUND OF THE INVENTION

The present invention is generally related to liquid aerosol generators. In particular, the present invention is related to methods and devices for identifying the contents of a nebule to improve the delivery of the aerosolized liquid to the patient.

The ability to aerosolize or nebulize small liquid droplets is important in a variety of industries. Merely by way of example, many pharmaceuticals can now be delivered to the lungs in liquid droplet form through use of an aerosol generator, such as a nebulizer inhaler. Aerosolization is also a useful technique to dispense deodorizers, perfumes, insecticides, or the like, into the atmosphere or to other target areas.

Aerosol generators can be configured to deliver a number of different pharmaceutical aerosols to the patient's lungs or other target areas of the body. Typically, the aerosol generator will utilize a removable supply of a liquid pharmaceutical that is contained in some type of portable nebule, such as an ampoule, container, canister, reservoir, or the like.

While the existing aerosol generators have proven to be effective, the existing aerosol generators suffer some limitations. One problem with existing aerosol generators is that users may inadvertently install and nebulize an incorrect drug nebule into the aerosol generator. As can be appreciated, delivery of the wrong drug can be extremely dangerous, if not fatal.

Another problem with existing aerosol generators is that the aerosol generator cannot identify the liquid in the nebule. Consequently, it has proven to be difficult to provide an efficient delivery of the aerosolized pharmaceutical to the patient. Since some of the pharmaceuticals to be aerosolized may be more effective when delivered near the beginning of a patient's breathing cycle, while other pharmaceuticals may be more effective when delivered near the end of the patient's breathing cycle it is preferable that the aerosol generator be able to identify the type of liquid disposed in the nebule so that the correct delivery sequence can be chosen to deliver the aerosol to the patient. While the existing nebulizers have proven to be effective within certain parameters, the existing nebulizers also present opportunities for improvements.

One area for improvement is the calculation and control of the precise time of aerosol delivery within a user's or patients breathing cycle. This is especially in issue with respect to patients that receive some of all of their inspiratory air from a ventilator device. Existing nebulizers may deliver a constant flow of aerosol into the ventilator tubing, which can lead to a significant amount of aerosol lingering in the tubing or other elements of the overall ventilator system - this lingering aerosol may not be inhaled, as it collects while the patient is exhaling or otherwise not inhaling, resulting in a significant amount of aerosolized medication being pushed out of the system, such as during exhalation, without being inhaled by the patient. Such situations are problematic for a number or reasons. First, the dosage of drug that actually is inhaled by the patient may be significantly inaccurate because the amount of medication the patient actually receives into the patient's respiratory system may vary with fluctuations of the patient's breathing pattern. Further, a significant amount of drug that is aerosolized may end up being wasted, and certain medications are quite costly, thus health-care costs can be escalated. Further still, unused aerosolized medication will typically be released to the ambient atmosphere with a patent's exhalation. This can end up medicating individuals in the patient's surroundings and this may give rise to adverse effects with respect to such individuals. Moreover, in a hospital environment such individuals may be either health-care providers, who could be exposed to such air pollution over a prolonged period of time, or other patients, who may be in a weakened condition or otherwise overly sensitive to exposure to non-prescribed or excessive amounts of a medication.

For these reasons, it is desired to provide an aerosol generator that can obtain information about the contents of the nebule. In particular, it is desired to provide methods and devices, which can determine the type of liquid disposed in the drug so as to provide an improved level of safety to the patient and an increased efficiency in the delivery of the aerosol to the patient. Further, for these reasons, it is desired to provide methods and devices that can provide aerosol to a patient at a selected interval of the breathing cycle. It is also desired to provide methods and devices that can provide aerosol to a patient at a selected interval wherein the interval is selected based on the identity of the drug to be administered.

BRIEF SUMMARY OF THE INVENTION

The present invention provides devices and methods for improving a level of safety to the patient and for providing an increased efficiency of delivery of an aerosol to the patient

In one method, the present invention provides a method of creating an aerosol. The method comprises providing an aerosol generator and coupling a nebule to an interface of the aerosol generator. An identification marker is read on the nebule and the aerosol generator is operated according to an operation program based on the information read from the identification marker on the nebule.

In another method, the present invention provides a method of nebulizing a liquid. The method comprises taking one or more breaths and measuring characteristics of the breath. Another breath is taken and an aerosol generator is operated based on the measured characteristics of the one or more measured breaths.

In yet another method, the present invention provides a method comprising providing a nebulizer system comprising a housing, an aerosol generator, a controller coupled to the aerosol generator, and a reservoir in communication with the aerosol generator. A nebule having a body and a keying element is provided. The nebule is inserted into the housing so that the key element provides access to the reservoir when properly keyed with the housing. The liquid is transferred from the nebule into the reservoir and the aerosol generator is operated with the controller to aerosolize the liquid.

In another aspect, the present invention provides an aerosol generator comprising an interface. A sensing device is coupled to the aerosol generator. An ampoule having at least one identification marker that can detected by the sensing device is attachable to the interface.

In another aspect, the present invention provides a nebulizer system comprising a housing that defines a passageway that is adapted to deliver an aerosolized liquid to a user. An aerosol generator is positioned to provide an aerosolized liquid into the passageway. A controller having a memory and a plurality of aerosol generator operation programs that control operation of the aerosol generator is coupled to the aerosol generator. A reader is configured to read an identification marker on a nebule having a supply of liquid for the aerosol generator, and is configured to send information from the identification marker to the controller. Typically, the controller is further configured to operate the aerosol generator according to one of the operation programs based on the information from the marker.

In another aspect, the present invention provides a nebule comprising a nebule body holding a liquid that is adapted to be supplied to an aerosol generator of a nebulizer; and an identification marker on the nebule body, the identification marker having information identifying the liquid, wherein the identification marker is readable by a nebulizer to control operation of the aerosol generator based on the information.

In another aspect, the present invention provides a nebulizing element positioned to provide nebulized fluid into a ventilator breathing circuit to provide nebulized fluid to a patient receiving air from a ventilator. It will be appreciated that a nebulizing element may also be referred to herein a an aerosolization element, and a ventilator may also be referred to herein as a respirator.

In another aspect, the present invention provides operation sequences by which aerosol is provided a predetermined points in a breath cycle provided by a ventilator. In one aspect, the present invention provides for an operation sequence in which aerosol production begins at a predetermined point within an inhalation phase, which may also be referred to herein as an inspiratory phase, and stops at a second predetermined point within the same inhalation phase. In another aspect, the present invention provides for an operation sequence, which may be referred to as an operation program, in which aerosol production begins at a predetermined point in an inhalation phase and stops at a point after the inhalation phase has ended, i.e. at a certain point in the exhalation phase. It will be appreciated that the exhalation phase may also be referred to as the expiratory phase, and may encompass the entire period of time during which no inhalation phase is taking place; in other words, the exhalation phase may include not only the actual exhalation of the patient, but also any pause that may occur before or after exhalation. In another aspect, the present invention provides an operation sequence in which aerosolization begins at a predetermined point within the exhalation phase and stops within that exhalation phase, or, alternatively, begins at a predetermined point within an exhalation phase and stops at a predetermined point in the succeeding inhalation phase.

In another aspect, the present invention provides for selection of a particular operating sequence from a plurality of available operating sequences. Similarly, the present invention provides for modes of operation, which modes may include one or more operating sequences.

In another aspect, the present invention provides for algorithms to set forth operation sequences, choice of operation sequences or choice of modes of operation.

In another aspect, the present invention provides for consideration of the identity of a drug to be administered in executing an algorithm, choosing a mode of operation, or selecting or running an operation sequence.

In another aspect, the present invention provides for nebulization of particular drug groups or drugs, such as, for example, antibodies, such as IgG or antibiotics, such as aminoglycosides, such as amikacin.

In another aspect, the present invention provides for a nebulized droplet ejection device for use with a ventilator, wherein the device produces droplets by a vibratory apertured element during a selected interval of a breathing cycle.

In another aspect, the present invention provides for apparatus and methods for varying the particle size distribution of a nebulized mist by varying the aperture exit diameter of an apertured vibratory aerosolization element. For a further understanding of the nature and advantages of the invention, reference should be made to the following description taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 schematically shows a system of the present invention;

Figures 2 to 4 illustrate an exemplary nebule and feed system interface of the present invention;

Figure 5 shows an elevational view of another exemplary system of the present invention comprising an electromechanical sensor;

Figure 6 shows a plan view of an ampoule and an electromechanical sensor of Figure 5;

Figures 7 and 8 show an ampoule and feed system interface having an alternative threaded interface;

Figure 9 is a cross sectional plan view illustrating another ampoule and feed system interface;

Figure 10 is a plan view of an ampoule having an identification marker disposed in a non-helical configuration;

Figure 11 illustrates a simplified flowchart illustrating one exemplary method of the present invention;

Figure 12 illustrates another simplified method of the present invention;

Figure 13 illustrates yet another simplified method of the present invention; and

Figure 14 illustrates another simplified method of the present invention.

Figure 15 is a graph showing various modes of aerosolization over the course of breathing cycles;

Figure 16a is a schematic cross-sectional representation of an aerosol generator in accordance with the present invention;

Figure 16b is a schematic cutaway cross-section detail of the aerosol generator represented in Figure 16a.

Figure 17 is a schematic perspective view of a nebulizer incorporated into a ventilator breathing circuit in accordance with the present invention;

Figure 18 is a schematic representation of algorithms of operating sequences in accordance with the present invention;

Figure 19 s an alternative schematic representation of the representation of Figure 18; Figure 20 is a further schematic representation of algorithms of operating sequences shown in Figure 19 and in accordance with the present invention.

Figure 21 is a schematic representation of an algorithm by which an operating sequence may be chosen base on the combination of a plurality of independent sets of information.

DETAILED DESCRIPTION OF THE INVENTION The aerosol generator systems of the present invention, in one aspect, include an aerosol generator coupled to a controller that is in communication with at least one sensor such that delivery sequence of the aerosol to the patient can be based at least in part on the information obtained with the sensors. In some exemplary embodiments, the system includes a nebule identification sensor to read an identification marker on the nebule so as to identify the type of liquid that is disposed within the nebule. In other exemplary embodiments, the system includes a breathing characteristic sensor that monitors and records the breathing characteristics of the patient so as to allow the controller to direct the delivery of the aerosol to coincide with the patient's breathing pattern. In yet other exemplary embodiments, the aerosol generator system includes both a nebule identification sensor and a breathing characteristic sensor.

Figure 1 schematically illustrates an exemplary aerosol generating system 20 of the present invention. The system 20 includes an aerosol generator (AG) 22 that is in communication with an output passageway 24, such as a ventilator circuit, mouthpiece, face mask, or the like. A nebule 28 containing a liquid can be removably coupled to a feed system interface 26 to deliver a liquid to aerosol generator 22 for aerosolization. A controller 30 is in communication with aerosol generator 22 to control the sequence of aerosolization of the liquid to the patient. Controller 30 can be coupled to a breathing sensor 32 that is in communication with output passageway 24 so as to monitor the breathing characteristics of the patient. Additionally or alternatively, controller 30 can be coupled to nebule identification sensor 34 to identify the type of liquid that is disposed in nebule 28 by reading an identification marker that is provided on nebule 28. Controller 30 can take the information from flow sensor 32 and/or nebule sensor 34 and run the information through an algorithm to determine an efficient sequence of aerosolization. Typically, the controller will run a selected pre-programmed delivery or sequence program that is stored in controller 30 so as to deliver the aerosol to the patient in an optimal time of the patient's breathing cycle. Controller 30 can include a memory and a microprocessor so as to store and run the algorithm that selects the pre-programmed drug delivery sequence. The memory of the controller can store a list or library of codes and/or drugs that are compatible with the aerosol generator, information about the drugs, such as a regime to be followed based on the particular drug, the time in the breathing cycle when the drug is best administered, the amount of the drug to be aerosolized, or the like.

Controller 30 will typically be in communication with at least one sensor. As noted above, one sensor can be a nebule identification sensor 34 that reads an identification marker on the nebule to identify the type of liquid disposed within the nebule. The sensor can be a mechanical sensor, an electromechanical sensor, an electrical sensor, an optical sensor or the like. Such sensors can be used to provide information to the controller for a number of purposes. For example, the identification information can be used to identify the type of drug so as to choose the delivery sequence program. Moreover, the identification information can be used as a quality control mechanism to prevent the aerosolization of an incompatible, unsafe, or unknown drug, and the like.

Another type of sensor that can be coupled to controller 30 is a breathing characteristic sensor 32 that can monitor the breathing characteristics of the user. The sensor can send breathing characteristic information to the controller to allow the controller to select an appropriate delivery cycle of the aerosolized liquid to the patient. Typically, breathing characteristic sensor 32 can be used to measure a breathing pattern of the patient, the peak flow, breathing rate, exhalation parameters, regularity of breathing, and the like. Such measured breathing characteristics can be delivered to controller 30 and run through a software algorithm to determine an appropriate sequence of delivery relative to the measured breathing cycle to the patient. One exemplary breathing characteristic that may be sensed by sensor 32 is the cycle of a ventilator providing air to a patient; for example, the start of an inhalation cycle generated by the ventilator. The sensor 32 may sense other parameters, for example, it may be an acoustic sensor that is activated through passing the respiratory flow of the patient through an acoustic chamber (not shown) so as to produce an acoustic tone, which is proportional to the inspiratory flow rate. The frequency of the acoustic tone indicates the inspiratory flow rate at any instant of the breathing cycle. The acoustic signal can be detected by the controller such that integration of the flow rate with time produces the tidal volume. Both the flow rate and the tidal volume can then be used by the controller to determine when the aerosol generator generates the droplets and at what mass flow rate such that maximum deposition of droplets is obtained. Further, the acoustic tone may be recorded to produce a record of the breathing pattern of the patient which may be stored in the microprocessor. This information can be later used to synchronize the ejection of droplets for the same patient. Such information may also be later employed for other diagnostic purposes. A more complete description of such a sensor is described in commonly owned, U.S. Patent 5,758,637, which was previously incorporated by reference.

In some embodiments, the sensor can be used to monitor the breathing characteristics of the patient throughout the delivery regime so as to ensure that the aerosol is efficiently delivered throughout the aerosolization procedure. In such embodiments, the controller can adjust the aerosol delivery based on any measured change in the breathing pattern of the patient during the aerosolization. With this monitoring and adjustment predetermined times for the beginning and ending of aerosolization can be reset based on the actual breathing of the patent. In other embodiments, however, the breathing sensor can be used to determine the breathing cycle of a tidal breath and to choose the appropriate preprogrammed delivery cycle that is stored in the memory of the controller. In other embodiments, the controller may be configured to provide aerosol based on the time. For example, the controller may be configured to start aerosol production at the beginning of an inhalation phase of a breathing cycle and stop at a point at which a predetermined percentage of the inhalation has taken place. Alternatively, the controller may be configured to start aerosolization at a first point at which a first predetermined percentage has taken place and stop aerosolization at a second point at which a second predetermined percentage of that inhalation has taken place. Alternatively, aerosol may begin during an inhalation phase and end during the subsequent exhalation phase. Alternatively, the controller may be configured to begin aerosol production at a certain point during exhalation and stop during that exhalation or during the subsequent inhalation. Thus, an aspect of the present invention may include a nebulizer comprising: an aerosol generator and a controller configured to have the controller begin aerosolization during exhalation and stop during that exhalation or in the subsequent inhalation. In addition, the controller may be operable to allow for a choice of modes of operation, for example, a mode in which aerosolization begins once a certain breath characteristic is detected, such as a sufficient level of inhalation, and ends when there is no longer a sufficient level; another mode in which aerosolization begins once a certain breath characteristic is detected, such as a sufficient level of inhalation, and ends at a predetermined time within the inhalation cycle, such as for example, before the level of inhalation falls below that required for operation of an aerosolization element, or, alternatively, at any other point within the inhalation cycle, such as after the inhalation phase of the cycle before exhalation has begun, or after exhalation has begun.

The level of inhalation may be sensed by a pressure transducer. Such a transducer may monitor a drop in air pressure or a rise in air pressure within a chamber that is in fluid communication with the ventilator circuit. In this manner, a pressure drop may be sensed by a patient inhaling through the circuit, for example, in an instance in which the ventilator provides an assisted ventilation initiated by a patient's commencement of an inhalation. Similarly, a pressure rise may be sensed in an instance in which the ventilator pushes inhalation air to the patient without the patient initiating a breath. Another mode in which the controller may be operable is a mode in which the on / off operation of the aerosol generator is triggered by time, which may be ascertained from an internal clock device, such as a clock built into a microprocessor, or from an external source. Another mode in which the controller may be operable is in which the on / off operation of the aerosol is triggered by the controller receiving an external signal, such as a signal from a ventilator, which can correspond to the point in the ventilator's cycle of that is the start of an inhalation phase in which the ventilator begins to push inspiratory air into the ventilator circuit. The controller may be operable between such modes, including a mode in which the aerosolization begins at a predetermined time in the breathing cycle and ends at a predetermined time in the breathing cycle. The first and second predetermined times in the third mode may be during inhalation. Alternatively, the first and second predetermined times may be during exhalation, or at the first predetermined time may be during exhalation and the second predetermined time may be during subsequent inhalation. These times may correspond to certain percentages of the inhalation phase taking place, or any other points of reference within a breathing cycle.

Alternatively, the first predetermined time and the second predetermined time may be designated as any point within a single breathing cycle, or alternatively, the first predetermined point may be at any point within one breathing cycle and the second predetermined point may be at any point in a subsequent breathing cycle. The controller may make the determination of when to begin, and operate to begin aerosolization, and may make the determination of when to stop aerosolization to stop, and cause aerosolization to stop. The controller may make such determinations and take such actions based on accessing stored algorithms. The controller may receive a signal from the ventilator that establishes a reference point, nonetheless, the controller, by making the determinations an taking the actions based on stored algorithms, and/or information obtained as to the identity of a drug to be administered, may cause aerosol production to begin and/or end independent of the instantaneous position of the ventilator with respect to the ventilator cycle.

The controller may be operable to allow for a single mode of operation, and such single mode of operation may be any mode, for example, as described above. For example, a mode in which aerosolization begins once a certain breath characteristic is detected, such as a sufficient level of inhalation, and ends when there is no longer a sufficient level. Similarly, the controller may operable in a mode in which aerosolization begins once a certain breath characteristic is detected, such as a sufficient level of inhalation, and ends at a predetermined time within the inhalation before there is no longer a sufficient level or an aerosolization element.

Alternatively, the mode may be a mode in which the aerosolization is commenced based on a signal from the ventilator indicating the attainment of a certain point within the ventilation output cycle or the inhalation cycle of the patient. (The ventilation output cycle of the ventilator may coincide with the inhalation cycle of the patient, such that the ventilation output phase of the ventilator output cycle and the inhalation phase of the inspiratory cycle of the patient occur substantially simultaneously. Such may be the case where a patient is completely passive and the only inhalation that occurs is by generation of air from the ventilator during the output phase of the ventilator cycle.). Such point may be during the output phase of the output cycle of the ventilator or during the inhalation phase of the inhalation cycle of the patient. The predetermined point can be chosen to coincide with a certain level of output from the ventilator or at a certain point in time during the ventilator output cycle. Such a predetermined point may be a specific point within the output phase of the ventilator cycle, or, a specific point within the non-output phase of the ventilator cycle, based, for example, on the timing of the previous or succeeding output phase of the ventilator. In another aspect, the present invention provides for a ventilator along with the aerosol generator and controller. In an aspect of the invention, a predetermined time may be based on the timing of a ventilator supplying air to a user. In this manner, the controller may be set to work off of the timing of the ventilator in one mode, while working off the patient's inspiratory effort in another mode, or mode that allows for a combination of the patient's inspiratory effort and the timing of the ventilator, for example, where the ventilator is set to assist the patient by supplying air upon the patient's effort or where the patient has not made a sufficient effort within a predetermined period of time.

In regard to the aerosol generators 22 of the present invention, they may be of the type, for example, where a vibratable member is vibrated at ultrasonic frequencies to produce liquid droplets. Some specific, non-limiting examples of technologies for producing fine liquid droplets is by supplying liquid to an aperture plate having a plurality of tapered apertures and vibrating the aperture plate to eject liquid droplets through the apertures. Such techniques are described generally in U.S. Patent Nos. 5,164,740; 5,938,117; 5,586,550; 5,758,637, 6,014,970, and 6,085,740, the complete disclosures of which are incorporated by reference. However, it should be appreciated that the present invention is not limited for use only with such devices.

Figures 2 to 10 illustrate some exemplary feed system interfaces 26 and nebules 28 of the present invention. As shown in Figure 2, nebule 28 can be an ampoule that comprises a body 36 with a top end 38 and a bottom end 40. Bottom end 40 can include a tapered opening that can deliver the liquid from ampoule 28 into a fluid reservoir 42 adjacent aerosol generator 22. Top end 38 can include a twist-off vent 44 that can be removed to create a drain vent in top end 38. Some exemplary ampoules that can be used with the present invention are described in co-pending U.S. Patent Application S.N. 09/812,755, filed March 20, 2001, the complete disclosure of which was previously incorporated by reference.

The ampoules of the invention may be used to store a wide variety of liquids. Merely by way of example, liquids that may be stored within the ampoules include various pharmaceuticals such as saline, albuterol, chromatin, budesinide, nicotine, THC, cocaine, antibodies, such as IgG, antibodies, such as aminoglycosides, and the like. Other liquids that may be stored include insecticides, deodorizers, perfumes, and the like. Hence, it will be appreciated that the ampoules of the invention may be used to store essentially any type of liquid that is capable of being aerosolized.

The ampoules of the invention may be constructed by blowing or vacuum-forming the ampoule in a mold, filling the ampoule with liquid, and melt-sealing the liquid into the ampoule. The ampoules may further be provided with a set of removable tabs to provide a drain vent and a drain opening. Typically, these will be located in the top and bottom of the ampoule so that the liquid may drain by force of gravity once the openings are formed. The tabs may be removed by twisting, cracking, or the like so that the opening may be formed. In some cases, the ampoules may be configured to be opened simply by piercing the top and/or bottom end. Such piercing elements may conveniently be incorporated into the aerosolization device.

Various materials may be used to construct the ampoules, such as moderate durometer polymer materials, thermoplastic synthetics, such as low density polyethylene and polypropylene, and the like. The ampoules may be provided with a thick enough wall to minimize droplet spillage. For instance, the wall thickness may be greater than about 0.030 inch. The ampoule may further be configured so that the diameter of the drain opening minimizes the drip potential for the fluid stored within the ampoule. For example, larger diameter openings may be provided when storing higher viscosity fluids and smaller diameter openings may be used for low viscosity fluids.

The ampoules of the present invention can include a connection or keying element 46, such as a thread or a tab so as to accurately align the ampoule 28 with a nebulizer feed system interface 26. The feed system interface 26 will have a corresponding feature or slot 48 to engage the connection element. In the exemplary embodiment illustrated in Figures 2 to 4, ampoule 28 can include a helical keying element 46 that is shaped to mate with the corresponding keying feature 48 in feed system 26. To insert the ampoule into feed the system, the ampoule is moved axially (in the direction of arrow 50) until helical keying element 46 is positioned adjacent the corresponding keying feature 48. Thereafter, the ampoule 28 is rotated to mate the keying element 46 and the keying feature 48 together so as to pull the ampoule 28 axially downward until the bottom end 40 of the ampoule 28 opens slit seal membrane 52 in feed system 26 (Figures 3 and 4).

In the exemplary embodiments, ampoule 28 includes an identification marker 35 to identify to the controller, the liquid that is within ampoule 28. Identification marker 35 can be a bar code (e.g., embossed or printed), one or more bumps or protrusions, a radio frequency identifier, a small chip containing stored information, or other suitable identification technology. In the embodiments depicted in Figures 2 to 4, information regarding the contents of the ampoule is conveyed through a series of protrusion identification markers 35 on the ampoule 28 that are sensed by their interaction with an optical detector 56 during the rotational engagement of ampoule 28 with the feed system interface 26. In this particular embodiment, a miniature light source 58 and the optical sensor 56 are coupled to the feed system 26 such that a passing protrusion 35 affects the sensed light in a manner such that the sensor 56 may provide information (e.g., typically binary information, i.e., a "0" or a "1") based on position, number, or absence of the protrusion. Thus, rotation of an ampoule 28 as it is threadedly inserted into the nebulizer feed system 26 may count the number of bumps or provide a code such as "1-0-1-0" so as to inform the nebulizer controller 30 (Figure 1) the type of medicant or other liquid that is disposed in the ampoule. A single sensor can read the code imparted by a series of protrusions as the ampoule 28 is moved axially into the nebulizer feed system 26 while it is rotated through the threaded features in the housing of feed system 26. Figure 5 illustrates another exemplary nebule identification sensor 34 and ampoule 28. Nebule sensor 34 can include an electromechanical switch that contacts the protrusions on the nebule as it is inserted into the feed system. As shown in Figure 5, the nebule includes a helical keying element 46 that interacts with a corresponding helical keying feature (not shown) to position the ampoule within feed system interface 26. As the ampoule is rotated and moved axially downward, the protrusion identification markers will contact and actuate a metal spring-like contact 60 of nebule sensor 34 so as to create a circuit and send an identification electrical signal to controller 30 to identify the type of drug in ampoule 28. As shown in the plan view of Figure 6, nebule sensor 34 can include one or more metal contacts 60, such that rotation of the ampoule 28 can cause the protrusion identification markers to contact the metal contacts 60, 60'. By changing the spacing and number of protrusion identification markers, a unique electrical identification signal can be generated to identify the liquid in the ampoule to the controller. In turn, the controller can then select and run a delivery program that provides an efficient delivery of the identified liquid.

Another exemplary ampoule 28 and feed system interface 26 is illustrated in Figures 7 and 8. As shown in Figure 7, an ampoule bottom end 40 having a keying tab 46 can interact with a spiral slot 48 in the feed system interface 26. As the ampoule is inserted and rotated within the feed system interface 26, the keying element(s) engage the spiral slot 48 so as to pull the ampoule down into the interface (Figure 8). Similar to the above embodiments, the bottom end of the ampoule can protrude through slit seal membrane 52 so as to be able to deliver the liquid to reservoir 42. Identification markers 35 can be sensed by the identification sensors (not shown), as described in the above embodiments.

The ampoule protrusion identification markers 35 can be in a single helix configuration or a double helix configuration. In exemplary embodiments, the identification markers are in a double helix arrangement so that as the first set of protrusions is read, providing a binary code to the system, the second set of protrusions can provide a complementary binary code (read by a second optical detector, not shown) as ampoule 28 is screwed into nebulizer feed system 26 (Figures 2 to 4). Thus, the binary code of the first series of protrusions might, for example, convey the code "1-0-1-0" as each of protrusions are sensed as the ampoule is screwed into the nebulizer feed system housing, while the second series provides the complementary code of "0-1-0-1". In this manner, the controller can check that when a particular binary code is transmitted by the first set of protrusions, the complementary binary code is sensed by the second set of protrusions. Thus, the system can prevent the potential mis-information that might be transmitted were there only a single set of protrusions provided to convey the information, and the insertion was done incorrectly.

Such interaction further allows the system to check against a situation in which one or more ampoule protrusions are damaged to the extent of effecting the sensing function, because the system will have the code provided by the second series of protrusions to check against the information provided by the first set of protrusions.

Alternatively, the second set of protrusions may be used to provide more code combinations for different drugs. In exemplary embodiments, by providing three bumps or protrusions on each side of the ampoule, the controller of the aerosol generator can determine which of 9 drugs or medicants are disposed in the ampoule. For example, the following distribution of bumps or protrusion can deliver a signal to the controller to indicate the identity of the following drugs:

Drug Type Number of Bumps on Side 1 Number of Bumps on Side 2

Drug A 1 0

Drug B 2 0

Drug C 3 0

Drug D 1 1

Drug E 2 1

Drug F 3 1

Drug G 2 2

Drug H 2 3

Drug I 3

In the embodiment illustrated in Figures 2 to 8, the protrusion identification markers 35 are disposed in a helical configuration that has a pitch that substantially matches the pitch of the helical keying element 46, such that as the helical keying element is rotated and moved through the corresponding keying feature 48, the protrusion identification markers pass by the optical sensor 56 or metal contacts 60. It should be appreciated however, that the identification markers 35 can be disposed in a variety of non-helical patterns, as will be described in relation to Figures 9 to 10.

Figure 9 illustrates one exemplary embodiment of an ampoule 28 having identification markers 35 that are disposed in a non-helical arrangement. As illustrated, ampoule includes a keying slot 62 adjacent a bottom end of ampoule 28 to allow the ampoule to be inserted into feed system interface 26. If keying slot 62 does not correspond with the keying tab 64 on the interface, the ampoule will be prevented from being seated within the interface and the liquid in the ampoule will be prevented from being delivered to reservoir 42. In situations where the keying slot matches the keying tab, as ampoule 28 is inserted axially into feed system and twisted to engage the keying slots with the keying tabs, the identification marker 35 will simultaneously pass across nebule sensor 34. The illustrated embodiment includes a bar code reader that reads a bar code identification marker, but it should be appreciated that the identification marker 35 and identification sensor 34 can include any of the other types of identification markers and sensors or their equivalents, as described above.

Figure 10 illustrates an ampoule 28 that includes bump identification markers that are disposed on the ampoule such that axial insertion of the ampoule (without rotation) into the feed system interface 26 contacts the bump identification markers 35 against the electromechanical contacts 60. Ampoule 28 can include a retainer or click positive position feedback element 66, and/or alignment means for aligning the ampoule into the feed system.

Variations to the above description may be made in accordance with the present invention. For example, ampoule 28 can include other keying elements and/or orientation elements to ensure that the ampoule is properly oriented when it is inserted into the aerosolization device. A more detailed description of such keying elements and orientation elements can be found in co-pending U.S. Patent Application 09/812,755, filed March 20, 2001, the complete disclosure of which was previously incorporated herein by reference. In such embodiments, the identification markers 35 can be disposed on the ampoule relative to such keying or orientation elements in any position in which the sensors can sense the markers and determine the type of medicament or drug that is disposed in the ampoule.

Methods of the present invention will now be described. In one method, the present invention identifies the contents of the nebule to improve the operation of the aerosol generator. As illustrated in Figure 11, an aerosol generator is provided (Step 100) and a nebule is coupled to a nebule interface of the aerosol generator (Step 102). An identification marker on the nebule is read by the aerosol generator (Step 104) and the aerosol generator is operated according to an operation program based on the information read from the identification marker on the nebule (Step 106).

Typically, the aerosol generator is operated with a controller (Figure 1). The controller typically includes a memory that stores a plurality of operation programs for delivering each of the compatible specific types of drugs or medication. After the identification marker is read by a sensor, the information is passed to the controller so that a correct operation program can be selected to operate the aerosol generator. The operation program can control the start and stop times of the aerosol generator, the aerosol production rate, the amplitude of vibration of the aerosolization element, the frequency of aerosolization, and the like.

It should be appreciated that, in addition to using the identification marker information to control the operation of the aerosol generator, the information from the identification marker may be used for other purposes. For example, as shown in Figure 1, the systems of the present invention 20 may optionally include an output device 68, such as a printer, audio speaker, or LCD. When the identification information received by the sensor matches a code entry inside the controller memory, the drug name, dosage information, or other pertinent information can be made available to the user by displaying or announcing the information via the attached output devices. Additionally, the identification markers can be used for preventing the wrong drug from being administered to the patient by setting the aerosol generator controller to operate the aerosol generator only on the reception and identification of one or more particular drug codes/identification markers to the exclusion of others: e.g. one patient's nebulizer may be set to accept nebules containing, and coded for, drug A and drug B, while another patient's nebulizer may be set to only operate if a nebule contains, and is coded for, drug A.

Typically, the identification marker is positioned adjacent a sensor through use of a keying element on the nebule. The keying elements can interact with a corresponding keying feature on the aerosol generator interface to position the identification marker adjacent the sensor. In other methods, however, the keying elements on the nebule can be used to control the types of nebules that can be coupled to the aerosol generator system. In such methods, as shown in Figure 12, a nebulizer system and a nebule comprising a nebule body with a keying element (e.g., threads, tabs, slots, and the like) are provided (Steps 110, 112). The nebule can be inserted into the housing. If the keying element is properly keyed with a housing of the nebulizer system, the nebule can access a reservoir of the system (Step 114). Thereafter, the liquid from the nebule will be transferred into the reservoir for aerosolization (Step 116). The aerosol generator can then be operated with a controller to aerosolize the liquid (Step 118).

The keying elements, identification markers, or both can be used to ensure that only nebules which are compatible with the feed system and aerosol generator are used. For example, as a first precaution, the aerosol generator systems of the present invention can include a keying feature that mates only with certain types of nebules. For example, nebules containing steroids may have a different keying element than nebules containing antibiotics. Therefore, patients using the aerosol generator only for steroidal delivery will be prevented from keying the nebule containing an antibiotic to the aerosol generator and inadvertently nebulizing the antibiotic, and vice versa.

Additionally or alternatively, the controller of each individual system can be programmed to only have available sequence delivery programs (which may be referred to as operation sequences, or algorithms for operation sequences) for selected medicants or drugs that are found in a library of codes and drugs in the controller memory. Thus, if the identification marker on a nebule that is coupled to the aerosol generator is not one of the drugs on the list stored in the controller memory, the controller will not deliver the aerosol to the patient. Optionally, the controller can provide an output informing the user that the installed nebule is incompatible with the system.

In other exemplary methods, the present invention can measure the characteristics of a persons inhaled breath, typically a tidal breath, to control the operation of the aerosol generator. As shown in Figure 13, a person can take one or more breaths (Step 120) and the characteristics of the breath can be measured (Step 122). The breathing characteristics that can be measured include, but are not limited to, a breathing pattern, peak inspiratory flow rate, breathing rate, exhalation parameters, regularity of breathing, tidal volume, and the like and can estimate a user's tidal volume based on such information. The user can take another tidal breath and the aerosol generator can be operated based on the measured characteristics of the tidal breath (Step 124). It should be appreciated however, that instead of a tidal breath, the person can take other types of breath. Alternatively, the controller may base the timing of operation of the aerosol generator so that aerosol is generated at specific time periods within a breathing cycle, (Step 125, Figure 13a). For example, the controller may operate the aerosol generator for the first 50 percent of inspiration. Alternatively, the controller may operate the aerosol generator to generate aerosol after a portion of inhalation has taken place and to cease producing aerosol after another portion of inhalation has taken place. For example, the controller may cause aerosol to be generated beginning after 20% of the inspiration has taken place and cause aerosol production to cease after 70% of inspiration has taken place. The controller may cause aerosol production to start after, for example, after 90%) of exhalation has taken place and, for example, cause aerosol production to stop after 30%) of the following inspiration has taken place. By controlling the specific timing within the breathing cycle that aerosolized medication is provided into the breathing circuit, greater efficiency of drug administration can be achieved. With reference to Figs. 15a- 15c, for example, continuous aerosolization may yield only about 10%> to about 15%> efficiency (Fig 15a), aerosolization during the entire inhalation phase of the breathing cycle may yield about 15%) to about 25% efficiency (Fig 15b), and delivery during a predetermined portion of the inhalation phase beginning, for example, at the onset of inhalation, may provide a drug yield between about 60%> to about 80%> efficacy (Fig 15c). Accordingly, the present invention, by controlling delivery to a predetermined percentage of the breathing cycle, such as a predetermined percentage of the inhalation phase of the breathing cycle, provides far greater efficiency than either continuous delivery or delivery during the entire inhalation phase. Further, and surprisingly, the percentage of increase in efficiency in delivery for such a predetermined portion of the inhalation phase (Fig. 15c) over delivery during the entire inhalation phase (Fig. 15b) is itself far greater than the increase in efficiency of delivery during the inhalation phase (Fig. 15b) over simply continuously providing aerosol (Fig. 15a).

By utilizing an aerosol generator that produces aerosol by the electric powering a vibratable member that causes an aperture plate to eject liquid at one face thereof, through its apertures, as a mist from the other face thereof, as generally described above (and as described generally in U.S. Patent Nos. 5,164,740; 5,938,117; 5,586,550; 5,758,637, 6,085,740; and 6,235,177, the complete disclosures of which are, and have been above, incorporated herein by reference), the starting and stopping of aerosol generation may be controlled on the level of accuracy of microseconds or milliseconds, thus providing accurate dosing. The timing of aerosol generation can be done based solely on a predetermined timing within a breathing cycle, on timing in conjunction with the length of a prior breath or portions thereof, on other breathing characteristics, on particular medication being administered, or a combination of any of these criteria (Step 135, Figure 13b).

The aerosolization element may be constructed of a variety of materials, comprising metals, which may be electroformed to create apertures as the element is formed, as described, for example, in U.S. patent No. 6,235,177 assigned to the present assignee and incorporated by reference herein in its entirety. Palladium is believed to be of particular usefulness in producing an electroformed, multi-apertured aerosolization element, as well as in operation thereof to aerosolize liquids. Other metals that can be used are palladium alloys, such as PdNi, with, for example, 80 percent palladium and 20% nickel. Other metals and materials may be used without departing from the present invention. The aerosolization element 70 (referring now to Figs. 16a and 16b) may be configured to have a curvature, as in a dome shape, which may be spherical, parabolic or any other curvature. The aerosolization element may be formed to have a dome portion 73 over its majority, and this may be concentric with the center of the aerosolization element, thus leaving a portion of the aerosolization element that is a substantially planar peripheral ring portion 75. The aerosolization element has a first face 71, a second face 72 and a plurality of apertures 74 (Fig. 16b) therethrough. The first face 71 may comprise the concave side of the dome portion 72 and the second face 72 may comprise the convex side of the dome portion 72 of the aerosolization element 70. The apertures may be tapered to have a narrow portion 76 at the first face 71 and a wide portion 78 at the second face 72 of the aerosolization element 70. Typically, a liquid will be placed at the first face of the aerosolization element, where it can be drawn into the narrow portion 76 of the apertures 74 and emitted as an aerosolized mist or cloud 79 from the wide portion 78 of the apertures 74 at the second face 72 of the aerosolization element 70.

The aerosolization element may be mounted on an aerosol actuator 80, which defines an aperture 81 therethrough. This may be done in such a manner that the dome portion of the aerosolization element protrudes through the aperture 81 of the aerosol actuator 80 and the substantially planar peripheral ring portion 74, on the second face 72 of the aerosolization element 70 abuts a first face 82 of the aerosol actuator 80. A vibratory element 84 may be provided, and may be mounted on the first face 82 of the aerosol actuator 80, or alternatively may be mounted on an opposing second face 83 of the aerosol actuator 80. The aerosolization element may be vibrated in such a manner as to draw liquid through the apertures 74 of the aerosolization element 70 from the first face to the second face, where the liquid is expelled from the apertures as a nebulized mist. The aerosolization element may be vibrated by a vibratory element 84, which may be a piezoelectric element. The vibratory element may be mounted to the aerosol actuator, such that vibration of the vibratory element may be mechanically transferred through the aerosol actuator to the aerosolization element. The vibratory element may be annular, and may surround the aperture of the aerosol actuator, for example, in a coaxial arrangement. In some embodiments of the present invention, the aerosolization element or the aerosol generator comprising the aerosolization element 70, the aerosol actuator 80 and the vibratory element 86 may be replaced with a respective assembly that has apertures of a different size, such as a different exit diameter, to produce a mist having a different aerosol particle size. A circuitry 86 may provide power from a power source. The circuitry may include a switch that may be operable to vibrate the vibratory element and thus the aerosolization element, and aerosolization performed in this manner may be achieved within milliseconds of operation of the switch. The circuitry may include a controller 87, for example, a microprocessor that can provide power to the vibratory element 84 to produce aerosol from the aerosolization element 70 within milliseconds or fractions of milliseconds of a signal to do so. For example, aerosol production may begin within about .02 to about 50 milliseconds of such a signal and may stop within about .02 to about 50 milliseconds from the cessation of a first signal or a second signal either of which may act as a trigger to turn of aerosolization. Similarly, aerosol production may begin and end within about .02 milliseconds to about 20 milliseconds of such respective signaling. Likewise, aerosol production may begin and end within about .02 milliseconds to about 2 milliseconds of such respective signaling. Further, this manner of aerosolization provides full aerosolization with a substantially uniform particle size of low velocity mist 79 being produced effectively instantaneously with operation of the switch.

With reference to Fig. 17, a nebulizer 85, which may have a top portion 93 through which liquid (either directly or within a nebule) may be provided, in accordance with the present invention may be incorporated into a ventilator breathing circuit of a ventilated patient. The breathing circuit may comprise a "Y" connector 88, which may in turn have an inlet portion 89, an endotracheal tube portion 90 and an outlet portion 91. The inlet portion 89 carries air provided from the ventilator 92 toward the patient. The endotracheal tube portion 90 of the Y connector 88 carries the incoming air to the patient's respiratory tract; this direction is represented by arrow a. The endotracheal tube portion 90 also carries the patient's exhalation to the outlet portion 91 of the Y connector 88, and the outlet portion may lead to an exhaust, represented by arrow b, to remove the patient's exhalation from the system. The nebulizer 85 of the present invention aerosolization element generates an aerosol cloud 94 that remains substantially within the inlet portion 89 of the Y connector 88 when there is no inspiratory air flowing through the inlet portion, by virtue of the aerosolization element, as described above, producing a low velocity mist. In this manner, aerosol that is generated when there is no inhalation air being provided will not be carried out through the outlet portion 91 of the Y connector and lost to the ambient environment. Accordingly, a dose of aerosolized medication may be preloaded, i.e., produced and placed substantially within the inlet portion 89 prior to an inhalation phase being sent by the ventilator 92. In this manner, such medication can be swept into a patient's respiratory system at the very start of the inhalation cycle. This may be of particular benefit in the case of neonatal patients and in other instances in which only the initial blast of inhalation phase will reach the target portion of the respiratory system.

The switch, described above, may be operable by a pressure transducer, which may be positioned in the mouthpiece of the nebulizer. The pressure transducer may be in electrical communication with the circuitry, and a microprocessor may also be in electrical communication with the circuitry, and the microprocessor may interpret electrical signals from the pressure transducer, and may also operate the switch to begin aerosolization. In this manner, nebulization can begin substantially instantaneously with the inhalation of a user upon the mouthpiece. An example of such a sensor switch can be found in co-assigned and co-pending U.S. application Ser. No. 09/705,063 assigned to the present assignee, the entire content of which is hereby incorporated herein by reference.

Another transducer may be used to sense the absence or presence of liquid in the reservoir, by sensing, for example, a difference between vibration characteristics of the aerosolization element, such as, for example, differences in frequency or amplitude, between wet vibration and substantially dry vibration. In this manner, the circuitry, may, for example by way of the microprocessor, turn the vibration off when there is essentially no more liquid to aerosolize, i.e., when the end of the dose has been achieved, thus minimizing operation of the aerosolization element in a dry state. Likewise, the switch may prevent vibration prior to delivery of a subsequent dose into the reservoir. An example of such a switch is shown in co- assigned and co-pending U.S. application Ser. No. 09/805,498, the entire content of which is hereby incorporated herein by reference.

As shown schematically in Figure 14, in exemplary embodiments, the aerosol generator controllers of the present invention can be coupled to both a nebule identification sensor and a breathing characteristic sensor so as to identify the liquid that is delivered to the aerosol generator and to monitor the breathing characteristics of the patient (Steps 130 to 140). In such embodiments, the aerosol generator can be operated (and a pre-programmed delivery program can be selected) to run the aerosol generator, based at least in part on the information obtained from the identification sensor and breathing characteristic sensor (Step 140).

If it is known what type of medication or drug is being delivered, the controller can select the best time during the patient's breathing cycle to deliver the aerosol, based upon a predetermined regimen for that drug that is stored in memory. As an additional benefit, an estimate of the patient's age and/or distress can be made, for example, by measuring the tidal volume and breathing rate. Such measurements can influence the efficiency requirements of the dose per breath. These or other variables can be used in establishing various regimes for aerosol delivery, in particular delivery into the breathing circuit of a ventilator. These regimes can be stored in memory and then accessed by the controller as appropriate for a given patient condition. For example, for a bronchodilator the best time to delivery may be halfway through the inhalation phase of a breath when impaction would be reduced since inhalation flows are reducing. For steroids, it may be best to deliver towards the end of the inhalation phase of a breath. For antibiotics, it may be best to slightly pre-load, i.e. deliver aerosol during the exhalation phase, or deliver right at the start of the breath. For example, antibiotics may be delivered at the beginning of a ventilator provided inhalation, and the aerosol delivery may stop after a predetermined percentage of the inhalation has been provided. One class of antibiotics that may be administered in accordance with the present invention is the class known as the aminoglycoside class of antibiotics. This class of antibiotics has typically been administered intravenously, however, such delivery may have unwanted side effects, which may be systemic. An object of the present invention is the administration of antibiotics, such as aminoglycosides including amikacin by delivering it in aerosolized form into the breathing circuit of a patient on a ventilator. In this manner, amikacin can be used to treat pulmonary infection conditions that typically arise when patients are mechanically ventilated, and the amikacin, or other aminoglycoside or other antibiotic, can be delivered directly to the target of treatment, the pulmonary tract, avoiding side effects that may otherwise arise from intravenous administration. Further, because of the great cost of such drugs, far greater efficiency is achieved through this pulmonary delivery. As noted above, with reference to Fig 15c, delivery of aerosol during a beginning percentage of the inhalation phase of a breathing cycle may yield up between about 60%> and about 80%> efficiency, an this is significantly higher than efficacy of continuous aerosolization or aerosolization for an entire inhalation phase of an inhalation cycle.

As described above, various regimes of aerosolization can be followed, depending on the situation. For example, in Fig 18, a selection between a first, second and third regime is shown. A regime may be selected manually or automatically, for example, through the application of an algorithm that selects an operation program based on information that is either input or stored. For manual selection, a user may operate a mechanical switch to select a regime, or may enter such a selection into an electronic input device, such as a keyboard. Alternatively, the controller may automatically choose a regimen, as described above, by matching a drug code on a drug nebule with a library of drug-regimen combinations. (It should be noted that in Figs. 18, 19 and 20, schematic flow charts of operation sequence algorithms are depicted. Although items therein will be referred to as steps for ease of discussion, they refer more broadly herein to states of operations or modalities in which a system may exist or cycle through. Steps depicted in a rectangle are essentially states of operation, actions or modalities. Steps depicted in diamonds indicate either a selection or the continuance of the previous state of operation, action or modality until a predetermined condition is satisfied. Two successive diamonds refer to satisfaction of a first condition and of a second condition respectively, the second of which may be a subset of the first.)

In step 200, a choice is made to follow a particular regime. In this case, regime I is a regime in which aerosol is generated continuously (step 202). Regime II provides aerosol generation during the inhalation phase only (step 204). In this case, in step 206, aerosol generation is set to start at the start of the inhalation phase and, in step 208, aerosol generation is set to stop when the inhalation phase stops. In step 210, aerosol generation begins at the start of the inhalation phase. In step 212, when the inhalation phase ends, aerosol generation stops (step 214).

Regime III provides for inhalation during a predetermined percentage of the inhalation phase (step 216). A predetermined percentage of an inhalation (or exhalation) phase may be based on a measured time from a discrete point in the ventilator cycle, such as the instantaneous commencement of inspiratory air generation by the ventilator. Alternatively, such predetermined percentage may be based on the time interval between successive discrete points in the ventilator, such as successive commencements of successive inhalation air generation by the ventilator. Alternatively, such percentages may be based upon air pressure in the ventilator circuit, or any other parameter. With respect to Regime III, in this case, in step 218, a first predetermined point is set to correspond with the completion of a first predetermined percent of the inhalation. In step 220, a second predetermined point is set to correspond to a second predetermined percent of inhalation percent being completed. For example, as described above, the first predetermined point may correspond to 20%> of the inhalation phase being completed, and the second predetermined point may correspond to a point at which 70%> of that same inhalation has taken place. In step 222, aerosol generation begins at the first predetermined point in the inhalation phase. In step 224, when the second predetermined point is reached, the controller carries out step 214 and stops the aerosol generation.

Similarly, as noted above, other regimes may be followed, for example, in which aerosol generation begins during the inhalation phase and ends during the exhalation phase, or begins during exhalation and ends during that exhalation, or begins during exhalation and ends in the subsequent breath cycle, for example, at a predetermined point in the subsequent inhalation phase. Accordingly, turning to Fig. 19, a selection may be made, at step 230, between regimes II (step 232) and III (step 234) as described above, and another regime, regime IV (steps 236 - 242), which is also available for selection. In regime IV, aerosol generation may begin at a first predetermined point (step 236), and this first predetermined point may be after a predetermined percentage of the inhalation phase has taken place, or it may be a predetermined point after the inhalation phase has been completed. For example, this point may be a predetermined point after a predetermined percent of the exhalation phase has taken place, or may be a predetermined point prior to the start of the subsequent inhalation phase. Aerosol generation may stop during exhalation (regime IVa, step 238), at the completion of exhalation (regime IVb, step 240), or aerosol generation may continue into the next breath cycle (regime IVc, step 242), and stop, for example, after a predetermined point during the subsequent inhalation phase.

In this example, with the controller having a selection choice between operation sequences corresponding to regimes II, III and IV, schematic representation of the operation sequences are shown in Fig. 20. In step 250, a regime is selected. In step 252, the aerosol generator controller selects an operation sequence based on selected regime. In step 254 , the controller receives a signal indicating that ventilator has begun to supply an inhalation phase. The signal, as described above, may be a signal provided directly by the ventilator. Alternatively, the signal may be provided by a sensor, and such sensor may sense the commencement of an inhalation phase provided by the ventilator, as described above, by sensing a pressure change in the breathing circuit. In step 256, the controller carries out selected operation sequence. In the case of regime II (step 258), the controller turns on aerosol generator upon commencement of inhalation phase provided by the ventilator. The controller continues to operate the aerosol generator until a point at which the inhalation phase completed (step 260). In step 262, controller turns off aerosol generator.

In the case of regime III, the controller does not take any action to begin aerosol generation, until a predetermined point in the inhalation phase, corresponding to a percentage of the inhalation phase being completed (step 264). In step 266, at a predetermined point in the inhalation phase, the controller turns on aerosol generator. In step 268, aerosol generation continues until a second predetermined point inhalation phase, corresponding to a second percentage point of completion of the inhalation phase. At this point, the controller carries out step 262 and turns off aerosol generator. With respect to regime IV, aerosol generation begins after a predetermined point of completion of the inhalation phase (step 264) and this point may be predetermined to occur after the inhalation phase has been completed and the exhalation phase has begun (step 270). In step 272, the controller turns the aerosol generator on to begin aerosolization. Variations can be made as to the point at which the aerosol generation is turned off. If it is desired that aerosol generation be completed before the completion of the exhalation phase (regime IVa), then aerosol generation may continue until a predetermined point prior to the subsequent inhalation (step 276). Alternatively, it may be desirable to continue aerosolization until the end of exhalation, which may correspond to the point of commencement of the subsequent inhalation, as in regime INb (step278). Alternatively, it may be desired to follow a regimen such as regime IVc, where aerosol generation continues through into the subsequent breath cycle (step 280), until, for example, a predetermined percent of the subsequent inhalation phase has been completed (step 282). In these regimes, aerosolization will continue until the satisfaction of these conditions (step 276 for regime IVa, step 278 for regime IVb or step 282 for regime IVc), at which point the controller carries out step 262 and stops the aerosol generator. The process may continue with the next signal indicating that the ventilator has begun to provide an inhalation phase, step 254.

Further, the choice of which operating sequence to follow may rely at least in part on the identity of a drug to be administered, which information can be considered by the controller as described above. In addition, it should be appreciated that modifications may be made to these examples without departing from the present invention. For example, a system may be configured, or a method may be carried out, to be able to select more than three initial regimes to follow. For example, regimes I, II, III and TV as described above may be simultaneously selectable. Further, various steps may be altered; for example, some steps may not be discrete steps. Thus, step 256 may not be a discrete step but rather the following of an operation sequence according to a selected regime. Similarly, the order of the steps may be changed, such as the controller may select an operating sequence (step 252) after receiving a signal that the ventilator has commenced to provide an inhalation phase (step 254). Steps may also be combined, such as, for example, in regime TV steps 264 and 270 may be combined as a single step, as these two steps represent successive criteria for the determining a single first predetermined point has been met. Likewise, step 274 may be combined with steps 276, 278 or 280, as step 274 is the predicate for the condition test specified in each of the other successive tests, steps 276, 278 or 280. The algorithm examples may be altered to form other operating sequences. For example, an operating sequence may call for the controller to start aerosol generation at the start of the inhalation cycle provided by the nebulizer, as in regime II, at step 258, and turn off the aerosol generator at a point at which a predetermined percentage of the inhalation phase has been completed, as in regime III, step 268 (and step 262). In a similar manner, other criteria may be used to trigger the turning on or off of the aerosol generator. For example, as described above, the start of aerosolization may be triggered by the sensing of a particular pressure or change in pressure in the ventilator circuit, and may end by following the turning off sequence of regimes III (steps 268 and 262) or IV (steps 274, 276, 278 or 280 and 282, followed by step 262, as described above.

Figure 21 is a schematic representation of an algorithm by which an operating sequence, for providing nebulized drug to a patient receiving air from a ventilator, may be chosen based on the combination of a plurality of independent sets of information, in this case, drug identity and a signal from the ventilator. In step 300, a library of drug regimes is provided, the library based on various drugs that may be administered. In step 302, the identity of a particular drug is provided to the system, and this may be provided, as described above, by a marker on a nebule containing the drug, the marker being read by the system. In step 304, the controller looks up a regime from the library of stored regimes to select a regime based on the particular drug to be administered. In step 306, the controller receives a signal from the ventilator. In step 308, the controller then chooses an operation sequence based in part on the drug identity and drug regime and in part on the independent information provided by the signal from the ventilator. In step 310, the controller carries out the operation sequence, which may be producing aerosol at a predetermined interval in the ventilation cycle based on the drug and the regime provided for the drug factored in with the inhalation cycle of the ventilator. These descriptions are illustrative, and accordingly, the order of the steps may be altered, and other variations, additions and modifications, as described above, may be made still in accordance with the present invention.

While all the above is a complete description of the preferred embodiments of the inventions, various alternatives, modifications, and equivalents may be used. Accordingly, although the foregoing invention has been described in detail for purposes of clarity of understanding, it will be obvious that certain modifications may be practiced within the scope of the appended claims.

Claims

WHAT IS CLAIMED IS:

1. A method of creating an aerosol, the method comprising: providing an aerosol generator; coupling a nebule to an interface of the aerosol generator; reading an identification marker on the nebule; and operating the aerosol generator according to an operation program based on the information read from the identification marker on the nebule.

2. A method as in claim 1 wherein operating comprises selecting the operating program from a plurality of stored operation programs.

3. A method as in claim 1 comprising informing a user of the type of liquid based on the information read from the identification marker.

4. A method as in claim 3 wherein information comprises displaying the type of liquid on an output display.

5. A method as in claim 1 wherein the identification marker comprises a bar code, wherein reading comprises reading the bar code with a bar code reader.

6. A method as in claim 1 wherein the identification marker comprises a protrusion, wherein reading comprises sensing the protrusions with an optical sensor.

7. A method as in claim 1 wherein the identification marker comprises a protrusion, wherein reading comprises contacting a sensor against the protrusion.

8. A method as in claim 1 wherein coupling comprises opening a sealing membrane with the nebule.

9. A method as in claim 1 wherein coupling comprises engaging at least one helical thread of the nebule with a threaded feature of the interface.

10. A method as in claim 9 wherein the identification markers are disposed in a helical configuration that follows a pitch of the helical thread(s).

11. A method of nebulizing a liquid, the method comprising: taking one or more breaths; measuring at least one breath characteristic; taking a subsequent breath; and operating an aerosol generator based on one or more of the measured breath characteristics.

12. A method as in claim 11 further comprising identifying a liquid in the aerosol generator and further modifying the operation of the aerosol generator based on the identification of the liquid in the aerosol generator.

13. A method as in claim 11 wherein the breath is a tidal breath.

14. A method as in claim 13 wherein identifying is carried out upon insertion of the nebule into a housing of the aerosol generator.

15. A method as in claim 11 wherein measuring comprises monitoring at least one of a group consisting of: breathing pattern, one or more discrete time points in a breath cycle, peak inspiratory flow rate, breathing rate, exhalation parameters, regularity of breathing, and tidal volume.

16. A method as in claim 11 wherein operating comprises controlling the start and stop times of the aerosol generator.

17. A method as in claim 11 wherein operating comprises establishing an operating program based on the measured breathing characteristics.

18. A method as in claim 17, wherein the operating program controls start and stop times of the aerosol generator.

19. A method of creating an aerosol, the method comprising: providing an aerosolization element comprising a first face, a second face, and a plurality of apertures therethrough; providing a vibratory element in mechanical communication with the aerosolization element such that vibration of the vibratory element may cause the aerosolization element to vibrate; providing an interface to receive a nebule in such a manner that fluid from the nebule may be deposited on the first face of the aerosolization element; coupling a nebule to an interface of the aerosol generator; reading an identification marker on the nebule; and vibrating the aerosolization element generator according to an operation program based on the information read from the identification marker on the nebule.

20. A method as in claim 19 wherein operating comprises selecting the operating program from a plurality of stored operation programs.

21. A method as in claim 19 comprising informing a user of the type of liquid based on the information read from the identification marker.

22. A method as in claim 19 wherein information comprises displaying the type of liquid on an output display.

23. A method as in claim 19 wherein the identification marker comprises a bar code, wherein reading comprises reading the bar code with a bar code reader.

24. A method as in claim 19 wherein the identification marker comprises a protrusion, wherein reading comprises sensing the protrusions with an optical sensor.

25. A method as in claim 19 wherein the identification marker comprises a protrusion, wherein reading comprises contacting a sensor against the protrusion.

26. A method as in claim 19 wherein coupling comprises opening a sealing membrane with the nebule.

27. A method as in claim 19 wherein coupling comprises engaging at least one helical thread of the nebule with a threaded feature of the interface.

28. A method as in claim 27 wherein the identification markers are disposed in a helical configuration that follows a pitch of the helical thread(s).

29. A method of nebulizing a liquid, the method comprising: providing a vibratory aerosolization element comprising a first face, a second face, and a plurality of apertures therethrough; taking one or more breaths; measuring at least one breath characteristic; taking a subsequent breath; providing liquid to the first face of the aerosolization element; and vibrating the aerosolization element based on one or more of the measured breath characteristics.

30. A method as in claim 29 further comprising: identifying a liquid provided to the aerosolization element; and basing the operation of the aerosol generator based on the identification of the liquid in the aerosol generator.

31. A method as in claim 29 wherein the breath is a tidal breath.

32. A method as in claim 31 wherein identifying is carried out upon insertion of the nebule into a housing within which the aerosolization element is situated .

33. A method as in claim 29 wherein measuring comprises monitoring at least one of a group consisting of: breathing pattern, one or more discrete time points in a breath cycle, peak inspiratory flow rate, breathing rate, exhalation parameters, regularity of breathing, and tidal volume.

34. A method as in claim 29 wherein operating comprises controlling the start and stop times of vibration of the aerosolization element.

35. A method as in claim 29 wherein operating comprises establishing an operating program based on the measured breathing characteristics.

36. A method as in claim 35, wherein the operating program controls start and stop times of vibration of the aerosolization element.

37. A method for nebulizing a liquid, comprising: providing a nebulizer system comprising a housing, an aerosol generator, a controller coupled to the aerosol generator, and a reservoir in communication with the aerosol generator; providing a nebule comprising a nebule body configured to hold a liquid, wherein the nebule body comprises a key element; inserting the nebule into the housing, wherein the key element provides access to the reservoir when properly keyed with the housing; transferring the liquid from the nebule into the reservoir; and operating the aerosol generator with the controller to aerosolize the liquid.

38. A method as in claim 37, wherein the nebulizer further comprises a slit seal membrane disposed over the reservoir, wherein insertion of the nebule into the housing provides communication from the nebule, through the slit seal membrane, to the reservoir.

39. A method as in claim 37, wherein the housing includes a tab, wherein the key element comprises a slot, and wherein insertion of the nebule causes the tab to fit within the slot when properly keyed.

40. A method as in claim 37, wherein the aerosol generator comprises a plate having a plurality of apertures, and wherein the aerosol generator operating step comprises vibrating the plate

41. A method as in claim 40, wherein the aerosol generator plate comprises a curvature.

42. A method as in claim 40, wherein the plate comprises a dome shape.

43. A method as in claim 37 wherein the key element is a helical thread, and the housing comprises a threaded feature, wherein inserting the nebule comprises rotating the nebule.

44. A method as in claim 37 comprising identifying the liquid disposed within the nebule, and modifying the operation of the aerosol generator based on the type of liquid identified.

45. A method for nebulizing a liquid, comprising: providing a nebulizer system comprising a housing, an aerosol generator, the aerosol generator comprising an aerosolization element having a first face, a second face and a plurality of apertures therethrough, a vibratory element, a controller coupled to the vibratory element, and a reservoir in fluid communication with the first face of the aerosolization element of the aerosol generator; providing a nebule comprising a nebule body, the nebule body configured to hold a liquid, and a key element; inserting the nebule into the housing, wherein the key element provides access to the reservoir when properly keyed with the housing; transferring the liquid from the nebule into the reservoir; and - operating the aerosol generator with the controller controlling vibration of the vibratory element to draw liquid through the apertures of the aerosolization, from the first face to the second face, to aerosolize the liquid.

46. A method as in claim 45, wherein the nebulizer further comprises a slit seal membrane disposed over the reservoir, wherein insertion of the nebule into the housing provides communication from the nebule, through the slit seal membrane, to the reservoir.

47. A method as in claim 45, wherein the housing includes a tab, wherein the key element comprises a slot, and wherein insertion of the nebule causes the tab to fit within the slot when properly keyed.

48. A method as in claim 45 wherein the key element is a helical thread, and the housing comprises a threaded feature, wherein inserting the nebule comprises rotating the nebule.

49. A method as in claim 45 comprising identifying the liquid disposed within the nebule, and modifying the operation of the aerosol generator based on the type of liquid identified.

50. A method as in claim 45 comprising monitoring at least one breathing characteristic of a user and modifying the operation of the aerosol generator based on the user's breathing characteristics.

51. A method as in claim 45 comprising monitoring breathing characteristics of a user and modifying the operation of the aerosol generator based on the user's breathing characteristics.

52. A method for nebulizing a liquid, the method comprising: providing a nebulizer comprising a housing having a gas flow passageway, and aerosol generator, a controller, and a reader; placing a nebule having a liquid into the housing; reading an identification marker on the nebule with the reader to identify the liquid; transferring liquid from the nebule to the aerosol generator; and operating the aerosol generator with the controller using an operation program selected by the controller based on the identified liquid to provide an aerosolized liquid in the gas flow passage.

53. A method as in claim 52, wherein the operation program controls start and stop times for the aerosol generator

54. A method as in claim 52, wherein the operation program controls aerosol production rates of the aerosol generator.

55. A method as in claim 52, wherein the operation program selected by the controller is selected from a plurality of stored operation programs.

56. A method as in claim 55, wherein the plurality of operation programs are indexed to one or more liquids.

57. A method as in claim 56, wherein the selection of an operation program is based on identifying the liquid in the ampoule as on one of the indexed liquids, and further comprising selecting an operation program indexed to that identified liquid.

58. A method as in claim 52, further comprising: inhaling through the passageway to produce a gas flow through the passageway; sensing the gas flow with a sensor; and modifying the operation of the aerosol generator based on the characteristics of the gas flow information measured by the sensor.

59. A method of nebulizing a liquid, the method comprising: providing an aerosol generator; delivering a fluid from a nebule to the aerosol generator; reading an identification marker on the nebule; measuring one or more breathing characteristics of the patient's breath; and operating the aerosol generator based on the information read from the identification marker on the nebule and the one or more measured breathing characteristics of the patient.

60. A method as in claim 59 wherein coupling comprises keying the nebule with the interface, wherein the nebule can deliver fluid to the aerosol generator only if the nebule is properly keyed to the interface.

61. A method as in claim 59 wherein delivering fluid comprises passing a bottom end of the nebule through a slit seal membrane.

62. A method identifying a liquid that is to be delivered to an aerosolization device, the method comprising: inserting an ampoule into an ampoule interface of an aerosol generator; rotating a threaded element on the ampoule into engagement with a corresponding threaded feature in the interface so as to pass an identification marker by a sensor; and sensing the identification marker on the ampoule to identify the liquid in the ampoule.

63. A method as in claim 62 comprising pushing a tip of the ampoule through a slit seal during rotating.

64. A method as in claim 62 wherein sensing comprises reflecting a light off of the markers and detecting the reflected light.

65. A method as in claim 64 wherein the marker comprises at least one protrusion.

66. A method as in claim 64 wherein the at least one protrusion is disposed in a helical pattern that coincides with a pitch of the threaded element.

67. A method as in claim 62 wherein sensing comprises mechanical contact between an identification marker and an adjacent electromechanical sensor.

68. A method as in claim 62 wherein rotating and sensing are carried out simultaneously.

69. An aerosol generator system comprising: an aerosol generator comprising an interface; a sensing device coupled to the aerosol generator; and an ampoule that is attachable to the interface, wherein the ampoule comprises at least one identification marker that can be detected by the sensing device.

70. An aerosol generator system according to claim 69, wherein the interface is configured to receive the ampoule in such a manner that at least one identification marker reaches a proximity of the sensing device sufficient for the sensing device to sense the identification marker.

71. The aerosol generator of claim 69 comprising a controller coupled to the sensing device and to the aerosol generator, wherein the controller operates the aerosol generator based on the identification marker detected by the sensing device.

72. The system of claim 69 wherein the ampoule comprises a helical shaped thread that can threadedly attach to a threaded interior of the interface.

73. The system of claim 72 wherein the markers are disposed in a helical configuration that follows the pitch of the helical shaped thread.

74. The system of claim 69 wherein the sensing device comprises a lightsource and an optical detector.

75. The system of claim 74 wherein the markers comprise a double helical shape.

76. The system of claim 69 wherein the marker comprises a series of protrusions.

77. A nebulizer system comprising: a housing defining a passageway that is adapted to deliver an aerosolized liquid to a user; an aerosol generator disposed to provide an aerosolized liquid into the passageway; a controller having a memory and a plurality of aerosol generator operation programs that control operation of the aerosol generator; and a reader that is configured to read an identification marker on a nebule having a supply of liquid for the aerosol generator, and to send information from the identification marker to the controller, wherein the controller is further configured to operate the aerosol generator according to one of the operation programs based on the information from the marker.

78. A nebulizer system as in claim 77, further comprising a flow sensor that is adapted to sense gas flows through the passageway and to send gas flow information to the controller, and wherein the controller is further configured to control operation of the aerosol generator based on the gas flow information.

79. A nebulizer system as in claim 77, wherein the operation programs are configured to control start and stop times for the aerosol generator.

80. A nebulizer as in claim 77, wherein the identification marker includes a bar code.

81. A nebulizer system as in claim 77, wherein the operation programs are configured to control aerosol production rates of the aerosol generator.

82. A nebulizer system as in claim 77, wherein the controller is configured to estimate a user's tidal volume based on the gas flow information and to select one of the operation programs based on the tidal volume.

83. A nebulizer as in claim 77, wherein the aerosol generator comprises a plate having a plurality of apertures and a vibratable element to vibrate the plate.

84. A nebulizer system comprising: a housing defining a passageway that is adapted to deliver an aerosolized liquid to a user; an aerosol generator disposed to provide an aerosolized liquid into the passageway; a flow sensor disposed to sense gas flows through the passageway; and a controller that is configured to determine at least one characteristic of user inhalation based on information from the flow sensor and to control operation of the aerosol generator based on the user inhalation characteristic.

85. A nebulizer system as in claim 84, wherein the inhalation characteristic is selected from a group consisting of breathing patterns, one or more discrete points in a breathing cycle, peak inspiratory flow rate, breathing rate, exhalation parameters, regularity of breathing, and tidal volume.

86. A nebulizer system as in claim 84, wherein the controller is configured to control start and stop times for the aerosol generator based on the inhalation characteristic.

87. A nebulizer system as in claim 84, wherein the controller is configured to control aerosol production rates of the aerosol generator based on the inhalation characteristic.

88. A nebulizer system as in claim 84, further comprising a reader that is configured to read an identification marker on a nebule having a supply of liquid for the aerosol generator, and wherein the controller is further configured to control operation of the aerosol generator based on identification information from the reader.

89. A nebulizer system as in claim 84, wherein the aerosol generator comprises a plate having a plurality of apertures and a vibratable element to vibrate the plate.

90. A nebule comprising: a nebule body holding a liquid that is adapted to be supplied to an aerosol generator of a nebulizer; and an identification marker on the nebule body, the identification marker having information identifying the liquid, wherein the identification marker is readable by the nebulizer to control operation of the aerosol generator based on the information.

91. A method of creating an aerosol, the method comprising: providing an aerosolization element comprising a first face, a second face, and a plurality of apertures therethrough; providing a vibratory element in mechanical communication with the aerosolization element such that vibration of the vibratory element may cause the aerosolization element to vibrate; providing an interface to receive a nebule in such a manner that fluid from the nebule may be deposited on the first face of the aerosolization element; coupling a nebule to an interface of the aerosol generator; reading an identification marker on the nebule; and vibrating the aerosolization element generator according to an operation program based on the information read from the identification marker on the nebule.

92. A method as in claim 91 wherein operating comprises selecting the operating program from a plurality of stored operation programs.

93. A method as in claim 91 comprising informing a user of the type of liquid based on the information read from the identification marker.

94. A method as in claim 93 wherein information comprises displaying the type of liquid on an output display.

95. A method as in claim 91 wherein the identification marker comprises a bar code, and wherein the reading comprises reading the bar code with a bar code reader.

96. A method as in claim 91 wherein the identification marker comprises a protrusion, wherein reading comprises sensing the protrusions with an optical sensor.

97. A method as in claim 91 wherein the identification marker comprises a protrusion, wherein reading comprises contacting a sensor against the protrusion.

98. A method as in claim 91 wherein coupling comprises opening a sealing membrane with the nebule.

99. A method as in claim 91 wherein coupling comprises engaging at least one helical thread of the nebule with a threaded feature of the interface.

100. A method as in claim 99 wherein the identification markers are disposed in a helical configuration that follows a pitch of the helical thread(s).

101. A method of nebulizing a liquid, the method comprising: providing an aerosolization element comprising a first face, a second face, and a plurality of apertures therethrough; taking one or more breaths; measuring at least one breath characteristic; taking a subsequent breath; providing liquid to the first face of the aerosolization element; and vibrating the aerosolization element based on one or more of the measured breath characteristics.

102. A method as in claim 101 further comprising identifying a liquid in the aerosol generator and further modifying the operation of the aerosol generator based on the identification of the liquid provided to the aerosolization element.

103. A method as in claim 101 wherein the breath is a tidal breath.

104. A method as in claim 103 wherein identifying is carried out upon insertion of the nebule into a housing within which the aerosolization element is situated.

105. A method as in claim 101 wherein measuring comprises monitoring at least one of a group consisting of: breathing pattern, one or more discrete time points in a breath cycle, peak inspiratory flow rate, breathing rate, exhalation parameters, regularity of breathing, and tidal volume.

106. A method as in claim 101 wherein operating comprises controlling the start and stop times of vibration of the aerosolization element.

107. A method as in claim 101 wherein operating comprises establishing an operating program based on the measured breathing characteristics.

108. A method as in claim 107, wherein the operating program controls start and stop times of vibration of the aerosolization element.

109. A nebulizer system comprising: a housing defining a passageway that is adapted to deliver an aerosolized liquid to a user, wherein the housing further includes an nebule interface; an aerosol generator disposed to provide an aerosolized liquid into the passageway; a reservoir in the housing that is configured to hold liquid for the aerosol generator; a slit seal membrane disposed over the reservoir; and a nebule having a supply of liquid and a key that is configured to interface with the nebule interface and configured to protrude through the slit seal membrane when properly interfaced with the housing, whereby the slit seal membrane is opened to permit the liquid to be transferred from the nebule and into the reservoir.

110. A nebulizer as in claim 109, wherein the key comprises a slot in the nebule, and wherein the nebule interface comprises a tab that fits within the slot.

111. A nebulizer as in claim 109, wherein the aerosol generator comprises a plate having a plurality of apertures and a vibratable element to vibrate the plate.

112. A system for providing air with nebulized liquid to a patient receiving air from a ventilator, comprising: a ventilator; a ventilator circuit configured to deliver air from the ventilator to a patient; a nebulizer positioned to emit an aerosol into the ventilator circuit and a stream of air coming from the ventilator, the nebulizer comprising: a vibratory element; an aerosolizing element having a first face, a second face and a plurality of apertures therethrough; an actuator in mechanical communication with the vibratory element and with the aerosolizing element, such that a liquid at one face of the aerosolizing element can be drawn through the apertures and be emitted from the other face as an aerosol upon vibration of the vibratory element; and an electronic circuitry in electrical communication with the vibratory element such that upon a predetermined amount of electric current traveling within the electronic circuitry the vibratory element will be caused to vibrate; wherein the circuitry is configured to control vibration of the vibratory element between a resting state, in which substantially no aerosol would be produced by the nebulizer, and an active state, in which the vibratory element will vibrate such that aerosol would be produced by the nebulizer, based on an electrical signal provided to the vibratory element from the electronic circuitry.

113. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 0.02 and about 50 milliseconds.

114. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 0.2 and about 50 milliseconds.

115. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 2 and about 50 milliseconds.

116. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 0.02 and about 20 milliseconds.

117. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 0.2 and about 20 milliseconds.

118. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from substantially no aerosol being produced to aerosol being produced in a period of about 0.02 and about 2 milliseconds.

119. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.02 and about 50 milliseconds.

120. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.2 and about 50 milliseconds.

121. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 2 and about 50 milliseconds.

122. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.02 and about 20 milliseconds.

123. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.2 and about 20 milliseconds.

124. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 2 and about 20 milliseconds.

125. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.02 and about 2 milliseconds.

126. The apparatus of claim 112 wherein the electronic circuitry can control operation of the nebulizer from aerosol being produced to substantially no aerosol being produced in a period of about 0.2 and about 2 milliseconds.

127. The apparatus of claim 112 wherein the ventilator is configured to produce a continuous flow of air.

128. The apparatus of claim 112 wherein the ventilator is configured to generate inspiratory air for a predetermined time and cycle between generating inspiratory air and not generating inspiratory air at a predetermined frequency.

129. The apparatus of claim 112 wherein the ventilator is configured to produce inspiratory air for a predetermined time upon a patient's effort to begin an inspiration.

130. The apparatus of claim 112 wherein the ventilator is further configured to produce a constant basal level of inspiratory air when the ventilator is not producing inspiratory air in response to a patient's effort to begin an inspiration, and then produce inspiratory air for a predetermined time upon a patient's effort to begin an inspiration.

131. The apparatus of claim 112, wherein the nebulizer further comprises a pressure transducer that comprises a first location and a second location and which is configured to send a signal based on a predetermined sensed pressure differential between the first location and the second location.

132. The apparatus of claim 131, wherein the first location and the second location are within the breathing circuit.

133. The apparatus of claim 131, wherein the first location and the second location are in fluid communication with breathing circuit, such that air may flow from the first location to the second location based on air flowing from the ventilator to the patient.

134. The apparatus of claim 112, wherein the circuitry is configured to control vibration of the vibratory element between the resting state and the active state based on an electrical signal provided to the vibratory element from the electronic circuitry based at least in part on the state of production of air by the ventilator.

135. The apparatus of claim 131, wherein the nebulizer further comprises a pressure transducer that comprises a first location and a second location and which is configured to send a signal based on a predetermined sensed pressure differential between the first location and the second location, and wherein the pressure differential is based at least in part on a predetermined velocity of air provided by the ventilator.

136. The apparatus of claim 134, wherein the electronic circuitry is configured to activate vibration of the vibratory element of the nebulizer based on a first predetermined pressure differential and to stop vibration of the vibratory element of the nebulized based on a second predetermined pressure differential.

137. The apparatus of claim, 136 wherein the first predetermined pressure differential is determined based on a first velocity of air produced by the ventilator.

138. The apparatus of claim 137, wherein the second predetermined pressure differential is determined based on a second velocity of air produced by the ventilator.

139. The apparatus of claim 136 wherein the first predetermined pressure differential is determined based on a first velocity of air produced by the ventilator and the second predetermined pressure differential is determined based on a second velocity of air produced by the ventilator.

140. A nebulizer comprising: an aerosolization element; a piezoelectric element, in mechanical communication with the aerosolization element; an electronic circuitry in electrical communication with the piezoelectric element; a microprocessor in electrical communication with the electronic circuitry; a sensor to sense at least one predetermined point of the breathing cycle of a user of the nebulizer, the sensor in electrical communication with the microprocessor, wherein the sensor, the microprocessor, the electronic circuitry and the piezoelectric element are electronically configured and the piezoelectric element and the aerosolization element are mechanically configured so that the aerosolization element can reach a predetermined maximum aerosol production within a predetermined time period from the sensing of the occurrence of a predetermined point of the breathing cycle.

141. The apparatus of claim 140 wherein the predetermined time period is between 0.02 and about 50 milliseconds.

142. The apparatus of claim 140 wherein the predetermined time period is between about 0.2 and about 50 milliseconds.

143. The apparatus of claim 140 wherein the predetermined time period is between about 2 and about 50 milliseconds.

144. The apparatus of claim 140 wherein the predetermined time period is between about 0.02 and about 20 milliseconds.

145. The apparatus of claim 140 wherein the predetermined time period is between about 0.2 and about 20 milliseconds.

146. The apparatus of claim 140 wherein the predetermined time period is between about 0.02 and about 2 milliseconds.

147. A system for providing air with nebulized liquid to a patient receiving air from a ventilator, comprising: a ventilator; an inflow pathway configured to carry inhalation air from the ventilator to a patient being ventilated by the ventilator; an aerosolization element configured to dispense aerosol into the inflow pathway; a piezoelectric element, in mechanical communication with the aerosolization element; an electronic circuitry in electrical communication with the piezoelectric element; a microprocessor in electrical communication with the electronic circuitry; and a sensor configured to sense at least one predetermined point within the breathing cycle of patient using the ventilator, the sensor in electrical communication with the microprocessor, wherein the sensor, the microprocessor, the electronic circuitry and the piezoelectric element are electronically configured and the piezoelectric element and the aerosolization element are mechanically configured so that the aerosolization element can reach a predetermined maximum aerosol production within a predetermined time period from the sensing of the occurrence of a predetermined point in the breathing cycle.

148. A system for providing air with nebulized liquid to a patient receiving air from a ventilator, comprising; a ventilator; an inflow pathway configured to carry inhalation air from the ventilator to a patient being ventilated by the ventilator; an aerosolization element configured to dispense aerosol into the inflow pathway; a piezoelectric element, in mechanical communication with the aerosolization element; an electronic circuitry in electrical communication with the piezoelectric element; a microprocessor in electrical communication with the electronic circuitry; and a signal transmitter configured to generate a signal based on at least one first predetermined point within the breathing cycle of patient using the ventilator, the signal transmitter in electrical communication with the microprocessor; wherein, the signal transmitter, the microprocessor, the electronic circuitry and the piezoelectric element are electronically configured and the piezoelectric element and the aerosolization element are mechanically configured so that the vibration of the piezoelectric element and the aerosolization element is based on the at least one predetermined point within the breathing cycle.

149. The apparatus of claim 148 wherein the aerosolization element can reach a predetermined maximum aerosol production within a predetermined time period from the sensing of the occurrence of a predetermined point in the breathing cycle.

150. The apparatus of claim 149 wherein the predetermined time period is between 0.02 and about 50 milliseconds.

151. The apparatus of claim 149 wherein the predetermined time period is between about 0.2 and about 50 milliseconds.

152. The apparatus of claim 149 wherein the predetermined time period is between about 2 and about 50 milliseconds.

153. The apparatus of claim 149 wherein the predetermined time period is between about 0.02 and about 20 milliseconds.

154. The apparatus of claim 149 wherein the predetermined time period is between about 0.2 and about 20 milliseconds.

155. The apparatus of claim 149 wherein the predetermined time period is between about 0.02 and about 2 milliseconds.

156 The apparatus of claim 148, wherein the signal transmitter is controlled by the ventilator.

157. The apparatus of claim 156, wherein the signal transmitter is contained within the ventilator.

158. The apparatus of claim 148, wherein, wherein the signal transmitter is configured to halt its signal transmission based at least in part on the at least one second predetermined point within the breathing cycle of patient using the ventilator.

159. The apparatus of claim 148, wherein the signal transmitter is controlled by the ventilator.

160. The apparatus of claim 159, wherein the signal transmitter is contained within the ventilator.

161. The apparatus of claim 148, wherein, wherein the signal transmitter is configured to halt its signal transmission based at least in part on the at least one second predetermined point within the breathing cycle of patient using the ventilator.

162. A method for providing nebulized fluid to a person receiving air from a ventilator, comprising: identifying the drug to be administered; selecting an algorithm, the algorithm providing a sequence of starting aerosol production and stopping aerosol production so that the drug is delivered at a predetermined interval of choice in a breathing cycle; receiving a signal from the ventilator to establish a point of reference as to the operation of the ventilator in providing cycles of comprising inhalation phases; selecting an operating sequence based the selected algorithm and the reference point; beginning production of aerosol at a point in the ventilator cycle in accordance with the operating sequence; stopping production of aerosol at a point in the ventilator cycle in accordance with the operating sequence; wherein the operating sequence sets the time for beginning production of aerosol and stopping production of aerosol based on the particular drug being administered an based on the specific cycle time of the ventilator to achieve a predetermined efficacy of aerosol administration.

163. A method of providing nebulized fluid to a patient receiving at least a portion of air from an artificial air source, the method comprising: providing a nebulizing element; providing a controller to operate the nebulizing element, choosing a sequence of start and stop of aerosol production to maximize the effect of administered drug as provided in combination with the air provided by the artificial air source.

164. A system for providing nebulized fluid to a patient receiving air from an artificial air source, comprising: an aerosolization element; a controller configured to control operation of the aerosolization element; a plurality of operation algorithms providing for the controller to operate the aerosolization element at predetermined intervals to achieve different regime of administration with respect to an inspiratory cycle, said inspiratory cycle comprising an inhalation phase and an exhalation phase; wherein the controller may be adjusted to follow one of the algorithms to cany out a specific operation sequence of operating the aerosolization element.

165. The system of claim 164, wherein the controller is manually adjustable by a person operating the system.

166. The system of claim 165, wherein the controller may adjust automatically, by following an initial algorithm that leads the controller to chose an operation algorithm.

167. The system of claim 164, wherein the controller has the ability to chose an alternate operating sequence based on receipt of instantaneous information as to the status of one or more of the group consisting of the breathing rhythm of the patient and the ongoing aerosol production sequence.

168. The system of claim 164, wherein the controller has the ability to follow a portion of a first operation sequence and a portion of a second operation sequence to carry out a third operation sequence that comprises a portion of the first operation sequence and a portion of the second operation sequence.

169. The system of claim 164, wherein the controller selects the portions of the operation sequences based on a sensed parameter in the course of operation of the system by which nebulized fluid is provided in conjunction with air from an artificial air source.

170. A method of providing an apparatus for providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal, the vibratory element positioned such that the nebulizing element can be caused to vibrate by vibration of the vibratory element in such a manner that a fluid at the first face may be drawn through the apertures and emitted therefrom at the second face as a nebulized mist; providing a circuitry in electrical communication with the vibratory element; providing a switch in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; wherein the time between the switch being moved from the off position to the on position to the time a nebulized mist can be emitted by vibration of the vibratory element is between about 2 milliseconds and about 50 milliseconds.

171. The method of claim 170 wherein the switch comprises a sensor capable of sensing a pressure differential.

172. The method of claim 171 wherein the pressure differential is calibrated to a predetermined velocity of air flowing to the patient.

173. The method of claim 172 wherein the switch maintains itself in the off position if a predetermined pressure differential is not present and in the on position if the predetermined pressure differential is present.

174. The method of claim 170 wherein the switch comprises a moveable member capable of moving from a first position to a second position.

175. The method of claim 174 wherein the first position corresponds to the absence of air flowing to the patient being of a predetermined velocity and the second position corresponds to the presence of air flowing to the patient being of a predetermined velocity.

176. The method of claim 170 further comprising a sensor to detect the presence of the moveable member in the second position.

177. The method of claim 170 wherein the sensor comprises a light sensor that can sense a difference of light received by it when the moveable member is in the second position than when the moveable member is not in the second position.

178. The method of claim 170 wherein the sensor comprises a film upon the moveable member, the film subject to a change in at least one physical characteristic when the moveable member is in the second position.

179. The method of claim 178 wherein the physical characteristic is electric resistance.

180. The method of claim 178 further comprising an electric sensor capable of sensing the electric resistance of the film corresponding to the moveable member being in the second position.

181. A method of providing nebulized fluid into an inspiratory flow of a user, comprising: providing a ventilator, providing tubing capable of carrying inspiratory air flowing to the user, providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal, the vibratory element positioned such that the nebulizing element can be caused to vibrate by vibration of the vibratory element in such a manner that a fluid at the first face may be drawn through the apertures and emitted therefrom at the second face as a nebulized mist; providing a circuitry in electrical communication with the vibratory element, the circuitry capable of supplying an electrical signal to the vibratory element to cause the vibratory element to vibrate; providing a switch that can be acted upon by inspiratory air, the switch in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present, the switch being arranged such that if it is in the on position, the circuitry may supply the electrical signal to the vibratory element; providing a fluid at the first face of the nebulizing element, providing inspiratory air flowing to the patient, wherein the velocity thereof becomes greater than or equal to the predetermined velocity, thus moving the switch to the on position, whereupon the nebulizing element is caused to vibrate; wherein the time between the switch being moved to the on position to the time a nebulized mist is emitted by vibration of the vibratory element is between about 2 milliseconds and about 50 milliseconds.

182. A method of providing nebulized fluid into an inspiratory flow of a user, comprising: providing a ventilator, providing tubing capable of carrying inspiratory air flowing to the user, providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element in such a manner that a fluid at the first face may be drawn through the apertures and emitted therefrom at the second face as a nebulized mist; providing a circuitry in electrical communication with the vibratory element; providing a switch in electrical communication with the circuitry and positioned to be acted upon by at least a portion of a stream of inspiratory air, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; allowing the switch to move to the on position upon the stream of inspiratory air attaining a predetermined velocity, whereupon the circuitry causes the vibratory element to vibrate in such a manner as to cause the nebulizing element to vibrate, thereby drawing fluid through the apertures thereof and therethrough emitting a nebulized mist within between about 2 milliseconds and about 50 milliseconds.

183. A method of providing an apparatus for providing nebulized fluid into an inspiratory flow of a user, comprising: providing a ventilator, providing tubing capable of carrying inspiratory air flowing to the user, providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal, the vibratory element positioned such that the nebulizing element can be caused to vibrate by vibration of the vibratory element in such a manner that a fluid at the first face may be drawn through the apertures and emitted therefrom at the second face as a nebulized mist; providing a circuitry in electrical communication with the vibratory element; providing a switch in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; wherein the time between the switch being moved to the on position to the time a nebulized mist can be emitted by vibration of the vibratory element is between about 2 milliseconds and about 50 milliseconds.

184. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a switch that can be acted upon by inspiratory air and that is in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a timer in electrical communication with the circuitry; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; moving the switch to the on position upon the stream of inspiratory air attaining a predetermined velocity, sending a signal to the vibratory element to vibrate in such a manner as to cause the nebulizing element to vibrate, drawing fluid through the apertures of the nebulizing element; emitting a nebulized mist; setting a cycle start time from the sending of the signal to the vibratory element; moving the switch to the off position upon the velocity of the inspiratory stream falling below the predetermined amount; ceasing to send the signal to the vibratory element; noting the time of cessation of the signal; calculating a first length of time from the setting of the time to the noting the time of cessation; calculating a second length of time as a fraction of the first length of time; providing a second stream of inspiratory air of which at least a portion thereof comes from the respirator; moving the switch to the on position upon the second stream of inspiratory air attaining a predetermined velocity, sending a second signal to the vibratory element to vibrate in such a manner as to cause the nebulizing element to vibrate, drawing fluid through the apertures of the nebulizing element; emitting a nebulized mist; setting a second cycle start time from the sending of the second signal to the vibratory element and counting time therefrom; upon reaching the second length of time counting from the second cycle start time, ceasing to send the second signal to the vibratory element.

185. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a switch which can be acted upon by inspiratory air and in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a timer in electrical communication with the circuitry; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; allowing the switch to move to the on position upon the stream of inspiratory air attaining a predetermined velocity, allowing a signal to be generated and sent to the vibratory element causing it to vibrate in such a manner as to cause the nebulizing element to vibrate to draw fluid through the apertures of the nebulizing element and emit therefrom the fluid as a nebulized mist; setting a cycle start time from the sending of the signal to the vibratory element; moving the switch to the off position upon the velocity of the inspiratory stream falling below the predetermined amount; ceasing to send the signal to the vibratory element; noting the time of cessation of the signal; calculating a first length of time L from the setting of the start time to the noting the time of cessation; providing a second stream of inspiratory air of which at least a portion thereof comes from the respirator; allowing the switch to move to the on position upon the second stream of inspiratory air attaining a predetermined velocity, allowing a second signal to be generated and sent to the vibratory element causing it to vibrate in such a manner as to cause the nebulizing element to vibrate to draw fluid through the apertures of the nebulizing element and emit therefrom the fluid as a nebulized mist; upon reaching the length of time L counting from the second cycle start time, ceasing to send the second signal to the vibratory element.

186. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a respirator; providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a switch which can be acted upon by inspiratory air and in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; providing information on the start and stop time of the firing of the respirator; sending a signal to the vibratory element, upon the firing of the respirator, to vibrate in such a manner as to cause the nebulizing element to vibrate to draw fluid through the apertures of the nebulizing element and emit the fluid therefrom as a nebulized; ceasing to send the signal to the vibratory element upon the cessation of the firing of the respirator.

187. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a respirator; providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a switch which can be acted upon by inspiratory air and in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; providing information on the start and stop time of the firing of the respirator; sending a signal to the vibratory element, upon the elapsing of a predetermined time from firing of the respirator, to vibrate in such a manner as to cause the nebulizing element to vibrate to draw fluid through the apertures of the nebulizing element and emit the fluid therefrom as a nebulized; ceasing to send the signal to the vibratory element upon the cessation of the firing of the respirator.

188. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a respirator; providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a sensor that can sense inspiratory air and that is in electrical communication with the circuitry, the sensor providing information as to the presence or absence of a predetermined velocity of air flowing from the respirator; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; providing information on the start time of the firing of the respirator; vibrating the nebulizing element base upon a combination of information from the sensor and the inform on the start time of the firing of the respirator.

189. A method of providing nebulized fluid to a patient receiving air flowing from a respirator, comprising: providing a respirator; providing a nebulizing element, the nebulizing element comprising a first face, a second face and a plurality of apertures therebetween; providing a vibratory element capable of vibrating upon receiving a predetermined electrical signal; positioning the vibratory element such that the nebulizing element can be caused to vibrate by vibration of the vibratory element; providing a circuitry in electrical communication with the vibratory element; providing a switch which can be acted upon by inspiratory air and in electrical communication with the circuitry, the switch being operable between an off position and an on position such that the switch maintains itself in the off position if a predetermined velocity of air flowing to the patient is not present and in the on position if the predetermined velocity of air flowing to the patient is present; providing a stream of inspiratory air of which at least a portion thereof comes from the respirator; providing information on the start and stop time of the firing of the respirator; sending a signal to the vibratory element, at predetermined time following the firing of the respirator, to vibrate in such a manner as to cause the nebulizing element to vibrate to draw fluid through the apertures of the nebulizing element and emit the fluid therefrom as a nebulized; ceasing to send the signal to the vibratory element at predetermined period of time prior to the cessation of the firing of the respirator.

190. The method of claim 189 wherein the predetermined period of time following the firing of the respirator and the predetermined time prior to the cessation of the firing of the respirator occur such that the time during which nebulized fluid is emitted is a percentage of an inspiratory cycle.

191. The method of claim 190 wherein the percentage is from about 20 percent to about 50 percent of an inspiratory cycle.

192. An apparatus for providing aerosol to a person receiving air from a respirator, comprising: an aerosolization element having a first face, a second face, and a plurality of apertures therethrough; a vibratory element, capable of vibrating upon receiving an predetermined electrical signal, the vibratory element positioned to impart vibration to the aerosolization element; a circuitry in electrical communication with the vibratory element capable of delivering a predetermined electrical signal to the vibratory element for the vibratory element to vibrate; a control operable on the circuitry to switch between at least a first mode of operation providing for at least one operation sequence and a second mode of operation providing for at least one operation sequence different from the at least one operation sequence of the first mode.

193. The apparatus of claim 120, wherein at least one operation sequence provides for signaling the vibratory element to begin vibration based on a predetermined velocity of air provided by the respirator and to stop vibration based on a percentage of inhalation having transpired.

194. An apparatus for providing aerosol to a person receiving air from a respirator, comprising: an aerosolization element having a first face, a second face, and a plurality of apertures therethrough; a vibratory element, capable of vibrating upon receiving an predetermined electrical signal, the vibratory element positioned to impart vibration to the aerosolization element; a circuitry in electrical communication with the vibratory element capable of delivering a predetermined electrical signal to the vibratory element for the vibratory element to vibrate; a control operable on the circuitry to switch between three or more modes of operation; wherein each mode comprises at least one operation sequence different from an operation sequence of one of the other modes.

195. The apparatus of claim 194, wherein one of the modes provides that the circuitry delivers the predetermined signal to the vibratory element during inspiration if the velocity of inspiratory air is above a predetermined velocity, another of the modes provides that the circuitry delivers the predetermined signal to the vibratory element during a portion of the time period in which the velocity of inspiratory air is above a predetermined velocity, and another of the modes provides that the circuitry delivers the predetermined signal to the vibratory element during a portion of time during which the person is exhaling.

196. A system for providing aerosol to a person, comprising: an aerosol generator; and a controller configured to cause the aerosol generator to generate aerosol and to cause the aerosol generator to not generate aerosol; wherein the controller is configured to operate between a first mode and a second mode, wherein the first mode configures the controller to cause the aerosol generate to generate aerosol based on a predetermined inspiration level and to cause the aerosol generator to not generate aerosol based on the absence of a predetermined level of inspiration and the second mode configures the controller to cause the aerosol generator to generate aerosol based on a predetermined level of inspiration and to cause the aerosol generator to not generate aerosol at a predetermined time in the breathing cycle.

197. The system of claim 196 wherein the controller is configured to operate between the first mode, the second mode and a third mode wherein the controller is configured to cause the aerosol generator to generate aerosol at a first predetermined time in the breathing cycle and to stop the aerosol generator from generating aerosol at a second predetermined time in the breathing cycle.

198. The system of claim 193 wherein the predetermined time of the second mode is calculated as a time at which a predetermined percentage of the inspiration has taken place.

199. The system of claim 197 wherein the first predetermined time of the third mode is set to occur during exhalation and the second predetermined time of the third mode is set to occur during exhalation.

200. The system of claim 197 wherein the second predetermined time is set to occur in the subsequent inspiration.

201. The system of claim 193, wherein the controller is configured to cause the aerosol generator to generate aerosol based on a predetermined parameter.

202. The system of claim 201 wherein the predetermined parameter is selected from the group consisting of a level of inspiration and a time within a breath.

203. The system of claim wherein the controller is configured to not operate the aerosol generator to not generate aerosol based on a predetermined parameter.

204. The system of claim 193 wherein the predetermined parameter is selected from the group consisting of a level of inspiration and a time within a breath.

205. A system for providing nebulized fluid to a person comprising: an aerosol generator; and a controller, wherein the controller is configured to cause the aerosol generator to begin generation of aerosol at a first predetermined time in a breathing cycle and to stop generating aerosol at a second predetermined time in the breathing cycle.

206. A nebulizer comprising: an aerosolization element; a piezoelectric element, in mechanical communication with the aerosolization element; an electronic circuitry in electrical communication with the piezoelectric element; a microprocessor in electrical communication with the electronic circuitry; a sensor to sense at least one predetermined point of the breathing cycle of a user of the nebulizer, the sensor in electrical communication with the microprocessor, wherein the sensor, the microprocessor, the electronic circuitry and the piezoelectric element are electronically configured and the piezoelectric element and the aerosolization element are mechanically configured so that the aerosolization element can reach a predetermined maximum aerosol production within a predetermined time period from the sensing of the occurrence of a predetermined point of the breathing cycle.

207. A system for providing nebulized fluid into the inflow pathway of a ventilator, comprising; a ventilator; an inflow pathway configured to carry inhalation air from the ventilator to a patient being ventilated by the ventilator; an aerosolization element configured to dispense aerosol into the inflow pathway; a piezoelectric element, in mechanical communication with the aerosolization element; an electronic circuitry in electrical communication with the piezoelectric element; a microprocessor in electrical communication with the electronic circuitry; a sensor configured to sense at least one predetermined point within the breathing cycle of patient using the ventilator, the sensor in electrical communication with the microprocessor, wherein the sensor, the microprocessor, the electronic circuitry and the piezoelectric element are electronically configured and the piezoelectric element and the aerosolization element are mechanically configured so that the aerosolization element can reach a predetermined maximum aerosol production within a predetermined time period from the sensing of the occurrence of a predetermined point in the breathing cycle.

208. A fluid droplet ejection device for use with a ventilator, said device produces droplets by a vibratory apertured element during a selected interval of a breathing cycle.

209. A nebulizer for providing nebulized fluid into a ventilator breathing circuit, comprising: a vibratory aerosolization element having a first face, a second face and a plurality of apertures therethrough; a controller configured to control vibration of the vibratory aerosolization element, wherein the controller may be configured to vibrate the vibratory aerosolization element during a selected interval of a breathing cycle.

210. The apparatus of claim 209, wherein the apertures are of substantially uniform exit diameter.

211. The apparatus of claim 209, wherein the apertures are tapered such that liquid is drawn into the narrow portions of the tapers and aerosol of the liquid is emitted from the wide portions of the tapers.

212. The apparatus of claim 209, wherein the aerosolization element has a curvature.

213. The apparatus of claim 209, wherein the aerosolization element comprises a dome shape.

214. The apparatus of claim 209, wherein the vibratory aerosolization element comprises palladium.

215. The apparatus of claim 209, wherein the vibratory aerosolization element consists of palladium.

216. The apparatus of claim 209, wherein the vibratory aerosolization element consists essentially of palladium.

217. The apparatus of claim 209, wherein the controller is configured to provide aerosol for substantially an entire inhalation phase.

218. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an inhalation phase beginning at the start of the inhalation phase and ending prior to completion of the inhalation phase.

219. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an inhalation phase beginning at a first predetermined point after the start of the inhalation phase and ending at a second predetermined point prior to completion of the inhalation phase.

220. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an inhalation phase beginning at a first predetermined point after the start of the inhalation phase and ending at the end of the inhalation phase.

221. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an inhalation phase and a portion of an exhalation phase, beginning at a first predetermined point after the start and before the end of the inhalation phase and ending after the end of the inhalation phase during the exhalation phase.

222. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of the inhalation phase and an entire exhalation phase, beginning at a first predetermined point after the start and before the end of the inhalation phase and ending at the end of the exhalation phase.

223. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising an entire exhalation phase.

224. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an exhalation phase, after the start of the exhalation phase and ending to completion of the exhalation phase.

225. The apparatus of claim 209, wherein the controller is configured to provide aerosol for an interval comprising a portion of an exhalation phase and a portion of the successive inhalation phase, beginning after the start of the exhalation phase and ending during the successive inhalation phase.

226. The apparatus of claim 209, wherein the controller may select an interval from the group of intervals comprising: an entire inhalation phase; a portion of an inhalation phase beginning at the start of the inhalation phase and ending prior to completion of the inhalation phase; a portion of an inhalation phase beginning at a first predetermined point after the start of the inhalation phase and ending at a second predetermined point prior to completion of the inhalation phase; a portion of an inhalation phase beginning at a first predetermined point after the start of the inhalation phase and ending at the end of the inhalation phase; a portion of an inhalation phase and a portion of an exhalation phase, beginning at a first predetermined point after the start and before the end of the inhalation phase and ending after the end of the inhalation phase during the exhalation phase; a portion of the inhalation phase and an entire exhalation phase, beginning at a first predetermined point after the start and before the end of the inhalation phase and ending at the end of the exhalation phase; an entire exhalation phase; a portion of an exhalation phase, after the start of the exhalation phase and ending to completion of the exhalation phase; and a portion of an exhalation phase and a portion of the successive inhalation phase, beginning after the start of the exhalation phase and ending during the successive inhalation phase.

227. The apparatus of claim 226, wherein the portions of the inhalation phases and the portions of the exhalation phases are predetermined percentages of the respective phase.

228. The apparatus of claim 209, wherein the vibratory aerosolization element is configured to produce a low velocity aerosol cloud.

229. The apparatus of claim 228, wherein the low velocity cloud is of such a velocity so as to remain substantially within the inlet portion of a Y connector, such Y connector comprising an inlet portion, an endotracheal tube portion and an outlet portion when the nebulizer is positioned to emit aerosol into the inlet portion of a Y connector.

230. The apparatus of claim 209, wherein the vibratory aerosolization element may be replaced by a second apertured vibratory element having a plurality of apertures of a different size than the apertures of the first apertured vibratory aerosolization element.

231. The apparatus of claim 210, further comprising: a vibratory element in mechanical communication with the aerosolization element; wherein the aerosolization element is vibrated by vibration of the vibratory element.

232. The apparatus of claim 231 , further comprising an aerosol actuator; wherein the aerosolization element and the vibratory element are each mechanically connected to the aerosol actuator.

233. The apparatus of claim 232, wherein the aerosolization element, the aerosol actuator and the vibratory element may be removed as a unit and replaced with a second assembly comprising a second aerosolization element, a second aerosol actuator and a second vibratory element; wherein the apertures of the second aerosolization element have a substantially uniform exit diameter that is different from the substantially uniform exit diameter of the apertures of the first aerosolization element.

234. A method of varying the particle size of nebulized fluid administered to a patient comprising: providing a first aerosolization element having a first face, a second face and a plurality of apertures therethrough, the apertures having a substantially uniform exit diameter at the second face, such that a liquid that may be provided at the first face may be drawn through the apertures and emitted from the aperture exits at the second face as a mist having a first particle size distribution; replacing the first aerosolization element with a second aerosolization element having a first face, a second face and a plurality of apertures therethrough, the apertures having a substantially uniform exit diameter at the second face that is different form the substantially uniform exit diameter of the apertures of the first aerosolization element, such that a liquid that may be provided at the first face of the second aerosolization element may be drawn through the apertures thereof and be emitted from the aperture exits at the second face as a mist having a second particle size distribution different than the first particle size distribution.

235. The method of claim 234 further comprising: vibrating the second aerosolization element to draw liquid into the apertures at the first face thereof and emit the liquid from the apertures at the second face thereof as a mist.

236. A nebulizing device for providing aerosol to a ventilated patient, comprising: a breathing circuit comprising a Y connector, the Y connector having an inlet portion, an endotracheal tube portion and an outlet portion, the inlet portion providing air from the ventilator to the patient via the endotracheal tube portion and the outlet portion providing an exhaust route, a nebulizer, comprising an apertured vibratory aerosolization element; a controller for controlling the vibratory operation of the apertured vibratory aerosolization element; wherein the vibratory aerosolization element is configured to vibrate in such a manner so as to provide an aerosol cloud that travels substantially no further into the breathing circuit than the inlet portion of the Y connector when there is no inspiratory air flowing through the inlet portion.

237. The apparatus of claim 236, wherein the apertured vibratory aerosolization element may be replaced by a second apertured vibratory element having a plurality of apertures of a different size than the apertures of the first apertured vibratory aerosolization element.

238. A system for providing nebulized fluid to a ventilated patient, comprising: a ventilator, a breathing circuit, a vibratory aerosolization element having a first face, a second face and a plurality of apertures therethrough; a controller configured to control vibration of the vibratory aerosolization element, wherein the controller may be configured to vibrate the vibratory aerosolization element during a selected interval of a breathing cycle.

239. The system of claim 238, wherein the selected interval is based on a predetermined point of the breath cycle provided by the ventilator.

240. The system of claim 239, wherein the predetermined point is the commencement of an inhalation phase provided by the ventilator

241. The system of claim 239, wherein the interval begins at a first predetermined point in the breathing cycle and ends at a second predetermined point in the breathing cycle.

242. A system for providing nebulized fluid to a patient receiving air from a ventilator, comprising: a breathing circuit comprising a Y connector, the Y connector comprising an inlet portion, an endotracheal tube portion and an outlet portion; a nebulizer positioned to provide nebulized fluid into the inlet portion of the Y connector, the nebulizer comprising: a vibratory aerosolization element having a first face, a second face and a plurality of apertures therethrough; wherein the vibratory element may be caused to vibrate at least in part by an electrical signal in a manner so as to draw fluid into the apertures at the first face thereof and emit the fluid as a low velocity nebulized cloud from the second face, and wherein the force of the emitted cloud is small enough that substantially no aerosol is lost through the outlet portion when there is no inspiratory flow through the inlet portion.

243. The apparatus of claim 242, wherein substantially no aerosol travels into the endotracheal tube portion of the Y connector when there is no inspiratory flow through the inlet portion.

244. A system for providing nebulized fluid to a patient receiving air from a ventilator, comprising: a breathing circuit comprising a Y connector, the Y connector comprising an inlet portion, an endotracheal tube portion and an outlet portion; a nebulizer positioned to provide nebulized fluid into the inlet portion of the Y connector, the nebulizer comprising: a vibratory aerosolization element having a first face, a second face and a plurality of apertures therethrough; wherein the vibratory element may be caused to vibrate at least in part by an electrical signal in a manner so as to draw fluid into the apertures at the first face thereof and emit the fluid as a low velocity nebulized cloud from the second face, and wherein the force of the emitted cloud is small enough that substantially all of the cloud may travel no further than the inlet portion of the Y connector when there is no inspiratory flow through the inlet portion.

245. A method of providing nebulized fluid to a patient receiving air from a ventilator, comprising: providing a ventilator, providing a breathing circuit to connect the ventilator to a patient, the breathing circuit comprising a Y connector, the Y connector comprising an inlet portion, an endotracheal portion and an outlet portion, providing a nebulizer positioned to provide aerosol into the inlet portion of the Y connector, the nebulizer comprising a vibratory aerosolization element, the vibratory aerosolization element operable in part by an electronic signal; providing an electronic signal that causes the aerosolization element to vibrate in such a manner as to deliver a cloud of mist into the inlet portion of the inlet portion during an interval in which there is substantially no inhalation flow through the inlet portion, such that the cloud remains substantially within the inlet portion; providing an inhalation flow from the ventilator in such a manner as to sweep substantially the entire cloud of nebulized fluid through the endotracheal tube portion to the patient substantially upon the commencement of the inhalation flow.

246. A method of providing nebulized fluid to a neonatal patient receiving air from a ventilator, comprising: providing a ventilator, providing a breathing circuit to connect the ventilator to a patient, the breathing circuit comprising a Y connector, the Y connector comprising an inlet portion, an endotracheal portion and an outlet portion, providing a nebulizer positioned to provide aerosol into the inlet portion of the Y connector, the nebulizer comprising a vibratory aerosolization element, the vibratory aerosolization element operable in part by an electronic signal; providing an electronic signal that causes the aerosolization element to vibrate in such a manner as to deliver a cloud of mist into the inlet portion of the inlet portion during an interval in which there is substantially no inhalation flow through the inlet portion, such that the cloud remains substantially within the inlet portion; providing an inhalation flow from the ventilator in such a manner as to sweep substantially the entire cloud of nebulized fluid through the endotracheal tube portion to the patient substantially upon the commencement of the inhalation flow.

247. A method for providing nebulized fluid to a patient receiving air from a ventilator, comprising: providing an aerosolization element; providing a controller configured to operate the aerosolization element; providing at least one algorithm that the controller may follow to determine a point to begin operation of the aerosolization element; wherein the controller can operate the aerosolization element independent of the instantaneous state of the ventilator.

248. The method of claim 247, further comprising: the controller receiving a signal from the ventilator which the controller may use in executing the algorithm.

249. A system for providing nebulized fluid to a patient receiving air from a ventilator, comprising: an aerosolization element; a controller configured to operate the aerosolization element; at least one algorithm accessible by the controller that the controller may follow to determine a point to begin operation of the aerosolization element; wherein the controller can operate the aerosolization element independent of the instantaneous state of the ventilator.

250. The system of claim 249, further comprising a signal receiver by which the controller may receive a signal from the ventilator.

251. A system for providing aerosol into a ventilator circuit, comprising; a ventilator capable of providing at least one cycle of inhalation air; a ventilator circuit comprising an inhalation tube, and exhalation tube and an intubation tube, and a Y connector therebetween; a sensor configured to monitor a point within an inhalation cycle of the ventilator; a nebulizer comprising a microprocessor, the microprocessor configured to calculate an inhalation profile based on the sensed point of operation of the ventilator, the microprocessor further configured to follow at least one algorithm for operating the nebulizer based on an inhalation profile, wherein the algorithm is configured to provide a point for the commencement of aerosolization and a point for the cessation of aerosolization.

252. The system of claim 251, wherein the of aerosolization and the point for cessation of aerosolization are not designed to coincide with the commencement of an inhalation phase and the cessation of an inhalation phase of an inhalation cycle provided by the nebulizer.

253. The system of claim 125, wherein the point for commencement of aerosolization and the point for cessation of aerosolization are not designed to coincide with the commencement of an exhalation phase and the cessation of an exhalation phase of an inhalation cycle provided by the nebulizer, nebulizer is mounted in a T connector in the inhalation tube of the ventilator circuit and wherein the nebulizer is configured to provide a mist propelled at low velocity such that the mist may occupy a portion of the ventilator circuit between the T and the Y connectors without any force of air.

254. The system of claim 251, wherein the point for commencement.

255. The system of claim 251, wherein the point for commencement of aerosolization and the point for cessation of aerosolization are chosen to maximize actual inhalation of aerosolized liquid.

256. The system of claim 255, wherein the point for commencement of aerosolization is a point following the completion of a predetermined portion of the inhalation phase of the inhalation cycle

257. The system of claim 256, wherein the point for cessation of aerosolization is a point prior to a predetermined portion of the inhalation phase of the inhalation cycle has occurred.

258. The system of claim 255, wherein the point for cessation of aerosolization is a point following the completion of a predetermined portion of the subsequent exhalation phase of the inhalation cycle.

259. The system of claim 255, wherein the point for commencement of aerosolization is a point following the completion of a predetermined portion of the exhalation phase of the inhalation cycle.

260. The system of claim 259, wherein the point for cessation of aerosolization is a point following the completion of a predetermined portion of the exhalation phase of the inhalation cycle

261. The system of claim 259, wherein the point for cessation of aerosolization is a point following the completion of a predetermined portion of the subsequent inhalation phase of the subsequent inhalation cycle.

262. The system of claim 252, wherein the nebulizer is configured to provide a mist propelled at low velocity such that between about 50%> and about 90%> of the mist generated in an inhalation cycle may occupy a portion of the ventilator circuit between the T and the Y connectors without any force of air.

263. The system of claim 252, wherein the nebulizer is configured to provide a mist propelled at low velocity such that between about 60 %> and about 80 % of the mist generated in an inhalation cycle may occupy a portion of the ventilator circuit between the T and the Y connectors without any force of air.

264. The system of claim 252, wherein the nebulizer is configured to provide a mist propelled at low velocity such that between about 65 %> and about 75 % of the mist generated in an inhalation cycle may occupy a portion of the ventilator circuit between the T and the Y connectors without any force of air.

265. A method of providing aerosol into the circuit of a ventilator over a predetermined portion of an inhalation cycle independent of the instantaneous point in the inhalation cycle provided by the ventilator, comprising: providing a ventilator circuit; providing an aerosolization element positioned to provide aerosol into the ventilator circuit; providing a controller to control the operation of the aerosolization element; providing an algorithm accessible by the controller; providing a reference signal from the ventilator; formulating an operation sequence for the controller to power the aerosolization element and to stop powering the aerosolization element, the formulation comprising utilizing the reference signal in combination with the algorithm to determine a time interval for providing aerosol into the ventilator circuit; and providing aerosol into the ventilator circuit according the operation sequence.

266. The method of claim 265, wherein the detection comprises detecting a pressure drop within the ventilation circuit.

267. The method of claim 265, wherein the algorithm is designed to have the controller start aerosol production based on the completion of a predetermined portion of an inhalation phase of an inhalation cycle.

268. The method of claim 265, wherein the algorithm is designed to have the controller stop aerosol production based on the completion of a predetermined portion of the inhalation phase of the inhalation cycle.

269. The method of claim 265, wherein the algorithm is designed to have the controller start aerosol production based on the completion of a predetermined portion of an exhalation phase of an inhalation cycle.

270. The method of claim 265, wherein the algorithm is designed to have the controller stop aerosol production based on the completion of a predetermined portion of the exhalation phase of the inhalation cycle.

271. A system for providing nebulized fluid to a person receiving air from a ventilator, comprising: an aerosolization element; a controller configured to cause the aerosol generator to begin aerosol production at a first predetermined time in a breathing cycle and to stop production of aerosol at a second predetermined time in the breathing cycle; an algorithm accessible by the controller, the algorithm configured to allow the controller to calculate an operating sequence based at least in part on the identity of a drug to be aerosolized.

272. The system of claim 271, further comprising a nebule containing drug to be aerosolized.

273. The system of claim 272, wherein the nebule comprises a marker identifying the drug therein.

274. The system of claim 273, further comprising a reader that can read the identifying marker and provide the identity of the drug to the controller.

275. The system of claim 274, wherein the drug is an antibiotic.

276. The system of claim 275, wherein the antibiotic is an aminoglycoside.

277. The system of claim 276, wherein the aminoglycoside is amikacin.

278. The system of claim 271, wherein the operation sequence calls for aerosol production to begin substantially at the start of an inhalation provided by the ventilator and for aerosol production to at a point at which substantially half of the inhalation phase has been completed.

279. The system of claim 276, wherein the operation sequence calls for aerosol production to begin substantially at the start of an inhalation provided by the ventilator and for aerosol production to at a point at which substantially half of the inhalation phase has been completed.

280. The system of claim 274, wherein the drug is an antibody.

281. They system of claim 280, wherein the drug is IgG.

282. A method of providing a particular drug as a nebulized fluid to a patient receiving air from a ventilator, the method comprising: providing an aerosolization element; providing a controller that is configured to cause the aerosol generator to begin aerosol production at a first predetermined time in a breathing cycle and to stop production of aerosol at a second predetermined time in the breathing cycle; providing an algorithm accessible by the controller, the algorithm configured to allow the controller to calculate an operating sequence based at least in part on the identity of a drug to be aerosolized.

283. The method of claim 282, further comprising providing a nebule that contains a drug to be aerosolized.

284. The method of claim 283, wherein the nebule comprises a marker identifying the drug therein.

285. The method of claim 284, further comprising: providing a reader that can read the identifying marker and that can provide the identity of the drug to the controller.

286. The method of claim 285, further comprising: having the reader read the identity of the drug; having the controller receive the identity of the drug; and having the controller establish an operating sequence based at least in part on the identity of the drug that it received.

287. The method of claim 286, wherein the drug is an antibiotic.

288. The method of claim 287, wherein the antibiotic is an aminoglycoside.

289. The method of claim 288, wherein the aminoglycoside is amikacin.

290. The method of claim 282, wherein the operation sequence calls for aerosol production to begin substantially at the start of an inhalation provided by the ventilator and for aerosol production to at a point at which substantially half of the inhalation phase has been completed.

291. The method of claim 289, wherein the operation sequence calls for aerosol production to begin substantially at the start of an inhalation provided by the ventilator and for aerosol production to at a point at which substantially half of the inhalation phase has been completed.

292. The method of claim 282, wherein the drug is an antibody.

293. They method of claim 292, wherein the drug is IgG.

294. A system for providing nebulized fluid to a person receiving air from a ventilator, comprising: an aerosolization element; a controller configured to cause the aerosol generator to begin aerosol production at a first predetermined time in a breathing cycle and to stop production of aerosol at a second predetermined time in the breathing cycle; wherein the controller is configured to adjust the time interval of aerosol production based on a change in the breath rhythm of a ventilated patient.