If you're in Southern California, you know that the local television weather reports include a daily update on the area's air quality. While this information is helpful to many, it is of grave importance to those persons suffering from respiratory ailments.

According to Rocky Hill, Conn.,-based Theta Reports, asthma affects 14 million to 15 million people in the United States and is one of the most common chronic pediatric diseases, afflicting approximately 4.8 million children. During the past decade, the number of serious complications resulting from asthma percent, has grown by about 40 percent, the report says. In addition, chronic obstructive pulmonary disease affects an estimated 17 million people, and its incidence is increasing each year, according to Theta Reports.

With the number of respiratory patients on the rise, the need for medication and drug delivery devices, such as nebulizers, compressors and metered-dose inhalers, will not disappear any time soon. Rather, the consensus among device manufacturers is that the market will continue to increase.

"The market is growing somewhere in the neighborhood of 10 to 15 percent a year," says John Snobarger, senior marketing manager, Salter Labs. "And everything says it's going to continue to grow for at least the next five to six years."

But while manufacturers are generally optimistic about the prospects for market growth, their enthusiasm is tempered by other concerns. The influx of new products and players over the years has increased the level of competition and caused the market to become very price-sensitive, they say.

"The market has become very competitive, and it's truly a commodity market," says Gregg Gaskins, vice president of sales and marketing, Nidek Medical. "Prices have dropped substantially over the last 12 to 18 months, so it's been a market in which everybody's had to work toward reducing costs and providing a lower cost unit to stay in the market. It's a high-volume market, but there's quite a bit of competition, too."

With this increased competition, manufacturers have been striving to differentiate themselves from each other. "The No. 1 challenge is education, having the physicians and dealers realize that there is a difference between nebulizers," says Kevin Gowanlock, product manager, Pari Respiratory Equipment. "There's been a myth out there that all nebulizers are the same. And we're out there educating the medical professionals that they're not. It's the same with the home care dealers. We try to get out of this commodity area where they'll buy just anything."

Manufacturers have also responded to increased competition by improving the quality of their devices. To better meet patient needs, they have developed products that are faster, more efficient and easier to use. They have created devices that deliver aerosols with smaller particle size, narrower bandwidth and drug delivery aimed at treating specific areas of the body as well as diseases. In addition, they have responded to consumer demands for products that are more compact. "There's a big trend toward smaller, lighter weight and more portable products," says Stephanie Webber, director of respiratory engineering, Invacare Corp.

"We're influencing people's lives because they're able to take their drugs and do everything else that they want to do," she adds. "Asthmatics are being a little less limited by their disease, since the treatment is better, and they're able to do more activities."

Because of this trend toward smaller and more portable products, some manufacturers believe that MDIs and chambers have assumed a dominant position in this market. They point to the MDI's compactness, as well as its ability to provide faster treatments.

"A lot of the medications that the pharmaceutical companies are coming out with are not even in a solution form because they are focused on delivering them through an MDI format," says Janice Kreitzer, aerosol products manager, Sunrise Medical. "So a lot of the market is being taken over by MDIs, and I feel that they are actually taking away from the nebulizer compressor portion."

In addition to MDIs, dry powder inhalers are making their presence known on the market. Already widely used in Europe, DPIs are gradually gaining greater use in the United States.

While recognizing the growing popularity of the two devices, other manufacturers still believe that nebulizers will remain a prominent force. They point out that Medicare reimburses for nebulizers but not for MDIs and chambers. Moreover, nebulizers are easier for infants and elderly persons to use, they say.

"Yes, there are lots of new MDIs, particularly powdered inhalers," says Susan Lloyd, vice president of the asthma and allergy division for Respironics Healthscan. "But I think you'll always see a role for nebulizers, because solutions will always be there for pediatric patients and geriatric patients, and for the patient who doesn't necessarily need to be taking the drug outside the home."

MANUFACTURERS HAVE NOTICED a growing trend toward using durable or reusable nebulizers, instead of disposable nebulizers.

"There's a big focus on reusable nebulizers," says Janice Kreitzer, aerosol products manager for Sunrise Medical. "A reusable nebulizer has higher efficiency, is more convenient for patients, gives them shorter treatment times, and that is definitely the way to go. The physicians are seeing that it's more efficient and a better treatment overall for their patients."

Other manufacturers say that ultrasonic nebulizers are catching on. Pneumatic nebulizers traditionally have been the standard-bearer in the industry. According to Theta Reports, 1.1 million pneumatic nebulizers were sold in 1996 in the United States, as opposed to only 10,000 ultrasonic nebulizers. The large gap in units sold was primarily due to the higher wholesale cost of ultrasonic nebulizers, according to the report. But makers of ultrasonic nebulizers today claim that ultrasonics deliver medications better and in less time, are lighter, more portable and, now, more reasonably priced.-R.P.

INSTEAD OF REACHING for a hypodermic needle, a diabetic turns on a compressor and breathes through it to take insulin. Sound unbelievable? Manufacturers say this scenario is a distinct possibility in an ever-evolving market where innovations are driven by growth."A lot of new medication s are coming into the market, and researchers are realizing that the lungs are the second quickest way into the bloodstream, compared to just having it done intravenously," says Janice Kreitzer, aerosol products manager for Sunrise Medical. "So if you have insulin delivery, it's a much nicer way to get it through an inhaler, compared to a shot."

With the development of such new medications, patients will be able to treat a plethora of other non-pulmonary diseases through aerosol delivery devices, manufacturers predict.

"New drugs are being formulated now for cancer that will be delivered through the lungs. Also pain-relief drugs. They're even using morphine nebulization for shortness of breath," says Kevin Gowanlock, product manager for Pari Respiratory Equipment.-R.P.

William Beal, director of sales and marketing, NextGen Inc., Woodland, Calif.; Russell Bird, president and chief executive officer, Medical Industries America, Adel, Iowa; Marc Burk, senior product manager, Hudson RCI, Temecula, Calif.; Dennis Cook, product manager of EMS and trauma products, and Janet Severine, product manager of hospital products, Allied Healthcare Products, St. Louis; Gregg Gaskins, vice president of sales and marketing, Nidek Medical, Birmingham, Ala.; Kevin Gowanlock, product manager, Pari Respiratory Equipment, Midlothian, Va.; Karen Hirsch, vice president of home medical equipment division, Medline Industries, Mundelein, Ill.; Janice Kreitzer, aerosol products manager, Sunrise Medical, Somerset, Pa.; Susan Lloyd, vice president of asthma and allergy division, Respironics Healthscan,Cedar Grove, N.J.; Fred Richards, manager of marketing and business development, DHD Healthcare, Canastota, N.Y.; John Shick, national sales manager, Ferraris Medical, Holland, N.Y.; John Snobarger, senior marketing manager, Salter Labs, Arvin, Calif.; Stephanie Webber, director of respiratory engineering, Invacare Corp., Elyria, Ohio.