I have on my bike an air horn (AirZound is the brand if I remember correctly). Its selling point is that it is licenced by the US Coastguard as a fog horn for use on small ocean-going vessels. My experience of using it on my bike is that it works pretty well even on double-decker buses and 40-ton trucks which get in my way, and sometimes even penetrates the ears of those walking or cycling while wearing headphones or ear-buds (who otherwise seem oblivious to warning noises).
But for unprotected pedestrian ears at short-range it is a bit louder than needed, and sometimes makes them jump up in the air a little, which can be unproductive as they can't easily change direction while they are no longer in contact with the ground. With practice one can make it emit a gentler sound, but in emergencies one tends to press the button enthusiastically so the sound can be rather loud.
Apart from the fact that the air reservoir needs pumping up almost every day, it works very well and I recommend the device.