Labiris NR, Dolovich MB. Pulmonary drug delivery: part II. the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications

Research in the area of pulmonary drug delivery has gathered momentum in the last several years, with increased interest in using the lung as a means of delivering drugs systemically. Advances in device technology have led to the development of more efficient delivery systems capable of delivering larger doses and finer particles into the lung. As more efficient pulmonary delivery devices and sophisticated formulations become available, physicians and health professionals will have a choice of a wide variety of device and formulation combinations that will target specific cells or regions of the lung, avoid the lung's clearance mechanisms and be retained within the lung for longer periods. It is now recognized that it is not enough just to have inhalation therapy available for prescribing; physicians and other healthcare providers need a basic understanding of aerosol science, inhaled formulations, delivery devices, and bioequivalence of products to prescribe these therapies optimally.

[1]  M. Dahlbäck Behavior of nebulizing solutions and suspensions. , 1994, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[2]  M. Newhouse,et al.  Optimal delivery of aerosols from metered dose inhalers. , 1981, Chest.

[3]  W. Bennett,et al.  Human variation in the peripheral air-space deposition of inhaled particles. , 1987, Journal of applied physiology.

[4]  K. Parameswaran Concepts of establishing clinical bioequivalence of chlorofluorocarbon and hydrofluoroalkane beta-agonists. , 1999, The Journal of allergy and clinical immunology.

[5]  L. Borgström,et al.  Total and regional lung deposition of terbutaline sulphate inhaled via a pressurised MDI or via Turbuhaler , 1993 .

[6]  M. Everard,et al.  Flow early in the inspiratory manoeuvre affects the aerosol particle size distribution from a Turbuhaler. , 1997, Respiratory medicine.

[7]  S. Sawyer,et al.  Liposomal DNA vectors for cystic fibrosis gene therapy. Current applications, limitations, and future directions , 1996 .

[8]  D. Ikle,et al.  A comparison of commercial jet nebulizers. , 1994, Chest.

[9]  D. Pavia,et al.  Effects of various inhalation modes on the deposition of radioactive pressurized aerosols. , 1982, European journal of respiratory diseases. Supplement.

[10]  K. Taylor,et al.  The Influence of Liposomal Encapsulation on Sodium Cromoglycate Pharmacokinetics in Man , 1989, Pharmaceutical Research.

[11]  K. Chapman,et al.  A comparison of breath-actuated and conventional metered-dose inhaler inhalation techniques in elderly subjects. , 1993, Chest.

[12]  S. Spiro,et al.  Lung deposition patterns of directly labelled salbutamol in normal subjects and in patients with reversible airflow obstruction. , 1993, Thorax.

[13]  M. Knowles,et al.  Pharmaceutical Dry Powder Aerosols: Correlation of Powder Properties with Dose Delivery and Implications for Pharmacodynamic Effect , 1999, Pharmaceutical Research.

[14]  H. Yang,et al.  Aerosol delivery of liposome-encapsulated ciprofloxacin: aerosol characterization and efficacy against Francisella tularensis infection in mice , 1997, Antimicrobial agents and chemotherapy.

[15]  B. Lipworth,et al.  Importance of drug-device interaction in determining systemic effects of inhaled cor ticosteroids , 1999, The Lancet.

[16]  S. Clarke,et al.  Deposition and clinical efficacy of terbutaline sulphate from Turbuhaler, a new multi-dose powder inhaler. , 1989, The European respiratory journal.

[17]  M. Dolovich Characterization of medical aerosols: physical and clinical requirements for new inhalers , 1995 .

[18]  L. Borgström,et al.  Lung deposition of budesonide inhaled via Turbuhaler: a comparison with terbutaline sulphate in normal subjects. , 1994, The European respiratory journal.

[19]  S. Newman,et al.  Lung deposition from four nebulizers. , 1993, Respiratory medicine.

[20]  J. Grossman The evolution of inhaler technology. , 1994, The Journal of asthma : official journal of the Association for the Care of Asthma.

[21]  Stephen C Lazarus,et al.  Systemic effect comparisons of six inhaled corticosteroid preparations. , 2002, American journal of respiratory and critical care medicine.

[22]  W. Busse,et al.  Efficacy and safety overview of a new inhaled corticosteroid, QVAR (hydrofluoroalkane-beclomethasone extrafine inhalation aerosol), in asthma. , 2000, The Journal of allergy and clinical immunology.

[23]  S. Clarke,et al.  Evaluation of jet nebulisers for use with gentamicin solution. , 1985, Thorax.

[24]  D. Ganderton Targeted delivery of inhaled drugs: current challenges and future goals. , 1999, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[25]  Mathias Winterhalter,et al.  Stealth® liposomes: from theory to product , 1997 .

[26]  S. Clarke,et al.  Terbutaline sulphate Turbuhaler: effect of inhaled flow rate on drug deposition and efficacy , 1991 .

[27]  H. Schreier,et al.  Nebulization of Liposomes. II. The Effects of Size and Modeling of Solute Release Profiles , 1991, Pharmaceutical Research.

[28]  M. Jenkins Clinical evaluation of CFC-free metered dose inhalers. , 1995, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[29]  A. Hollingworth,et al.  The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers--implications for in vitro testing. , 1993, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[30]  V. Turjanmaa,et al.  Pulmonary distribution and clearance of two beclomethasone liposome formulations in healthy volunteers. , 1999, International journal of pharmaceutics.

[31]  L. Harrison,et al.  Pharmacokinetics and dose proportionality of beclomethasone from three strengths of a CFC‐free beclomethasone dipropionate metered‐dose inhaler , 1997, Biopharmaceutics & drug disposition.

[32]  M Dolovich,et al.  Clinical evaluation of a simple demand inhalation MDI aerosol delivery device. , 1983, Chest.

[33]  A. Ullman,et al.  Salmeterol, a new long acting inhaled beta 2 adrenoceptor agonist: comparison with salbutamol in adult asthmatic patients. , 1988, Thorax.

[34]  Bioequivalence of metered-dose inhaled medications. , 1993, The Journal of allergy and clinical immunology.

[35]  A. Woodcock,et al.  Review of therapeutically equivalent alternatives to short acting β2 adrenoceptor agonists delivered via chlorofluorocarbon-containing inhalers , 1999, Thorax.

[36]  B. O'connor,et al.  Hydrofluoroalkane-134a beclomethasone dipropionate extrafine aerosol provides equivalent asthma control to chlorofluorocarbon beclomethasone dipropionate at approximately half the total daily dose. , 1998, Respiratory medicine.

[37]  M. Nakanishi,et al.  Confocal and probe microscopy to study gene transfection mediated by cationic liposomes with a cationic cholesterol derivative. , 2001, Advanced drug delivery reviews.

[38]  S. Clarke,et al.  Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. , 1991, Thorax.

[39]  C. Leach Improved delivery of inhaled steroids to the large and small airways. , 1998, Respiratory medicine.

[40]  H. Boushey,et al.  Alteration in osmolarity of inhaled aerosols cause bronchoconstriction and cough, but absence of a permeant anion causes cough alone. , 1984, The American review of respiratory disease.

[41]  P. O'Byrne,et al.  Protection against methacholine bronchoconstriction to assess relative potency of inhaled beta2-agonist. , 1999, American journal of respiratory and critical care medicine.

[42]  Ilya Prigogine,et al.  Order out of chaos , 1984 .

[43]  S. Clarke,et al.  Delivery of albuterol and ipratropium bromide from two nebulizer systems in chronic stable asthma. Efficacy and pulmonary deposition. , 1989, Chest.

[44]  C O'Callaghan,et al.  The science of nebulised drug delivery , 1997, Thorax.

[45]  Sumby,et al.  Latest advances in the development of dry powder inhalers. , 2000, Pharmaceutical science & technology today.

[46]  A. R. Clark,et al.  Medical Aerosol Inhalers: Past, Present, and Future , 1995 .

[47]  H. Schreier,et al.  Pulmonary delivery of liposomes , 1993 .

[48]  N Lotan,et al.  Large porous particles for pulmonary drug delivery. , 1997, Science.

[49]  R. Richards,et al.  Need for a comparative performance standard for dry powder inhalers. , 1993, Thorax.

[50]  M. Dolovich New delivery systems and propellants. , 1999, Canadian respiratory journal.

[51]  Amarnath Sharma,et al.  Liposomes in drug delivery: Progress and limitations , 1997 .

[52]  J. Staniforth,et al.  British Pharmaceutical Conference Science Award Lecture 1986: Order out of chaos , 1987, The Journal of pharmacy and pharmacology.

[53]  A. Boner,et al.  Allergen avoidance at high altitude and urinary eosinophil protein X. , 1999, The Journal of allergy and clinical immunology.

[54]  H. Schreier,et al.  Nebulization of Liposomes. I. Effects of Lipid Composition , 1990, Pharmaceutical Research.

[55]  P. Paronen,et al.  In vivo evaluation of the new multiple dose powder inhaler and the Rotahaler using the gamma scintigraphy. , 1990, Acta pharmaceutica Nordica.

[56]  A. Tanswell,et al.  Targeting transgene expression for cystic fibrosis gene therapy. , 2001, Molecular therapy : the journal of the American Society of Gene Therapy.

[57]  G K Crompton,et al.  Problems patients have using pressurized aerosol inhalers. , 1982, European journal of respiratory diseases. Supplement.

[58]  N. Sheahan,et al.  Deposition of pressurised aerosols in the human respiratory tract. , 1981, Thorax.

[59]  M. Newhouse,et al.  Aerosol penetration into the lung; influence on airway responses. , 1981, Chest.

[60]  S. Newman,et al.  Effect of different modes of inhalation on drug delivery from a dry powder inhaler , 1994 .

[61]  B. Ramsey,et al.  Effect of nebulizer type and antibiotic concentration on device performance , 1997, Pediatric pulmonology.

[62]  H S Shannon,et al.  Effect of lung function and mode of inhalation on penetration of aerosol into the human lung. , 1977, Thorax.

[63]  S. Pedersen Inhalers and nebulizers: which to choose and why. , 1996, Respiratory medicine.

[64]  Y. Kawashima,et al.  A New Powder Design Method to Improve Inhalation Efficiency of Pranlukast Hydrate Dry Powder Aerosols by Surface Modification with Hydroxypropylmethylcellulose Phthalate Nanospheres , 1998, Pharmaceutical Research.

[65]  J. Lagacé,et al.  Aerosolization of low phase transition temperature liposomal tobramycin as a dry powder in an animal model of chronic pulmonary infection caused by Pseudomonas aeruginosa. , 1999, Journal of drug targeting.

[66]  A. Kendrick,et al.  Selecting and using nebuliser equipment , 1997, Thorax.

[67]  I. Kellaway,et al.  Poly(l-lactic acid) microspheres for pulmonary drug delivery: release kinetics and aerosolization studies , 1998 .

[68]  Abdelwahab Omri,et al.  Pulmonary retention of free and liposome-encapsulated tobramycin after intratracheal administration in uninfected rats and rats infected with Pseudomonas aeruginosa , 1994, Antimicrobial Agents and Chemotherapy.

[69]  R. Farinotti,et al.  Nebulizer Performance: AFLM Study , 1995 .

[70]  M. Dolovich New propellant-free technologies under investigation. , 1999, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[71]  P. O'Byrne,et al.  Clinical models to compare the safety and efficacy of inhaled corticosteroids in patients with asthma. , 2003, Canadian respiratory journal.

[72]  K. Taylor,et al.  Liposomes for controlled delivery of drugs to the lung. , 1992, Thorax.

[73]  M. Svartengren,et al.  Added external resistance reduces oropharyngeal deposition and increases lung deposition of aerosol particles in asthmatics. , 1995, American journal of respiratory and critical care medicine.

[74]  D. Hess,et al.  Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. , 1996, Chest.

[75]  P. Paronen,et al.  Effect of powder inhaler design on drug deposition in the respiratory tract , 1988 .

[76]  D. Rogers,et al.  Determining equivalence of inhaled medications. Consensus statement from a workshop of the British Association for Lung Research, held at Royal Brompton National Heart & Lung Institute, London 24 June 1994. , 1995, Respiratory medicine.