As the end organ for the treatment of local diseases or as the route of administration for systemic therapies, the lung is a very attractive target for drug delivery. It provides direct access to disease in the treatment of respiratory diseases, while providing an enormous surface area and a relatively low enzymatic, controlled environment for systemic absorption of medications. As a major port of entry, the lung has evolved to prevent the invasion of unwanted airborne particles from entering into the body. Airway geometry, humidity, mucociliary clearance and alveolar macrophages play a vital role in maintaining the sterility of the lung and consequently are barriers to the therapeutic effectiveness of inhaled medications. In addition, a drug's efficacy may be affected by where in the respiratory tract it is deposited, its delivered dose and the disease it may be trying to treat.

https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1046/j.1365-2125.2003.01892.x

Pulmonary drug delivery. Part I: Physiological factors affecting therapeutic effectiveness of aerosolized medications

In recent years, the use of nebulisers to generate aerosols has been greatly extended because of their numerous advantages. Two types of nebulisers are commonly used, each based on a different principle : - jet nebulisers, based on the Venturi effect to fragment liquid preparations into small droplets. - ultrasonic nebulisers, using the vibrations of a quartz to produce aerosol. The use of nebulisers lacks standardisation, which may account for certain inefficiency. First of all, we defined the parameters required to evaluate nebulisation efficiency. Although droplet size is a commonly used parameter, it is not sufficient to forecast efficiency. It must be associated with the quantity of drug nebulised and nebulisation time. Secondly, we listed factors influencing nebulisation efficiency.

Factors influencing nebulizing efficiency

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

https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2125.2003.01893.x

Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications.

Drug delivery to the respiratory tract using dry powder inhalers

In vivo, in vitro and ex vivo models to assess pulmonary absorption and disposition of inhaled therapeutics for systemic delivery.

Part 1 Upper Airway - Structure, Function and Therapy (N. Mygind): Introduction. Anatomy of the nose. Applied physiology of the nose. Pathology of rhinitis. Aerosol therapy in the nose. Pharynx and larynx. References. Part 2 Lower Airway - Structure and Function (J.B. Forrest): Introduction. General organization of lung structure. Acknowledgements. References. Part 3 Aerosol Characterization and Generation (D.L. Swift): Characteristics of aerosols. Aerosol generation. References. Part 4 Airflow Dynamics in the Human Airways (H.K. Chang, A.S. Menon): Introduction. Airway models. Flow in the large airways (trachea, main and lobar bronchi). Flow in the upper airways (nose, nasopharynx, mouth, oropharynx, pharynx and anterior larynx). Relevance of fluid dynamics to particle deposition. References. Part 5 Mechanisms of Particle Deposition and Clearance (J.D. Brain, J.D. Blanchard): Introduction. Particle transport and deposition mechanisms. Characterizing and delivering therapeutic aerosol. Factors influencing particle deposition. Selecting deposition patterns. Clearance and retention of particles. Cough. Measuring particle retention. Conclusions. References. Part 6 Models of Aerosol Behaviour in Airways and Alveoli (P.E. Morrow, C.P. Yu): Introduction. Particle deposition. Particle removal from the respiratory system. Acknowledgement. References. Part 7 Aerosols in Diagnosis - Ventilation, Airway Penetrance, Epithelial Permeability, Mucociliary Transport and Airway Responsiveness (M.B. Dolovich, D.W. Cockcroft, G. Coates): Introduction. Aerosols and the assessment of ventilation. Aerosol "penetrance" in the assessment of airway obstruction. Aerosol and airway pharmacological responses. Aerosols in the assessment of pulmonary epithelial permeability. Aerosols in the assessment of mucociliary transport. Use of aerosols in assessment of airway responsiveness. Acknowledgement. References. Part 8 Epithelial Permeability (R.M. Effros): Introduction. Correlation of structure and permeability. Indicator properties which affect transport. Reflection coefficients of the pulmonary epithelium. Radioaerosol studies. Active transport across the pulmonary epithelium. Clinical applications of radioaerosol clearance. References. Part 9 Airway Mucus Clearance and Mucociliary Transport (P. Camner, B. Mossberg): Introduction. Basic data. Importance of mucociliary clearance. Lung diseases. Interventions. Environmental factors. References. Part 10 Bronchial Asthma, Chronic Bronchitis and Pulmonary Parenchymal Diseases (0. Selroos): Introduction. Drugs for inhalation. Delivery systems. Clinical indications. References. Part 11 Pulmonary Infections (C. Breese Hall, J.T. McBride): Introduction. Aerosolised antibacterial agents. Aerosolised chemoprophylactic therapy for Pneumocystis carinii. Aerosolised antiviral agents. Environmental agents. Summary. References. (Part contents).

Aerosols in Medicine : Principles, Diagnosis and Therapy

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Aerosols in Medicine : Principles, Diagnosis and Therapy