INHALATION THERAPY - APPROACHES AND CHALLENGES
Â Inhalation therapy is an effective way for local and systemic delivery of miscellaneous drugs for pulmonary and non-pulmonary diseases. The inhalation therapy aims to target specific cells or regions of the lung, bypassing the lungâ€™s clearance mechanisms and thereby providing high retention of the drug for longer periods. It helps in improved penetration of intravenously administered antibiotics into lung parenchymal tissue and bronchial secretions, and as a result, their potential systemic toxicity is reduced when given over prolonged periods of time. The advancement in device technology supports the development of more efficient therapy in the form of delivering finer particles into the lung in large doses. Therefore, meticulous daily management of lung disease, together with prompt, aggressive treatment of exacerbations can be achieved through inhalation to preserve lung function. This review summarizes the features of inhalation delivery devices, their advantages and limitations, challenges in formulation and brief description of novel technologies currently marketed.
2. Zhang J, Wu L, Chan HK, Watanabe W. Formation, characterization, and fate of inhaled drug nanoparticles. Adv Drug Deliv Rev 2011;63:441-55.
3. Heijerman H, Westerman E, Conway S, Touw D. Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis: A European consensus. J Cyst Fibros 2009;8:295-315.
4. Sanders M. Inhalation therapy: An historical review. Prim Care Respir J 2007;16:71-81.
5. Kuzmov A, Minko T. Nanotechnology approaches for inhalation treatment of lung diseases. J Control Release 2015;219:500-18.
6. Schulz H, Brand P, Heyder J. Particle deposition in the respiratory tract. In: Gehr P, Heyder J, editors. Particleâ€“Lung Interactions. New York: Dekker; 2000.
7. Jain KK. Drug Delivery Systems: An Overview (Methods in Molecular Biology). New York: Humana Press; 2008.
8. Darquenne C. Particle deposition in the lung. Encyclopedia of Respiratory Medicine. Amsterdam, UK: Elsevier Ltd.; 2006. p. 300-4.
9. Lee WH, Loo CY, Traini D, Young PM. Inhalation of nanoparticle-based drug for lung cancer treatment: Advantages and challenges. Asian J Pharm Sci 2015;10:481-9.
10. Todoroff J, Vanbever R. Fate of nanomedicines in the lungs. Curr Opin Colloid Interface Sci 2011;16:246-54.
11. Heyder J. Particle transport onto human airway surfaces. Eur J Respir Dis Suppl 1982;119:29-50.
12. Hinds WC, Liu WC, Froines JR. Particle bounce in a personal cascade impactor: A field evaluation. Am Ind Hyg Assoc J 1985;46:517-23.
13. Ibrahim M, Verma R, Garcia-Contreras L. Inhalation drug delivery devices: Technology update. Med Devices (Auckl) 2015;8:131-9.
14. Ari A, Restrepo RD. American association for respiratory C. Aerosol delivery device selection for spontaneously breathing patients. RespiCare 2012;57:613-26.
15. Newman SP. Aerosol deposition considerations in inhalation therapy. Chest 1985;88:152S-60.
16. Hess D, Fisher D, Williams P, Pooler S, Kacmarek RM. Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996;110:498-505.
17. Loffert DT, Ikle D, Nelson HS. A comparison of commercial jet nebulizers. Chest 1994;106:1788-92.
18. Niven RW, Schreier H. Nebulization of liposomes. I. Effects of lipid composition. Pharm Res 1990;7:1127-33.
19. Dean RH, Timothy R, Myers JL. A Guide to Aerosol Delivery Devices for Respiratory Therapy. Respirosonic; 2007.
20. Hess DR. Nebulizers: Principles and performance. RespirCare 2000;45:609-22.
21. Jet AA. Ultrasonic and mesh nebulizers: An evaluation of nebulizers for better clinical outcomes. Eur J Pulmonol 2014;16:1-7.
22. Muchao FP, Silva FL. Advances in inhalation therapy in pediatrics. J Pediatr (Rio J) 2010;86:367-76.
23. Dhand R. Intelligent nebulizers in the age of the internet: The I-neb adaptive aerosol delivery (AAD) system. J Aerosol Med Pulm Drug Deliv 2010;23:iii-v.
24. Vecellio L. The mesh nebuliser: A recent technical innovation for aerosol delivery. Breathe 2006;2:253-60.
25. Available from: http://www.omnisurge.co.za/what-are-nebulizers-and-how-do-they-work. [Last accessed on 2017 May 03].
26. Cairo JM. Humidity and aerosol therapy In: Mosbyâ€™s Respiratory care Equipment. 9th ed. Missouri: Elseiver Inc.; 2014.
27. Pilcer G, Amighi K. Formulation strategy and use of excipients in pulmonary drug delivery. Int J Pharm 2010;392:1-9.
28. Newhouse MT, Hirst PH, Duddu SP, Walter YH, Tarara TE, Clark AR, et al. Inhalation of a dry powder tobramycin pulmo Sphere formulation in healthy volunteers. Chest 2003;124:360-6.
29. Nikolaizik WH, Jenni-Galovic B, Schoni MH. Bronchial constriction after nebulised tobramycin preparations and saline in patients with cystic fibrosis. Pneumology 1996;155:608-11.
30. Yang XF, Xu Y, Qu DS, Li HY. The influence of amino acids on aztreonam spray-dried powders for inhalation. Asian J Pharm Sci 2015;10:541-8.
31. dâ€™Angelo I, Conte C, La Rotonda MI, Miro A, Quaglia F, Ungaro F, et al. Improving the efficacy of inhaled drugs in cystic fibrosis: Challenges and emerging drug delivery strategies. Adv Drug Deliv Rev 2014;75:92-111.
32. Vaswani SK, Creticos PS. Metered dose inhaler: Past, present, and future. Ann Allergy Asthma Immunol 1998;80:11-9.
33. Oâ€™Donnell A, Swarnakar R, Yashina L, Nikolova P, Marinov R, Waghray P, et al. A Placebo Controlled Study of Liposomal Amikacin for Inhalation (ARIKACEâ„¢) Nebulized Once-Daily in the Treatment of Bronchiectasis Patients with Chronic Pseudomonas aeruginosa lung infection. Presented at: ERS Annual Conference Abstract 1361, Vienna, Austria, 13 September; 2009.
34. Cipolla D, Gonda I, Chan HK. Liposomal formulations for inhalation. Ther Deliv 2013;4:1047-72.
35. Ibiapina CC, Cruz AA, Camargos PA. Hydrofluoroalkane as a propellant for pressurized metered-dose inhalers: History, pulmonary deposition, pharmacokinetics, efficacy and safety. J Pediatr (Rio J) 2004;80:441-6.
36. Labiris NR, Dolovich MB. Pulmonary drug delivery. Part II: The role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications. Br J Clin Pharmacol 2003;56:600-12.
37. Newman SP. Principles of metered-dose inhaler design. Respir Care 2005;50:1177-90.
38. Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax 1991;46:712-6.
39. Yadav N, Morris G, Harding SE, Ang S, Adams GG. Various non-injectable delivery systems for the treatment of diabetes mellitus. Endocr Metab Immune Disord Drug Targets 2009;9:1-3.
40. Dalby RN, Eicher J, Zierenberg B. Development of respimatÂ® soft mist inhaler and its clinical utility in respiratory disorders. Med Devices 2011;4:145-55.
41. Islam N, Gladki E. Dry powder inhalers (DPIs) â€“ A review of device reliability and innovation. Int J Pharm 2008;360:1-1.
42. Hoppentocht M, Hagedoorn P, Frijlink HW, de Boer AH. Technological and practical challenges of dry powder inhalers and formulations. Adv Drug Deliv Rev 2014;75:18-31.
43. Atkins PJ. Dry powder inhalers: An overview. Respir Care 2005;50:1304-12.
44. Rabbani NR, Seville PC. The influence of formulation components on the aerosolisation properties of spray-dried powders. J Control Release 2005;110:130-40.
45. Rabbani NR, Seville PC. The use of amino acids as formulation excipients in lactose based spray-dried powders. J Pharm Pharmacol 2004;56:32-3.
46. Yamamoto A, Okumura S, Fukuda Y, Fukui M, Takahashi K, Muranishi S, et al. Improvement of the pulmonary absorption of (Asu1,7)-eel calcitonin by various absorption enhancers and their pulmonary toxicity in rats. J Pharm Sci 1997;86:1144-7.
47. Zhao M, You Y, Ren Y, Zhang Y, Tang X. Formulation, characteristics and aerosolization performance of azithromycin DPI prepared by spray-drying. Powder Technol 2008;187:214-21.
48. Thorsson L, Geller D. Factors guiding the choice of delivery device for inhaled corticosteroids in the long-term management of stable asthma and COPD: Focus on budesonide. Respir Med 2005;99:836-49.
49. Available from: https://www.medicines.org.uk/emc/medicine/29177. [Last accessed on 2017 Aug 16].
50. Dalby RN, Eicher J, Zierenberg B. Development of respimatÂ®softmisttm inhaler and its clinical utility in respiratory disorders. Med Dev 2011;4:145-55.
51. Anderson P. Use of respimatÂ® soft misttm inhaler in COPD patients. Int J Chron Obstruct Pulmon Dis 2006;1:251-9.
52. Staniforth JN. Pre-formulation aspects of dry powder aerosols. In: Dalby RN, Byron PR, Farr ST, editors. Respiratory Drug Delivery. Vol. 5. Buffalo Grove, IL: Interpharm Press; 1996.
53. Scheuch G, Fischer A. Intelligent Inhalation technology. IPT 2009;29:61-4.
54. Huh AJ, Kwon YJ. â€œNanoantibioticsâ€: A new paradigm for treating infectious diseases using nanomaterials in the antibiotics resistant era. J Control Release 2011;156:128-45.
55. Shaji J, Shaikh M. Formulation, optimization, and characterization of biocompatible inhalable d-cycloserine-loaded alginate-chitosan nanoparticles for pulmonary drug delivery. Asian J Pharm Clin Res 2016;9:82-95.
56. Vyas SP, Kannan ME, Jain S, Mishra V, Singh P. Design of liposomal aerosols for improved delivery of rifampicin to alveolar macrophages. Int J Pharm 2004;269:37-49.
57. Paranjpe M, MÃ¼ller-Goymann CC. Nanoparticle-mediated pulmonary drug delivery: A review. Int J Mol Sci 2014;15:5852-73.
58. van den Hoven JM, Metselaar JM, Storm G, Beijnen JH, Nuijen B. Cyclodextrin as membrane protectant in spray-drying and freeze-drying of PEGylated liposomes. Int J Pharm 2012;438:209-16.
59. Wang Y, Kho K, Cheow WS, Hadinoto K. A comparison between spray dries and spray freeze drying for dry powder inhaler formulation of drug-loaded lipid-polymer hybrid nanoparticles. Int J Pharm 2012;424:98-106.
60. Ye T, Yu J, Luo Q, Wang S, Chan HK. Inhalable clarithromycin liposomal dry powders using ultrasonic spray freeze drying. Powder Technol 2017;305:63-70
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.