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Hsu YC, Li HH, Chiu LC, Chiang WC, Fang TP, Lin HL. Predicting Inhaled Drug Dose Generated by Mesh Nebulizers. J Aerosol Med Pulm Drug Deliv 2023; 36:162-170. [PMID: 37219568 DOI: 10.1089/jamp.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background: The lung dose of nebulized drugs for spontaneous breathing is influenced by breathing patterns and nebulizer performance. This study aimed to develop a system for measuring breath patterns and a formula for estimating inhaled drugs, and then to validate the hypothesized prediction formula. Methods: An in vitro model was first used to determine correlations among the delivered dose, breath patterns, and doses deposited on the accessories and reservoirs testing with a breathing simulator to generate 12 adult breathing patterns (n = 5). A pressure sensor was developed to measure breathing parameters and used along with a prediction formula that accounted for the initial charge dose, respiratory pattern, and dose on the accessory and reservoir of a nebulizer. Three brands of nebulizers were tested by placing salbutamol (5.0 mg/2.5 mL) in the drug holding chamber. Ten healthy individuals participated in the ex vivo study to validate the prediction formula. The agreement between the predicted and inhaled doses was analyzed using the Bland-Altman plot. Results: The in vitro model showed that the inspiratory time to total respiratory cycle time (Ti/Ttotal; %) was significantly directly correlated with the delivered dose among the respiratory factors, followed by inspiratory flow, respiratory rate, and tidal volume. The ex vivo model showed that Ti/Ttotal was significantly directly correlated with the delivered dose among the respiratory factors, in addition to the nebulization time and accessory dose. The Bland-Altman plots for the ex vivo model showed similar results between the two methods. Large differences in inhaled dose measured at the mouth were observed among the subjects, ranging from 12.68% to 21.68%; however, the difference between the predicted dose and inhaled dose was lower, at 3.98%-5.02%. Conclusions: The inhaled drug dose could be predicted with the hypothesized estimation formula, which was validated by the agreement between the inhaled and predicted doses of breathing patterns of healthy individuals.
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Affiliation(s)
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chung Chiu
- Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital-Linkou Branch, Taoyuan, Taiwan
| | | | - Tien-Pei Fang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan
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2
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Chaugule V, Wong CY, Inthavong K, Fletcher DF, Young PM, Soria J, Traini D. Combining experimental and computational techniques to understand and improve dry powder inhalers. Expert Opin Drug Deliv 2022; 19:59-73. [PMID: 34989629 DOI: 10.1080/17425247.2022.2026922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION : Dry Powder Inhalers (DPIs) continue to be developed to deliver an expanding range of drugs to treat an ever-increasing range of medical conditions; with each drug and device combination needing a specifically designed inhaler. Fast regulatory approval is essential to be first to market, ensuring commercial profitability. AREAS COVERED : In vitro deposition, particle image velocimetry, and computational modelling using the physiological geometry and representative anatomy can be combined to give complementary information to determine the suitability of a proposed inhaler design and to optimise its formulation performance. In combination they allow the entire range of questions to be addressed cost-effectively and rapidly. EXPERT OPINION : Experimental techniques and computational methods are improving rapidly, but each needs a skilled user to maximize results obtained from these techniques. Multidisciplinary teams are therefore key to making optimal use of these methods and such qualified teams can provide enormous benefits to pharmaceutical companies to improve device efficacy and thus time to market. There is already a move to integrate the benefits of Industry 4.0 into inhaler design and usage, a trend that will accelerate.
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Affiliation(s)
- V Chaugule
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - C Y Wong
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - K Inthavong
- Mechanical and Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW 2006, Australia
| | - P M Young
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Department of Marketing, Macquarie Business School, Macquarie University, NSW 2109, Australia
| | - J Soria
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - D Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Macquarie Medical School, Department of Biological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
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Debnath SK, Srivastava R, Debnath M, Omri A. Status of inhalable antimicrobial agents for lung infection: progress and prospects. Expert Rev Respir Med 2021; 15:1251-1270. [PMID: 33866900 DOI: 10.1080/17476348.2021.1919514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Available parenteral and oral administration of antimicrobial agents (AMAs) in respiratory infections often show less penetration into the lung parenchyma. Due to inappropriate dose availability, the rate of antibiotic resistance is increasing gradually. Inhaled antibiotics intensely improve the availability of drugs at the site of respiratory infections. This targeted delivery minimizes systemic exposure and associated toxicity.Area covers: This review was performed by searching in the scientific database like PubMed and several trusted government sites like fda.gov, cdc.gov, ClinicalTrials.gov, etc. For better understanding, AMAs are classified in different stages of approval. Mechanism and characterization of pulmonary drug deposition section helps to understand the effective delivery of AMAs to the respiratory tract. There is a need for proper adoption of delivery devices for inhalable AMAs. Thus, delivery devices are extensively explained. Inspiratory flow has a remarkable impact on the delivery device that has been explained in detail.Expert opinion: Pulmonary delivery restricts the bulk administration of drugs in comparison with other routes. Therefore, novel AMAs with higher bactericidal activity at lower concentrations need to be synthesized. Extensive research is indeed in developing innovative delivery devices that would able to deliver higher doses of AMAs through the pulmonary route.
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Affiliation(s)
- Sujit Kumar Debnath
- Department of Biosciences and Bioengineering, Indian Institute of Technology, Bombay, Mumbai, India
| | - Rohit Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology, Bombay, Mumbai, India
| | - Monalisha Debnath
- School of Medical Sciences and Technology, Indian Institute of Technology, Kharagpur, India
| | - Abdelwahab Omri
- Chemistry and Biochemistry, Laurentian University, Sudbury, Canada
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Molimard M, Kottakis I, Jauernig J, Lederhilger S, Nikolaev I. Performance Characteristics of Breezhaler ® and Aerolizer ® in the Real-World Setting. Clin Drug Investig 2021; 41:415-424. [PMID: 33768480 PMCID: PMC8149341 DOI: 10.1007/s40261-021-01021-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
The evaluation of errors in use with different inhaler devices is challenging to quantify as there are a number of definitions of critical and non-critical errors with respect to inhaler use; in addition, performance characteristics of the device, such as airflow resistance, can also influence effective use in the real-world setting. Repeated observations and checking/correcting inhaler use are essential to optimise clinical effectiveness of inhaled therapy in patients. Breezhaler® is a single unit-dose dry powder inhaler used in chronic obstructive pulmonary disease and in asthma (budesonide) that has low airflow resistance, making it easier for patients of varying disease severities to achieve the inhalation flow rate required for lung deposition of treatment. Similar to Breezhaler®, the Aerolizer® is a single unit-dose dry powder inhaler used in asthma management with low airflow resistance. Studies have shown relatively low rates of critical errors with Breezhaler® and Aerolizer®, with similarities in the critical errors reported; these data on critical errors together with similarities in the usability of Breezhaler® and Aerolizer® further support the functional similarity between the two devices in both asthma and chronic obstructive pulmonary disease. Breezhaler® also has patient-feedback features, including use of a transparent drug capsule that can be checked after inhalation to see it is empty. The low resistance of the dose-confirming Breezhaler® results in less inspiratory effort being required by patients for its effective use, which allows the device to be used effectively across a wide age range of patients and disease severities.
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Affiliation(s)
- Mathieu Molimard
- Service de Pharmacologie Médicale, CHU de Bordeaux-Université de Bordeaux-INSERM CR1219, 33076, Bordeaux Cedex, France.
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Zhang X, Cui Y, Liang R, Wang G, Yue X, Zhao Z, Huang Z, Huang Y, Geng J, Pan X, Wu C. Novel approach for real-time monitoring of carrier-based DPIs delivery process via pulmonary route based on modular modified Sympatec HELOS. Acta Pharm Sin B 2020; 10:1331-1346. [PMID: 32874832 PMCID: PMC7452036 DOI: 10.1016/j.apsb.2020.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/31/2022] Open
Abstract
An explicit illustration of pulmonary delivery processes (PDPs) was a prerequisite for the formulation design and optimization of carrier-based DPIs. However, the current evaluation approaches for DPIs could not provide precise investigation of each PDP separately, or the approaches merely used a simplified and idealized model. In the present study, a novel modular modified Sympatec HELOS (MMSH) was developed to fully investigate the mechanism of each PDP separately in real-time. An inhaler device, artificial throat and pre-separator were separately integrated with a Sympatec HELOS. The dispersion and fluidization, transportation, detachment and deposition processes of pulmonary delivery for model DPIs were explored under different flow rates. Moreover, time-sliced measurements were used to monitor the PDPs in real-time. The Next Generation Impactor (NGI) was applied to determine the aerosolization performance of the model DPIs. The release profiles of the drug particles, drug aggregations and carriers were obtained by MMSH in real-time. Each PDP of the DPIs was analyzed in detail. Moreover, a positive correlation was established between the total release amount of drug particles and the fine particle fraction (FPF) values (R 2 = 0.9898). The innovative MMSH was successfully developed and was capable of illustrating the PDPs and the mechanism of carrier-based DPIs, providing a theoretical basis for the design and optimization of carrier-based DPIs.
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Key Words
- ACI, Anderson Cascade Impactor
- APIs, active pharmaceutical ingredients
- Air flow rate
- CFD-DEM, computational fluid dynamics-discrete element method
- CIA, cascade impactor analysis
- Carrier
- Copt, optical concentration
- DPIs, dry powder inhalations
- Dry powder inhalation
- ED, emitted dose
- EDXS, energy-dispersive X-ray spectroscopy
- FC, centrifugal force
- FD, drag force
- FF, friction force
- FG, gravity
- FI, interaction force
- FPD, fine particle dose
- FPF, fine particle fraction
- HPLC, high performance liquid chromatography
- HPMC, hydroxy propyl methyl cellulose
- LAC, lactose carrier
- MFV, minimum fluidization velocity
- MMAD, mass median aerodynamic diameter
- MMSH, modular modified Sympatec HELOs
- MOC, micro orifice collector
- MSS, micronized salbutamol sulfate
- Mechanism of drug delivery
- Modular modification
- NGI, Next Generation Impactor
- O, oxygen
- PDP, pulmonary delivery process
- Pulmonary delivery process
- R, release amount
- RAUC, total release amount
- Real-time monitoring
- Rmax, maximum of release amount
- S, stopping distance
- SEM, scanning electron microscope
- Tmax, the time to Rmax
- Tt, terminal time
- U0, air flow rate
- V0, velocity
- a, acceleration
- dQ3, the volume percentage of particles within certain range
- dae, aerodynamic diameter
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Fröhlich E. Biological Obstacles for Identifying In Vitro- In Vivo Correlations of Orally Inhaled Formulations. Pharmaceutics 2019; 11:E316. [PMID: 31284402 PMCID: PMC6680885 DOI: 10.3390/pharmaceutics11070316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 12/26/2022] Open
Abstract
Oral inhalation of drugs is the classic therapy of obstructive lung diseases. In contrast to the oral route, the link between in vitro and in vivo findings is less well defined and predictive models and parameters for in vitro-in vivo correlations are missing. Frequently used in vitro models and problems in obtaining in vivo values to establish such models and to identify the action of formulations in vivo are discussed. It may be concluded that major obstacles to link in vitro parameters on in vivo action include lack of treatment adherence and incorrect use of inhalers by patients, variation in inhaler performance, changes by humidity, uncertainties about lung deposition, and difficulties to measure drug levels in epithelial lining fluid and tissue. Physiologically more relevant in vitro models, improvement in inhaler performance, and better techniques for in vivo measurements may help to better understand importance and interactions between individual in vitro parameters in pulmonary delivery.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University of Graz, 8010 Graz, Austria.
- Research Center Pharmaceutical Engineering GmbH, 8010 Graz, Austria.
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