Penetration of inhaled aerosols in the bronchial tree

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Nebulised delivery of RNA formulations to the lungs: From aerosol to cytosol

In the past decade RNA-based therapies such as small interfering RNA (siRNA) and messenger RNA (mRNA) have emerged as new and ground-breaking therapeutic agents for the treatment and prevention of many conditions from viral infection to cancer. Most clinically approved RNA therapies are parenterally administered which impacts patient compliance and adds to healthcare costs. Pulmonary administration via inhalation is a non-invasive means to deliver RNA and offers an attractive alternative to injection. Nebulisation is a particularly appealing method due to the capacity to deliver large RNA doses during tidal breathing. In this review, we discuss the unique physiological barriers presented by the lung to efficient nebulised RNA delivery and approaches adopted to circumvent this problem. Additionally, the different types of nebulisers are evaluated from the perspective of their suitability for RNA delivery. Furthermore, we discuss recent preclinical studies involving nebulisation of RNA and analysis in in vitro and in vivo settings. Several studies have also demonstrated the importance of an effective delivery vector in RNA nebulisation therefore we assess the variety of lipid, polymeric and hybrid-based delivery systems utilised to date. We also consider the outlook for nebulised RNA medicinal products and the hurdles which must be overcome for successful clinical translation. In summary, nebulised RNA delivery has demonstrated promising potential for the treatment of several lung-related conditions such as asthma, COPD and cystic fibrosis, to which the mode of delivery is of crucial importance for clinical success.

Bovine Airway Models: Approaches for Investigating Bovine Respiratory Disease

Bovine respiratory disease (BRD) is a multifactorial condition where different genera of bacteria, such as Mannheimia haemolytica, Histophilus somni, Pasteurella multocida, and Mycoplasma bovis, and viruses, like bovine respiratory syncytial virus, bovine viral diarrhea virus, and bovine herpes virus-1, infect the lower respiratory tract of cattle. These pathogens can co-infect cells in the respiratory system, thereby making specific treatment very difficult. Currently, the most common models for studying BRD include a submerged tissue culture (STC), where monolayers of epithelial cells are typically covered either in cellular or spent biofilm culture medium. Another model is an air-liquid interface (ALI), where epithelial cells are exposed on their apical side and allowed to differentiate. However, limited work has been reported on the study of three-dimensional (3D) bovine models that incorporate multiple cell types to represent the architecture of the respiratory tract. The roles of different defense mechanisms in an infected bovine respiratory system, such as mucin production, tight junction barriers, and the production of antimicrobial peptides in in vitro cultures require further investigation in order to provide a comprehensive understanding of the disease pathogenesis. In this report, we describe the different aspects of BRD, including the most implicated pathogens and the respiratory tract, which are important to incorporate in disease models assembled in vitro. Although current advancements of bovine respiratory cultures have led to knowledge of the disease, 3D multicellular organoids that better recapitulate the in vivo environment exhibit potential for future investigations.

Risk assessment of COVID infection by respiratory droplets from cough for various ventilation scenarios inside an elevator: An OpenFOAM-based computational fluid dynamics analysis

Respiratory droplets-which may contain disease spreading virus-exhaled during speaking, coughing, or sneezing are one of the significant causes for the spread of the ongoing COVID-19 pandemic. The droplet dispersion depends on the surrounding air velocity, ambient temperature, and relative humidity. In a confined space like an elevator, the risk of transmission becomes higher when there is an infected person inside the elevator with other individuals. In this work, a numerical investigation is carried out in a three-dimensional domain resembling an elevator using OpenFoam. Three different modes of air ventilation, viz., quiescent, axial exhaust draft, and exhaust fan, have been considered to investigate the effect of ventilation on droplet transmission for two different climatic conditions (30  °C , 50% relative humidity and 10  °C , 90% relative humidity). The risk assessment is quantified using a risk factor based on the time-averaged droplet count present near the passenger's hand to head region (risky height zone). The risk factor drops from 40% in a quiescent scenario to 0% in an exhaust fan ventilation condition in a hot dry environment. In general, cold humid conditions are safer than hot dry conditions as the droplets settle down quickly below the risky height zone owing to their larger masses maintained by negligible evaporation. However, an exhaust fan renders the domain in a hot dry ambience completely safe (risk factor, 0%) in 5.5 s whereas it takes 7.48 s for a cold humid ambience.

Case Report: Occupational Dust Exposure Among Bakery Workers in Perth, Western Australia

Occupational dust exposure can occur in various settings, including bakeries. A case study was conducted in an industrial bakery in Perth, Western Australia, to assess exposure to particulate dust concentration. The factory was separated into three production zones and an office area which represented as a control zone. Results indicated that bakery workers in the production zones were exposed to higher ambient dust particle concentrations compared to those from the office environment. Coarse particles (>10 μm in aerodynamic diameter) were the predominant particle size fraction measured in all studied areas with the highest median exposure level recorded in the dough room (0.181 mg/m3, interquartile range 0.283). High personal concentration of respirable particles was also measured in the dough room (median 2.26 mg/m3) which exceeded the recommended limit of 1.5 mg/m3 and was more than 50 times higher than the concentration recorded in the office (0.04 mg/m3). The variation in dust concentrations between production zones underlines the need of more knowledge about how aerosol fractions are distributed across the production process. The findings also suggest that bakery workers are exposed to high dust levels that may increase their risk of developing respiratory diseases and the decrease of present exposure levels is imperative.

Development and testing of a new-generation aerosol exposure system: The independent holistic air-liquid exposure system (InHALES)

The dose of inhaled materials delivered to the respiratory tract is to a large extent a function of the kinetics of particle deposition and gas dissolution on or in the airway and lung epithelia, and therefore of the structural and functional properties of the respiratory tract. In vitro aerosol exposure systems commonly do not simulate these properties, which may result in the delivery of non-realistic, non-human-relevant doses of inhalable test substances to the in vitro biological test systems. We developed a new-generation in vitro aerosol exposure system, the InHALES, that can, like the human respiratory tract, actively breathe, operate medical inhalers, or take puffs from tobacco products. Due to its structural and functional similarity to the human respiratory tract, the system is expected to deliver human-relevant doses of inhalable materials to cell cultures representing respiratory tract epithelia. We here describe the proof of concept of the InHALES with respect to aerosol delivery and compatibility with oral, bronchial, and alveolar cell cultures. The results indicate that the system structure and function translate into complex patterns of test atmosphere delivery that, with increasing system complexity, may closely mimic the patterns observable in the human respiratory tract.

Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review

Healthcare workers are at risk of infection during the severe acute respiratory syndrome coronavirus‐2 pandemic. International guidance suggests direct droplet transmission is likely and airborne transmission occurs only with aerosol‐generating procedures. Recommendations determining infection control measures to ensure healthcare worker safety follow these presumptions. Three mechanisms have been described for the production of smaller sized respiratory particles (‘aerosols’) that, if inhaled, can deposit in the distal airways. These include: laryngeal activity such as talking and coughing; high velocity gas flow; and cyclical opening and closure of terminal airways. Sneezing and coughing are effective aerosol generators, but all forms of expiration produce particles across a range of sizes. The 5‐μm diameter threshold used to differentiate droplet from airborne is an over‐simplification of multiple complex, poorly understood biological and physical variables. The evidence defining aerosol‐generating procedures comes largely from low‐quality case and cohort studies where the exact mode of transmission is unknown as aerosol production was never quantified. We propose that transmission is associated with time in proximity to severe acute respiratory syndrome coronavirus‐1 patients with respiratory symptoms, rather than the procedures per se. There is no proven relation between any aerosol‐generating procedure with airborne viral content with the exception of bronchoscopy and suctioning. The mechanism for severe acute respiratory syndrome coronavirus‐2 transmission is unknown but the evidence suggestive of airborne spread is growing. We speculate that infected patients who cough, have high work of breathing, increased closing capacity and altered respiratory tract lining fluid will be significant producers of pathogenic aerosols. We suggest several aerosol‐generating procedures may in fact result in less pathogen aerosolisation than a dyspnoeic and coughing patient. Healthcare workers should appraise the current evidence regarding transmission and apply this to the local infection prevalence. Measures to mitigate airborne transmission should be employed at times of risk. However, the mechanisms and risk factors for transmission are largely unconfirmed. Whilst awaiting robust evidence, a precautionary approach should be considered to assure healthcare worker safety.

Numerical modeling of particle deposition in the conducting airways of asthmatic children

Mounting evidence has linked long- and short-term exposure to particulate air pollution with the incidence and exacerbation of asthma in children, but the biological pathogenesis is unclear. We examined the deposition of particles in the airways of asthmatic children. A planar and symmetric model of airways for 4-year-old asthmatic children was considered. Airflow and particle deposition in the upper (G3-G6) and lower (G9-G12) conducting airways were numerically investigated using computation fluid dynamics (CFD) method. We considered the manifestation of moderate (30% reduction in airway diameter) and severe (60% reduction) asthma. Micron particles (1-10 µm) were considered. We found that particle deposition in the asthmatic children was significantly higher than that in healthy children. The deposition efficiency increased slowly with particle size for healthy children, but increased rapidly for asthmatic children, such that smaller particles could be deposited in the conducting airways of asthmatics. For healthy children, particles were deposited by inertial impaction and gravitational sedimentation respectively in the upper and lower airways, but deposited by inertial impaction in asthmatic children. The severity of the asthma increased the particle deposition in the airways. Our study indicated that asthmatic children were more susceptible to the effect of particulate air pollution. The constricted airways increased the particle deposition by inertial impaction, which may be the biological pathogenesis that causes the hospitalization of asthma in children. Avoiding exposure during air pollution events will be an effective measure to reduce the asthma attack.

Magnetic aerosol drug targeting in lung cancer therapy using permanent magnet

Primary bronchial cancer accounts for almost 20% of all cancer death worldwide. One of the emerging techniques with tremendous power for lung cancer therapy is magnetic aerosol drug targeting (MADT). The use of a permanent magnet for effective drug delivery in a desired location throughout the lung requires extensive optimization, but it has not been addressed yet. In the present study, the possibility of using a permanent magnet for trapping the particles on a lung tumor is evaluated numerically in the Weibel's model from G0 to G3. The effect of different parameters is considered on the efficiency of particle deposition in a tumor located on a distant position of the lung bronchi and bronchioles. Also, the effective position of the magnetic source, tumor size, and location are the objectives for particle deposition. The results show that a limited particle deposition occurs on the lung branches in passive targeting. However, the incorporation of a permanent magnet next to the tumor enhanced the particle deposition fraction on G2 to up to 49% for the particles of 7 µm diameter. Optimizing the magnet size could also improve the particle deposition fraction by 68%. It was also shown that the utilization of MADT is essential for effective drug delivery to the tumors located on the lower wall of airway branches given the dominance of the air velocity and resultant drag force in this region. The results demonstrated the high competence and necessity of MADT as a noninvasive drug delivery method for lung cancer therapy.

The Effectiveness of An Averaged Airway Model in Predicting the Airflow and Particle Transport Through the Airway

Background: In this study, we proposed an averaged airway model design based on four healthy subjects and numerically evaluated its effectiveness for predicting the airflow and particle transport through an airway. Methods: Direct-averaged models of the conducting airways of four subjects were restored by averaging the three-dimensional (3D) skeletons of four healthy airways, which were calculated using an inverse 3D thinning algorithm. We simulated the airflow and particle transport in the individual and the averaged airway models using computational fluid dynamics. Results: The bifurcation geometry differs even among healthy subjects, but the averaged model retains the typical geometrical characteristics of the airways. The Reynolds number of the averaged model varied within the range found in the individual subject models, and the averaged model had similar inspiratory flow characteristics as the individual subject models. The deposition fractions at almost all individual lobes ranged within the variation observed in the subjects, however, the deposition fraction was higher in only one lobe. The deposition distribution at the main bifurcation point differed among the healthy subjects, but the characteristics of the averaged model fell within the variation observed in the individual subject models. On the contrary, the deposition fraction of the averaged model was higher than that of the average of the individual subject models and deviated from the range observed in the subject models. Conclusion: These results indicate that the direct-averaged model may be useful for predicting the individual airflow and particle transport on a macroscopic scale.

Experimental Views of Tran-Bend Particle Deposition in Turbulent Flow with Nanoscale Effect

This paper presented experimental views of nano- and microaerosol distribution and deposition in turbulent tran-bend flows. These views included the particle flow measurement and particle depositions through individual bends, bifurcation bends, and those behind bends. Selected experiments were summarized and compared according to the gas flow, the bend geometry, and the particle flow properties. Based on recent studies, the influencing factors of environmental humidity, particle and surface properties, nanoparticle formation, coagulation, or evolution phenomena were discussed, and then research suggestions were given for future research and applications. It is specially mentioned that the new particle formation and nanoparticle growth affect its deposition under environmental contaminant conditions; nanoscale particle dynamics and transport have a growing trend on attracting the research and industry attentions.

Influenza A Virus Reassortment Is Limited by Anatomical Compartmentalization following Coinfection via Distinct Routes

Exchange of gene segments through reassortment is a major feature of influenza A virus evolution and frequently contributes to the emergence of novel epidemic, pandemic, and zoonotic strains. It has long been evident that viral diversification through reassortment is constrained by genetic incompatibility between divergent parental viruses. In contrast, the role of virus-extrinsic factors in determining the likelihood of reassortment has remained unclear. To evaluate the impact of such factors in the absence of confounding effects of segment mismatch, we previously reported an approach in which reassortment between wild-type (wt) and genetically tagged variant (var) viruses of the same strain is measured. Here, using wt/var systems in the A/Netherlands/602/2009 (pH1N1) and A/Panama/2007/99 (H3N2) strain backgrounds, we tested whether inoculation of parental viruses into distinct sites within the respiratory tract limits their reassortment. Using a ferret (Mustella putorius furo) model, either matched parental viruses were coinoculated intranasally or one virus was instilled intranasally whereas the second was instilled intratracheally. Dual intranasal inoculation resulted in robust reassortment for wt/var viruses of both strain backgrounds. In contrast, when infections were initiated simultaneously at distinct sites, strong compartmentalization of viral replication was observed and minimal reassortment was detected. The observed lack of viral spread between upper and lower respiratory tract tissues may be attributable to localized exclusion of superinfection within the host, mediated by innate immune responses. Our findings indicate that dual infections in nature are more likely to result in reassortment if viruses are seeded into similar anatomical locations and have matched tissue tropisms.IMPORTANCE Genetic exchange between influenza A viruses (IAVs) through reassortment can facilitate the emergence of antigenically drifted seasonal strains and plays a prominent role in the development of pandemics. Typical human influenza infections are concentrated in the upper respiratory tract; however, lower respiratory tract (LRT) infection is an important feature of severe cases, which are more common in the very young, the elderly, and individuals with underlying conditions. In addition to host factors, viral characteristics and mode of transmission can also increase the likelihood of LRT infection: certain zoonotic IAVs are thought to favor the LRT, and transmission via small droplets allows direct seeding into lower respiratory tract tissues. To gauge the likelihood of reassortment in coinfected hosts, we assessed the extent to which initiation of infection at distinct respiratory tract sites impacts reassortment frequency. Our results reveal that spatially distinct inoculations result in anatomical compartmentalization of infection, which in turn strongly limits reassortment.