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Capecelatro J, Longest W, Boerman C, Sulaiman M, Sundaresan S. Recent developments in the computational simulation of dry powder inhalers. Adv Drug Deliv Rev 2022; 188:114461. [PMID: 35868587 DOI: 10.1016/j.addr.2022.114461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
This article reviews recent developments in computational modeling of dry powder inhalers (DPIs). DPIs deliver drug formulations (sometimes blended with larger carrier particles) to a patient's lungs via inhalation. Inhaler design is complicated by the need for maximum aerosolization efficiency, which is favored by high levels of turbulence near the mouthpiece, with low extrathoracic depositional loss, which requires low turbulence levels near the mouth-throat region. In this article, we review the physical processes contributing to aerosolization and subsequent dispersion and deposition. We assess the performance characteristics of DPIs using existing simulation techniques and offer a perspective on how such simulations can be improved to capture the physical processes occurring over a wide range of length- and timescales more efficiently.
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Affiliation(s)
- Jesse Capecelatro
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Connor Boerman
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mostafa Sulaiman
- Department of Chemical and Biological Engineering, Princeton University, Princeton, NJ 08544, USA
| | - Sankaran Sundaresan
- Department of Chemical and Biological Engineering, Princeton University, Princeton, NJ 08544, USA
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2
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Beitz S, Zetzener H, Bradley MS, Kwade A. Development and validation of an analytical method for tensile strength determination of fibrous bulk solids. ADV POWDER TECHNOL 2021. [DOI: 10.1016/j.apt.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Mukherjee R, Halder A, Sansare S, Naik S, Chaudhuri B. A Simplex Centroid Design to Quantify Triboelectric Charging in Pharmaceutical Mixtures. J Pharm Sci 2020; 109:1765-1771. [PMID: 32105661 DOI: 10.1016/j.xphs.2020.02.001] [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] [Received: 12/29/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
The present study focuses on the implementation of a modified simplex centroid statistical design to predict the triboelectrification phenomenon in pharmaceutical mixtures. Two drugs (Ibuprofen and Theophylline), 2 excipients (lactose monohydrate and microcrystalline cellulose/MCC), and 2 blender wall materials (aluminum and poly-methyl methacrylate) were studied to identify the trends in charge transfer in pharmaceutical blends. The statistical model confirmed the excipient-drug interactions, irrespective of the blender wall materials, as the most significant factor leading to reduced charging. Also, lactose monohydrate was able to explain the charge variability more consistently compared with MCC powders when used as secondary material. The ratio of the individual components in the blends explained almost 80% of the bulk charging for Ibuprofen mixtures and 70% for Theophylline mixtures. The study also explored the potential lack of efficacy of lactose-MCC as a combination in ternary systems when compared with binary mixtures, for impacts on charge variability in pharmaceutical blends.
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Affiliation(s)
- Raj Mukherjee
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269
| | - Aritra Halder
- Department of Statistics, University of Connecticut, Storrs, Connecticut 06269
| | - Sameera Sansare
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269
| | - Shivangi Naik
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269
| | - Bodhisattwa Chaudhuri
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut 06269; Institute of Material Sciences, University of Connecticut, Storrs, Connecticut 06269; Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269.
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4
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Lechanteur A, Evrard B. Influence of Composition and Spray-Drying Process Parameters on Carrier-Free DPI Properties and Behaviors in the Lung: A review. Pharmaceutics 2020; 12:pharmaceutics12010055. [PMID: 31936628 PMCID: PMC7022846 DOI: 10.3390/pharmaceutics12010055] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022] Open
Abstract
Although dry powder inhalers (DPIs) have attracted great interest compared to nebulizers and metered-dose inhalers (MDIs), drug deposition in the deep lung is still insufficient to enhance therapeutic activity. Indeed, it is estimated that only 10–15% of the drug reaches the deep lung while 20% of the drug is lost in the oropharyngeal sphere and 65% is not released from the carrier. The potentiality of the powders to disperse in the air during the patient’s inhalation, the aerosolization, should be optimized. To do so, new strategies, in addition to classical lactose-carrier, have emerged. The lung deposition of carrier-free particles, mainly produced by spray drying, is higher due to non-interparticulate forces between the carrier and drug, as well as better powder uniformity and aerosolization. Moreover, the association of two or three active ingredients within the same powder seems easier. This review is focused on a new type of carrier-free particles which are characterized by a sugar-based core encompassed by a corrugated shell layer produced by spray drying. All excipients used to produce such particles are dissected and their physico-chemical properties (Péclet number, glass transition temperature) are put in relation with the lung deposition ability of powders. The importance of spray-drying parameters on powders’ properties and behaviors is also evaluated. Special attention is given to the relation between the morphology (characterized by a corrugated surface) and lung deposition performance. The understanding of the closed relation between particle material composition and spray-drying process parameters, impacting the final powder properties, could help in the development of promising DPI systems suitable for local or systemic drug delivery.
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5
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Zellnitz S, Roblegg E, Pinto J, Fröhlich E. Delivery of Dry Powders to the Lungs: Influence of Particle Attributes from a Biological and Technological Point of View. Curr Drug Deliv 2019; 16:180-194. [PMID: 30360739 DOI: 10.2174/1567201815666181024143249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/21/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
Dry powder inhalers are medical devices used to deliver powder formulations of active pharmaceutical ingredients via oral inhalation to the lungs. Drug particles, from a biological perspective, should reach the targeted site, dissolve and permeate through the epithelial cell layer in order to deliver a therapeutic effect. However, drug particle attributes that lead to a biological activity are not always consistent with the technical requirements necessary for formulation design. For example, small cohesive drug particles may interact with neighbouring particles, resulting in large aggregates or even agglomerates that show poor flowability, solubility and permeability. To circumvent these hurdles, most dry powder inhalers currently on the market are carrier-based formulations. These formulations comprise drug particles, which are blended with larger carrier particles that need to detach again from the carrier during inhalation. Apart from blending process parameters, inhaler type used and patient's inspiratory force, drug detachment strongly depends on the drug and carrier particle characteristics such as size, shape, solid-state and morphology as well as their interdependency. This review discusses critical particle characteristics. We consider size of the drug (1-5 µm in order to reach the lung), solid-state (crystalline to guarantee stability versus amorphous to improve dissolution), shape (spherical drug particles to avoid macrophage clearance) and surface morphology of the carrier (regular shaped smooth or nano-rough carrier surfaces for improved drug detachment.) that need to be considered in dry powder inhaler development taking into account the lung as biological barrier.
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Affiliation(s)
- Sarah Zellnitz
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - Eva Roblegg
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria.,Department of Pharmaceutical Technology and Biopharmacy, Institute of Pharmaceutical Sciences, University of Graz, Graz, Austria
| | - Joana Pinto
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria.,Department of Pharmaceutical Technology and Biopharmacy, Institute of Pharmaceutical Sciences, University of Graz, Graz, Austria
| | - Eleonore Fröhlich
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria
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6
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1H NMR quantification of spray dried and spray freeze-dried saccharide carriers in dry powder inhaler formulations. Int J Pharm 2019; 564:318-328. [DOI: 10.1016/j.ijpharm.2019.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/24/2022]
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7
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Huang Y, Huang Z, Zhang X, Zhao Z, Zhang X, Wang K, Ma C, Zhu C, Pan X, Wu C. Chitosan-based binary dry powder inhaler carrier with nanometer roughness for improving in vitro and in vivo aerosolization performance. Drug Deliv Transl Res 2018; 8:1274-1288. [PMID: 30112607 DOI: 10.1007/s13346-018-0564-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Suitable nanometer roughness favors interactions between drugs and carriers, and it is a promising approach to enhance the aerosolization performance of carrier-based dry powder inhalers (DPIs). In this study, by altering the molecular migration rates, chitosan-based binary carriers (CBBCs) with nanometer roughness were fabricated for DPIs. Comprehensive physicochemical characterizations were conducted to elucidate the formation mechanism of the CBBCs. It was hypothesized that different constituent ratios in the formulations would result in different assembling of the particles and diverse roughness scales. The fine particle fractions (FPF, approximately 40~60%) of nanometer roughness CBBC-based DPI formulations were satisfactory, demonstrating the enhancement of the in vitro aerodynamic performance. The positive correlation (R2 = 0.9883) between the nanometer roughness and FPF was revealed, and the surface roughness of 20 nm might achieve the best aerosolization performance. CBBCs (optimal formulations) showed no difference in cytotoxicity on A549 and Calu-3 cells (p > 0.05). Additionally, the increased Cmax and AUC0-8h of the formulation with the nanometer roughness (p < 0.05) were observed in pharmacokinetic studies, which resulted from the improved in vivo aerosolization performance. In summary, the CBBCs were a prospective tool to improve the in vitro and in vivo aerosolization performance of DPIs. Graphical abstract ᅟ.
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Affiliation(s)
- Ying Huang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Zhengwei Huang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Xuejuan Zhang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China.,Institute for Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Ziyu Zhao
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Xuan Zhang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China.,Department of Pharmacy, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, People's Republic of China
| | - Kexin Wang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Cheng Ma
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Chune Zhu
- Institute for Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Xin Pan
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China.
| | - Chuanbin Wu
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006, Guangdong, People's Republic of China
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8
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Zafar U, Alfano F, Ghadiri M. Evaluation of a new dispersion technique for assessing triboelectric charging of powders. Int J Pharm 2018; 543:151-159. [DOI: 10.1016/j.ijpharm.2018.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
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9
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Zhao Z, Huang Z, Zhang X, Huang Y, Cui Y, Ma C, Wang G, Freeman T, Lu XY, Pan X, Wu C. Low density, good flowability cyclodextrin-raffinose binary carrier for dry powder inhaler: anti-hygroscopicity and aerosolization performance enhancement. Expert Opin Drug Deliv 2018. [PMID: 29532682 DOI: 10.1080/17425247.2018.1450865] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The hygroscopicity of raffinose carrier for dry powder inhaler (DPI) was the main obstacle for its further application. Hygroscopicity-induced agglomeration would cause deterioration of aerosolization performance of raffinose, undermining the delivery efficiency. METHODS Cyclodextrin-raffinose binary carriers (CRBCs) were produced by spray-drying so as to surmount the above issue. Physicochemical attributes and formation mechanism of CRBCs were explored in detail. The flow property of CRBCs was examined by FT4 Powder Rheometer. Hygroscopicity of CRBCs was elucidated by dynamic vapor sorption study. Aerosolization performance was evaluated by in vitro deposition profile and in vivo pharmacokinetic profile of CRBC based DPI formulations. RESULTS The optimal formulation of CRBC (R4) was proven to possess anti-hygroscopicity and aerosolization performance enhancement properties. Concisely, the moisture uptake of R4 was c.a. 5% which was far lower than spray-dried raffinose (R0, c.a. 65%). R4 exhibited a high fine particle fraction value of 70.56 ± 0.61% and it was 3.75-fold against R0. The pulmonary and plasmatic bioavailability of R4 were significantly higher than R0 (p < 0.05). CONCLUSION CRBC with anti-hygroscopicity and aerosolization performance enhancement properties was a promising approach for pulmonary drug delivery, which could provide new possibilities to the application of hygroscopic carriers for DPI.
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Affiliation(s)
- Ziyu Zhao
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Zhengwei Huang
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Xuejuan Zhang
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China.,b Institute for Biomedical and Pharmaceutical Sciences , Guangdong University of Technology , Guangzhou , P.R. China
| | - Ying Huang
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Yingtong Cui
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Cheng Ma
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Guanlin Wang
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | | | | | - Xin Pan
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
| | - Chuanbin Wu
- a School of Pharmaceutical Sciences , Sun Yat-Sen University , Guangzhou , P.R. China
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10
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Pinto JT, Radivojev S, Zellnitz S, Roblegg E, Paudel A. How does secondary processing affect the physicochemical properties of inhalable salbutamol sulphate particles? A temporal investigation. Int J Pharm 2017; 528:416-428. [DOI: 10.1016/j.ijpharm.2017.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/09/2017] [Accepted: 06/10/2017] [Indexed: 02/06/2023]
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11
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12
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Biegaj KW, Rowland MG, Lukas TM, Heng JYY. Surface Chemistry and Humidity in Powder Electrostatics: A Comparative Study between Tribocharging and Corona Discharge. ACS OMEGA 2017; 2:1576-1582. [PMID: 31457523 PMCID: PMC6641046 DOI: 10.1021/acsomega.7b00125] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/30/2017] [Indexed: 06/08/2023]
Abstract
In the present study, the correlation between surface chemical groups and the electrostatic properties of particulate materials was studied. Glass beads were modified to produce OH-, NH2-, CN-, and F-functionalized materials. The materials were charged separately both by friction and by conventional corona charging, and the results were compared. The results obtained from both methods indicated that the electrostatic properties are directly related to the surface functional group chemistry, with hydrophobic groups accumulating greater quantities of charge than hydrophilic groups. The fluorine-rich surface accumulated 5.89 times greater charge upon tribocharging with stainless steel than the hydroxyl-rich surface. However, in contrast to the tribocharging method, the charge polarity could not be determined when corona charging was used. Moreover, discharge profiles at different humidity levels (25% RH, 50% RH, and 75% RH) were obtained for each modified surface, which showed that higher humidity facilitates faster charge decay; however, this enhancement is surface chemistry-dependent. By increasing the humidity from 25% RH to 75% RH, the charge relaxation times can be accelerated 1.6 times for fluorine and 12.2 times for the cyano group. These data confirm that surface functional groups may dictate powder electrostatic behavior and account for observed charge accumulation and discharge phenomena.
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Affiliation(s)
- Karolina W. Biegaj
- Surfaces and Particle
Engineering Laboratory, Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United
Kingdom
| | - Martin G. Rowland
- Pfizer Research and Development, Pfizer Ltd., Discovery Park House, Sandwich, Kent CT13 9NJ, United Kingdom
| | - Tim M. Lukas
- Pfizer Research and Development, Pfizer Ltd., Discovery Park House, Sandwich, Kent CT13 9NJ, United Kingdom
| | - Jerry Y. Y. Heng
- Surfaces and Particle
Engineering Laboratory, Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United
Kingdom
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13
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Renner N, Steckel H, Urbanetz N, Scherließ R. Nano- and Microstructured model carrier surfaces to alter dry powder inhaler performance. Int J Pharm 2016; 518:20-28. [PMID: 28025073 DOI: 10.1016/j.ijpharm.2016.12.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Abstract
The present study investigates the effect of different carrier surface modifications on the aerosolisation performance and on the effective carrier payload of interactive blends for inhalation. Two different active pharmaceutical ingredients (APIs) were used: Formoterol fumarate dihydrate (FF) and budesonide (BUD). Blends were prepared with glass beads as model carriers which have been subjected to mechanical surface modifications in order to introduce surface roughness via treatment with hydrofluoric acid (HF) and/or milling with tungsten carbide (TC). As far as effective carrier payload, in this study expressed as true surface coverage (TSC), is concerned, surface modification had varying effects on blends containing BUD or FF. Aerodynamic characterisation in vitro showed a significant decrease in respirable fraction for glass beads treated with HF (40.2-50.1%), due to the presence of clefts and cavities, where drug particles were sheltered during inhalation. In contrast, grinding with TC leads to surface roughness on a nano scale, ultimately increasing aerodynamic performance up to 20.0-38.1%. These findings are true for both APIs, regardless of their chemical properties.
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Affiliation(s)
- Niklas Renner
- Department of Pharmaceutics and Biopharmaceutics, Kiel University, Grasweg 9a, 24118 Kiel, Germany
| | | | | | - Regina Scherließ
- Department of Pharmaceutics and Biopharmaceutics, Kiel University, Grasweg 9a, 24118 Kiel, Germany.
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14
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An experimental and numerical modeling study of tribocharging in pharmaceutical granular mixtures. POWDER TECHNOL 2016. [DOI: 10.1016/j.powtec.2016.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Triboelectrification: A review of experimental and mechanistic modeling approaches with a special focus on pharmaceutical powders. Int J Pharm 2016; 510:375-85. [DOI: 10.1016/j.ijpharm.2016.06.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
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16
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Kaialy W. A review of factors affecting electrostatic charging of pharmaceuticals and adhesive mixtures for inhalation. Int J Pharm 2016; 503:262-76. [DOI: 10.1016/j.ijpharm.2016.01.076] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/13/2016] [Accepted: 01/28/2016] [Indexed: 11/15/2022]
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17
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Maurer S, Durán SR, Künstle M, Biollaz SM. Influence of interparticle forces on attrition and elutriation in bubbling fluidized beds. POWDER TECHNOL 2016. [DOI: 10.1016/j.powtec.2015.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Prasad LK, Keen JM, LaFountaine JS, Maincent J, Williams RO, McGinity JW. Electrostatic powder deposition to prepare films for drug delivery. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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