Predicted Deposition of Nonhygroscopic Aerosols in the Human Lung as a Function of Subject Age

Numerical modeling of particle deposition in a realistic respiratory airway using CFD-DPM and genetic algorithm

In this study, a realistic model of the respiratory tract obtained from CT medical images was used to solve the flow field and particle motion using the Eulerian-Lagrangian approach to obtain the maximum particle deposition in the bronchial tree for the main purpose of optimizing the performance of drug delivery devices. The effects of different parameters, including particle diameter, particle shape factor, and air velocity, on the airflow field and particle deposition pattern in different zones of the lung were investigated. In addition, a genetic algorithm was employed to obtain the maximum particle deposition in the bronchial tree and the effect of the aforementioned parameters on particle deposition. Reverse flow, vortex formation, and laryngeal jet all affect the airflow structure and particle deposition pattern. The mouth-throat region had the highest deposition fraction at various flow rates. A change in the deposition pattern with an increased deposition fraction in the throat was observed owing to the increased diameter and shape factor of the particles, resulting from the higher inertia and drag force, respectively. The particle deposition analysis showed that three parameters, shape factor, diameter, and velocity, are directly related to particle deposition, and the diameter is the most effective parameter for particle deposition, with an effect of 60% compared to the shape factor and velocity. Finally, the prediction of the genetic algorithm reported a maximum particle deposition in the bronchial tree of 17%, whereas, based on the numerical results, the maximum particle deposition was reported to be 16%. Therefore, there is a 1% difference between the prediction of the genetic algorithm and the numerical results, which indicates the high accuracy of the prediction of the genetic algorithm.

Effect of laryngeal jet on dry powder inhaler aerosol deposition: a numerical simulation

Although pulmonary drug delivery has been deeply investigated, the effect of the laryngeal jet on particle deposition during drug delivery with dry powder inhalers (DPI) has not been evaluated profoundly. In this study, the flow structure and particle deposition pattern of a DPI in two airway models, one with mouth-throat region including the larynx and the other one without it, are numerically investigated. The results revealed that the laryngeal jet has a considerable effect on particle deposition. The presence of laryngeal jet leads to 4-fold and 2-fold higher deposition efficiencies for inlet flow rates of 30 and 90 L/min, respectively.

A Numerical Simulation of the Airflow and Aerosol Particle Deposition in a Realistic Airway Model of a Healthy Adult

Determining the behavior of aerosol drug particles is of vital importance in the treatment of respiratory tract diseases. Despite the development of imaging techniques in the pulmonary region in recent years, current imaging techniques are insufficient to detect particle deposition. Computational fluid dynamics (CFD) methods can fill the gap in this field as they take into account the very different physical processes that occur during aerosol transport. This study aims to numerically investigate the airflow and the aerosol particle dynamics on a realistic human respiratory tract model during multiple breathing cycles. The simulations were conducted on the different breathing conditions for people under light, normal, and heavy physical activities, and the aerosol particles with different aerodynamic diameters (i.e., dp=2, 5, and 7 µm). The numerical results were validated by comparing extensively with experimental and numerical results. The results indicated that the airflow during inspiration and expiration was characteristically different from each other and changed with the inspiration flow rate. It was determined that small-sized particles followed the streamlines and moved towards the distal of the lung under low respiratory conditions. On the other hand, larger particles tended to deposit in higher generations due to the higher inertia. It was found that with the increase of inspiration flow rate the deposition of particles increased for all particles during multiple breaths. For light breathing conditions, low deposition efficiencies were obtained because the particles followed the streamlines and moved towards the distal part of the lung. The particle deposition efficiency under heavy breathing conditions was 28.2% for 2 µm, 33.05% for 5 µm, and 38.4% for 7 µm particles. The results showed that inertial impaction plays an active role in particle deposition.

Count- and mass-based dosimetry of MDI spray droplets with polydisperse and monodisperse size distributions

Most previous numerical studies of inhalation drug delivery used monodisperse aerosols or quantified deposition as the ratio of deposited particle number over the total number of released particles (i.e., count-based). These practices are reasonable when the aerosols have a sufficiently narrow size range. However, spray droplets from metered-dose inhalers (MDIs) are often polydisperse with a wide size range, so using monodisperse aerosols and/or count-based deposition quantification may lead to significant errors. The objective of this study was to develop a mass-based dosimetry method and evaluate its performance in lung delivery in a mouth-lung (G9) geometry with an albuterol-CFC inhaler. The conventional practices (monodisperse and polydisperse-count-based) were also simulated for comparison purposes. The MDI actuation in the open space was studied using both high-speed imaging and LES-Lagrangian simulations. Experimentally measured spray velocities and size distribution were implemented in the computational model as boundary conditions. Good agreement was achieved between recorded and simulated spray plume evolution spatially and temporally. The polydisperse-mass-based predictions of MDI doses compared favorably with the measurements in all three regions considered (device, mouth-throat, and lung). Significant errors in MDI regional deposition were predicted using the monodisperse and count-based methods. The new polydisperse-mass-based method also predicted local deposition hot spots that were one order of magnitude higher in intensity than the two conventional methods. The results of this study highlighted that a presentative polydisperse size distribution and appropriate deposition quantification method should be applied to reliably predict the MDI drug delivery in the human respiratory tract.

Differences between cigarette smoking and biomass smoke exposure: An in silico comparative assessment of particulate deposition in the lungs

Cigarette smoking and biomass smoke are the two main environmental risk factors of chronic obstructive pulmonary disease (COPD) worldwide. However, it remains unclear why these exposures result in two different disease phenotypes. In this study, we assessed the lung deposition from biomass and cigarette smoke exposures and examined whether differences due to inherently different particle size distributions and inhalation conditions may contribute to the differences between biomass- and tobacco-related COPD phenotypes. Using high-fidelity three-dimensional computational fluid-particle dynamics in a representative upper airway geometry, coupled to one-dimensional models of the lower airways, we computed total deposited doses and examined regional deposition patterns based on exposure data from a randomized control trial in Peru and from the literature for biomass and mainstream cigarette smoke, respectively. Our results showed that intrathoracic deposition was higher in cigarette smoking, with 36.8% of inhaled biomass smoke particles and 57.7% of cigarette smoke particles depositing in the intrathoracic airways. We observed higher fractions of cigarette smoke particles in the last few airway generations, which could explain why cigarette smoking is associated with more emphysema than biomass smoke exposure. Mean daily deposited dose was two orders of magnitude higher in cigarette smoking. Lobar distributions of the deposited dose also differed, with the left lower and right upper lobes receiving the highest doses of biomass and cigarette smoke particles, respectively. Our findings suggest that the differences between biomass- and tobacco-related COPD could, at least in part, be due to differences in total and regional lung deposition of biomass and cigarette smoke.

A whole lung in silico model to estimate age dependent particle dosimetry

Anatomical and physiological changes alter airflow characteristics and aerosol distribution in the developing lung. Correlation between age and aerosol dosimetry is needed, specifically because youth are more susceptible to medication side effects. In this study, we estimate aerosol dosages (particle diameters of 1, 3, and 5 [Formula: see text]m) in a 3 month-old infant, a 6 year-old child, and a 36 year-old adult by performing whole lung subject-specific particle simulations throughout respiration. For 3 [Formula: see text]m diameter particles we estimate total deposition as 88, 73, and [Formula: see text] and the conducting versus respiratory deposition ratios as 4.0, 0.5, and 0.4 for the infant, child, and adult, respectively. Due to their lower tidal volumes and functional residual capacities the deposited mass is smaller while the tissue concentrations are larger in the infant and child subjects, compared to the adult. Furthermore, we find that dose cannot be predicted by simply scaling by tidal volumes. These results highlight the need for additional clinical and computational studies that investigate the efficiency of treatment, while optimizing dosage levels in order to alleviate side effects, in youth.

Experimentally determined deposition of ambient urban ultrafine particles in the respiratory tract of children

A critical element of the risk assessment of exposure to airborne ambient ultrafine particles (UFP) is the quantification of respiratory tract deposition (RTD) of the particles, which is intrinsically challenging, particularly at the population scale. In this study, we used a recently proposed method to experimentally determine the RTD of urban UFP in a large group of children exposed to these particles in a school setting in Brisbane, Australia. Children are one of the most susceptible population groups; However, little is known about the deposition of UFP from urban traffic in their airways. In order to advance the knowledge in this field, the objectives of this study were: to determine the deposition of ambient urbane UFP in large number children, to catergorize the source of inhaled UFPs and hence to assess the contribution of air pollution sources to the deposition. RTD was measured in children aged 8-11 at primary schools using a flow-through chamber bag system. First, the inhaled and exhaled air was separated; then the particle number size distribution and particle number concentration were measured. The sources of inhaled UFP were categorized according to their particle number size distribution by a K means cluster technique. A total of 128 children from five schools performed the RTD measurement. The mean total deposition fraction of urban UFP in all children was 0.59 ± 0.10. Inhaled UFP were categorized into two groups: traffic and urban background, with the GMD of corresponding particle number size distribution of 20 nm and 40 nm, respectively. The total deposition fraction (mean ± SD) of UFP from these two groups was 0.68 ± 0.09 for traffic and 0.55 ± 0.08 for urban background respectively. This is the first study in which RTD was measured in a large group of children inhaling real urban UFP. First, we proved that this novel method can indeed be applied easily and quickly to a large group of people. Second, we quantified the RTD of children, thus providing an important input to the risk assessment for exposure to UFP.

Regional Deposition: Deposition Models

Modeling particle deposition in the human lung requires information about the morphology of the lung in terms of simple geometric units, e.g., characterizing bronchial airways by straight cylindrical tubes. Five different regional deposition models are discussed in this section with respect to morphometric lung models and related mathematical modeling techniques: 1) one-dimensional cross-section or "trumpet" model, 2) deterministic symmetric generation or "single-path" model, 3) deterministic asymmetric generation or "multiple-path" model, 4) stochastic asymmetric generation or "multiple-path" model, and 5) single-path computational fluid and particle dynamics (CFPD) model. Current deposition models can predict the following regional deposition quantities relevant for the administration of medical aerosols: 1) regional bronchial and alveolar deposition, 2) generational lung deposition, 3) lobar deposition, 4) generational lobar deposition, and 5) generational surface deposition. Although deposition fractions predicted by the different models depend on the selection of a specific morphometric lung model and a specific set of analytical deposition equations, all models predict the same trends as functions of particle diameter and breathing parameters. In general, the overall agreement between the modeling predictions obtained by the various deposition models and the available experimental evidence indicates that current deposition models correctly predict regional and generational deposition.

Initial Development of an Air-Jet Dry Powder Inhaler for Rapid Delivery of Pharmaceutical Aerosols to Infants

Background: Positive-pressure dry powder inhalers (DPIs) have recently been developed that in combination with highly dispersible spray-dried powder formulations can achieve high efficiency aerosolization with low actuation air-volumes (AAVs). The objective of this study was to initially develop the positive-pressure air-jet DPI platform for high efficiency aerosol delivery to newborn infants by using the nose-to-lung route. Methods: Aerosolization performance metrics of six air-jet DPIs were first assessed at AAVs that were consistent with full-term (30 mL) and preterm (10 mL) neonates. Designs of the air-jet DPIs varied based on geometry of the inlet and outlet flow passages and shape of the aerosolization chamber. Aerosolization metrics evaluated at the device outlet were emitted dose (ED) and mass median aerodynamic diameter (MMAD). Designs with the best aerosolization performance were connected to a smoothly expanding nasal interface and full-term infant (3550 g) nose-throat (NT) model with tracheal filter. Results: The three best performing devices had characteristics of a cylindrical and horizontal aerosolization chamber with a flush or protruding outlet orifice. Including multiple air inlets resulted in meeting the aerosolization targets of >80% ED (based on loaded dose) and MMAD <1.8 μm. Reducing the AAV by a factor of threefold from 30 to 10 mL had little effect on aerosol formation. The three leading devices all delivered ∼50% of the loaded dose through a full-term NT in vitro model by using an AAV of 30 mL. Conclusion: With careful selection of design attributes, the air-jet DPI platform is capable of high-efficiency aerosolization of a 10 mg powder mass by using AAVs that are consistent with infant inhalation. The associated infant air-jet DPI system, which forms a seal at the nostril(s) and delivers both the aerosol and a complete inhalation, is capable of rapid and efficient aerosol administration to infant lungs, based on initial testing in a full-term in vitro NT model.

Experimental investigation of aerosol deposition through a realistic respiratory airway replica: An evaluation for MDI and DPI performance

PURPOSE

In the present work, a comparison between MDI and DPI for evaluating performance of the devices were carried out by experimentally investigating the deposition parameters through a realistic airway replica.

METHODS

Computed tomography (CT) images of the respiratory airway of a healthy subject were used to develop the realistic model. The airway replica was included extrathoracic, trachea, and tracheobronchial tree up to fourth generations which was fabricated by rapid prototyping. Afterward, in vitro experiments were performed to validate the airway model by comparing the total deposition (G0 to G3) of present replica with available data in the literature. Drug deposition (Salbutamol) in the model was measured by determining concentration of the segments sample by High Performance Liquid Chromatography (HPLC) assay.

RESULTS

Deposition parameters were used for investigating the deposition patterns of the inhaled particles. Results showed that inertial impaction is the dominant mechanism in the most regions of the replica. It was found that the MDI delivered more drug to the tracheobronchial tree compared to the DPI for three different flow rate.

CONCLUSION

The developed realistic respiratory airways model provided an opportunity to more accurately evaluate the performance of drug delivery devices and studying mechanisms of the drug deposition.

Targeting inhaled aerosol delivery to upper airways in children: Insight from computational fluid dynamics (CFD)

Despite the prevalence of inhalation therapy in the treatment of pediatric respiratory disorders, most prominently asthma, the fraction of inhaled drugs reaching the lungs for maximal efficacy remains adversely low. By and large drug delivery devices and their inhalation guidelines are typically derived from adult studies with child dosages adapted according to body weight. While it has long been recognized that physiological (e.g. airway sizes, breathing maneuvers) and physical transport (e.g. aerosol dynamics) characteristics are critical in governing deposition outcomes, such knowledge has yet to be extensively adapted to younger populations. Motivated by such shortcomings, the present work leverages in a first step in silico computational fluid dynamics (CFD) to explore opportunities for augmenting aerosol deposition in children based on respiratory physiological and physical transport determinants. Using an idealized, anatomically-faithful upper airway geometry, airflow and aerosol motion are simulated as a function of age, spanning a five year old to an adult. Breathing conditions mimic realistic age-specific inhalation maneuvers representative of Dry Powder Inhalers (DPI) and nebulizer inhalation. Our findings point to the existence of a single dimensionless curve governing deposition in the conductive airways via the dimensionless Stokes number (Stk). Most significantly, we uncover the existence of a distinct deposition peak irrespective of age. For the DPI simulations, this peak (∼ 80%) occurs at Stk ≈ 0.06 whereas for nebulizer simulations, the corresponding peak (∼ 45%) occurs in the range of Stk between 0.03-0.04. Such dimensionless findings hence translate to an optimal window of micron-sized aerosols that evolves with age and varies with inhalation device. The existence of such deposition optima advocates revisiting design guidelines for optimizing deposition outcomes in pediatric inhalation therapy.

Are children more vulnerable to mesothelioma than adults? A comparison of mesothelioma risk among children and adults exposed non-occupationally to blue asbestos at Wittenoom

OBJECTIVES

The presence of asbestos in public buildings is a legacy of past asbestos use in many developed countries. Of particular concern is the amount and current condition in schools and the vulnerability of children to mesothelioma. Our aim was to compare the risk of mesothelioma between those exposed to blue asbestos as children and as adults at Wittenoom.

METHODS

Public sources were used to establish the Wittenoom residents' cohort. Mesothelioma incidence rates per 100 000 person-years at risk were derived for those first exposed to asbestos at Wittenoom as children (<15 years) or adults separately. Proportional hazards survival models examined the slope of the exposure-response relationship between asbestos exposure and incidence of mesothelioma in different sex and age groups.

RESULTS

The mesothelioma rate was lower among those first exposed as children (76.8 per 100 000) than those first exposed as adults (121.3 per 100 000). Adjusting for cumulative exposure to asbestos and sex, those exposed as adults had a greater risk of mesothelioma (adjusted HR 2.5, 95% CI 1.7 to 3.7). The slope of the exposure-response relationship did not differ between those exposed as children and those exposed as adults.

CONCLUSION

We found no greater susceptibility to mesothelioma among those first exposed to asbestos as children than those first exposed as adults. However, given the long latency of mesothelioma, and the greater years of life yet to be lived by the Wittenoom children, it is likely that there will be more cases of mesothelioma in the future among those first exposed as children.

Simulation of the human airways using virtual topology tools and meshing optimization

A method is proposed to improve the quality of the three-dimensional airway geometric models using a commercial software, checking the number of elements, meshing time, and aspect ratio and skewness parameters. The use of real and virtual topologies combined with patch-conforming and patch-independent meshing algorithms results in four different models being the best solution the combination of virtual topology and patch-independent algorithm, due to an excellent aspect ratio and skewness of the elements, and minimum meshing time. The result is a reduction in the computational time required for both meshing and simulation due to a smaller number of cells. The use of virtual topologies combined with patch-independent meshing algorithms could be extended in bioengineering because the geometries handling is similar to this case. The method is applied to a healthy person using their computed tomography images. The resulting numerical models are able to simulate correctly a forced spirometry.

Design of a numerical model of lung by means of a special boundary condition in the truncated branches

BACKGROUND

The need for a better understanding of pulmonary diseases has led to increased interest in the development of realistic computational models of the human lung.

METHODS

To minimize computational cost, a reduced geometry model is used for a model lung airway geometry up to generation 16. Truncated airway branches require physiologically realistic boundary conditions to accurately represent the effect of the removed airway sections. A user-defined function has been developed, which applies velocities mapped from similar locations in fully resolved airway sections. The methodology can be applied in any general purpose computational fluid dynamics code, with the only limitation that the lung model must be symmetrical in each truncated branch.

RESULTS

Unsteady simulations have been performed to verify the operation of the model. The test case simulates a spirometry because the lung is obliged to rapidly perform both inspiration and expiration. Once the simulation was completed, the obtained pressure in the lower level of the lung was used as a boundary condition. The output velocity, which is a numerical spirometry, was compared with the experimental spirometry for validation purposes.

CONCLUSIONS

This model can be applied for a wide range of patient-specific resolution levels. If the upper airway generations have been constructed from a computed tomography scan, it would be possible to quickly obtain a complete reconstruction of the lung specific to a specific person, which would allow individualized therapies.

Measurements of Deposition, Lung Surface Area and Lung Fluid for Simulation of Inhaled Compounds

Modern strategies in drug development employ in silico techniques in the design of compounds as well as estimations of pharmacokinetics, pharmacodynamics and toxicity parameters. The quality of the results depends on software algorithm, data library and input data. Compared to simulations of absorption, distribution, metabolism, excretion, and toxicity of oral drug compounds, relatively few studies report predictions of pharmacokinetics and pharmacodynamics of inhaled substances. For calculation of the drug concentration at the absorption site, the pulmonary epithelium, physiological parameters such as lung surface and distribution volume (lung lining fluid) have to be known. These parameters can only be determined by invasive techniques and by postmortem studies. Very different values have been reported in the literature. This review addresses the state of software programs for simulation of orally inhaled substances and focuses on problems in the determination of particle deposition, lung surface and of lung lining fluid. The different surface areas for deposition and for drug absorption are difficult to include directly into the simulations. As drug levels are influenced by multiple parameters the role of single parameters in the simulations cannot be identified easily.

Computational Models of Inhalation Therapy in Early Childhood: Therapeutic Aerosols in the Developing Acinus

BACKGROUND

Inhalation therapy targeted to the deep alveolated regions holds great promise, specifically in pediatric populations. Yet, inhalation devices and medical protocols are overwhelmingly derived from adult guidelines, with very low therapeutic efficiency in young children. During the first years of life, airway remodeling and changing ventilation patterns are anticipated to alter aerosol deposition with underachieving outcomes in infants. As past research is still overwhelmingly focused on adults or limited to models of upper airways, a fundamental understanding of inhaled therapeutic transport and deposition in the acinar regions is needed to shed light on delivering medication to the developing alveoli.

METHODS

Using computational fluid dynamics (CFD), we simulated inhalation maneuvers in anatomically-inspired models of developing acinar airways, covering the distinct phases of lung development, from underdeveloped, saccular pulmonary architectures in infants, to structural changes in toddlers, ultimately mimicking space-filling morphologies of a young child, representing scaled-down adult lungs. We model aerosols whose diameters span the range of sizes acknowledged to reach the alveolar regions and examine the coupling between morphological changes, varying ventilation patterns and particle characteristics on deposition outcomes.

RESULTS

Spatial distributions of deposited particles point to noticeable changes in the patterns of aerosol deposition with age, in particular in the youngest age group examined (3 month). Total deposition efficiency, as well as deposition dispersion, vary not only with the phases of lung development but also and critically with aerosol diameter.

CONCLUSIONS

Given the various challenges when prescribing inhalation therapy to a young infant, our findings underline some mechanistic aspects to consider when targeting medication to the developing alveoli. Not only does the intricate coupling between acinar morphology and ventilation patterns need to be considered, but the physical properties (i.e., aerodynamic size) of therapeutic aerosols also closely affect the anticipated success rates of the inhaled medication.

Pediatric in vitro and in silico models of deposition via oral and nasal inhalation

Respiratory tract deposition models provide a useful method for optimizing the design and administration of inhaled pharmaceutical aerosols, and can be useful for estimating exposure risks to inhaled particulate matter. As aerosol must first pass through the extrathoracic region prior to reaching the lungs, deposition in this region plays an important role in both cases. Compared to adults, much less extrathoracic deposition data are available with pediatric subjects. Recently, progress in magnetic resonance imaging and computed tomography scans to develop pediatric extrathoracic airway replicas has facilitated addressing this issue. Indeed, the use of realistic replicas for benchtop inhaler testing is now relatively common during the development and in vitro evaluation of pediatric respiratory drug delivery devices. Recently, in vitro empirical modeling studies using a moderate number of these realistic replicas have related airway geometry, particle size, fluid properties, and flow rate to extrathoracic deposition. Idealized geometries provide a standardized platform for inhaler testing and exposure risk assessment and have been designed to mimic average in vitro deposition in infants and children by replicating representative average geometrical dimensions. In silico mathematical models have used morphometric data and aerosol physics to illustrate the relative importance of different deposition mechanisms on respiratory tract deposition. Computational fluid dynamics simulations allow for the quantification of local deposition patterns and an in-depth examination of aerosol behavior in the respiratory tract. Recent studies have used both in vitro and in silico deposition measurements in realistic pediatric airway geometries to some success. This article reviews the current understanding of pediatric in vitro and in silico deposition modeling via oral and nasal inhalation.

An Apparatus to Deliver Mannitol Powder for Bronchial Provocation in Children Under Six Years Old

BACKGROUND

Currently bronchial provocation testing (BPT) using mannitol powder cannot be performed in children under 6 years. A primary reason is it is challenging for children at this age to generate a consistent inspiratory effort to inhale mannitol efficiently from a dry powder inhaler. A prototype system, which does not require any inhalation training from the pediatric subject, is reported here. It uses an external source of compressed air to disperse mannitol powder into a commercial holding chamber. Then the subject uses tidal breathing to inhale the aerosol.

METHOD

The setup consists of a commercially available powder disperser and Volumatic™ holding chamber. Taguchi experimental design was used to identify the effect of dispersion parameters (flow rate of compressed air, time compressed air is applied, mass of powder, and the time between dispersion and inhalation) on the fine particle dose (FPD). The prototype was tested in vitro using a USP throat connected to a next generation impactor. The aerosols from the holding chamber were drawn at 10 L/min. A scaling factor for estimating the provoking dose to induce a 15% reduction in forced expiratory volume in 1 second (FEV1) (PD15) was calculated using anatomical dimensions of the human respiratory tract at various ages combined with known dosing values from the adult BPT.

RESULTS

Consistent and doubling FPDs were successfully generated based on the Taguchi experimental design. The FPD was reliable over a range of 0.8 (±0.09) mg to 14 (±0.94) mg. The calculated PD15 for children aged 1-6 years ranged from 7.1-30 mg. The FPDs generated from the proposed set up are lower than the calculated PD15 and therefore are not expected to cause sudden bronchoconstriction.

CONCLUSION

A prototype aerosol delivery system has been developed that is consistently able to deliver doubling doses suitable for bronchial provocation testing in young children.

Optimal delivery of aerosols to infants during mechanical ventilation

PURPOSE

The objective of this study was to determine optimal aerosol delivery conditions for a full-term (3.6 kg) infant receiving invasive mechanical ventilation by evaluating the effects of aerosol particle size, a new wye connector, and timing of aerosol delivery.

METHODS

In vitro experiments used a vibrating mesh nebulizer and evaluated drug deposition fraction and emitted dose through ventilation circuits containing either a commercial (CM) or new streamlined (SL) wye connector and 3-mm endotracheal tube (ETT) for aerosols with mass median aerodynamic diameters of 880 nm, 1.78 μm, and 4.9 μm. The aerosol was released into the circuit either over the full inhalation cycle (T1 delivery) or over the first half of inhalation (T2 delivery). Validated computational fluid dynamics (CFD) simulations and whole-lung model predictions were used to assess lung deposition and exhaled dose during cyclic ventilation.

RESULTS

In vitro experiments at a steady-state tracheal flow rate of 5 L/min resulted in 80-90% transmission of the 880-nm and 1.78-μm aerosols from the ETT. Based on CFD simulations with cyclic ventilation, the SL wye design reduced depositional losses in the wye by a factor of approximately 2-4 and improved lung delivery efficiencies by a factor of approximately 2 compared with the CM device. Delivery of the aerosol over the first half of the inspiratory cycle (T2) reduced exhaled dose from the ventilation circuit by a factor of 4 compared with T1 delivery. Optimal lung deposition was achieved with the SL wye connector and T2 delivery, resulting in 45% and 60% lung deposition for optimal polydisperse (∼1.78 μm) and monodisperse (∼2.5 μm) particle sizes, respectively.

CONCLUSIONS

Optimization of selected factors and use of a new SL wye connector can substantially increase the lung delivery efficiency of medical aerosols to infants from current values of <1-10% to a range of 45-60%.

Development of a new technique for the efficient delivery of aerosolized medications to infants on mechanical ventilation

PURPOSE

To evaluate the efficiency of a new technique for delivering aerosols to intubated infants that employs a new Y-connector, access port administration of a dry powder, and excipient enhanced growth (EEG) formulation particles that change size in the airways.

METHODS

A previously developed CFD model combined with algebraic correlations were used to predict delivery system and lung deposition of typical nebulized droplets (MMAD = 4.9 μm) and EEG dry powder aerosols. The delivery system consisted of a Y-connector [commercial (CM); streamlined (SL); or streamlined with access port (SL-port)] attached to a 4-mm diameter endotracheal tube leading to the airways of a 6-month-old infant.

RESULTS

Compared to the CM device and nebulized aerosol, the EEG approach with an initial 0.9 μm aerosol combined with the SL and SL-port geometries reduced device depositional losses by factors of 3-fold and >10-fold, respectively. With EEG powder aerosols, the SL geometry provided the maximum tracheobronchial deposition fraction (55.7%), whereas the SL-port geometry provided the maximum alveolar (67.6%) and total lung (95.7%) deposition fractions, respectively.

CONCLUSIONS

Provided the aerosol can be administered in the first portion of the inspiration cycle, the proposed new method can significantly improve the deposition of pharmaceutical aerosols in the lungs of intubated infants.

Delivery of inhalation drugs to children for asthma and other respiratory diseases

Infants and children constitute a patient group that has unique requirements in pulmonary drug delivery. Since their lungs develop continuously until they reach adulthood, the airways undergo changes in dimensions and number. Computational models have been devised on the growth dynamics of the airways during childhood, as well as the particle deposition mechanisms in these growing lungs. The models indicate that total aerosol deposition in the body decreases with age, while deposition in the lungs increases with age. This has been observed on paediatric subjects in in vivo studies. Issues unique to children in pulmonary drug delivery include their lower tidal volume, highly variable breathing patterns, air leaks from facemasks, and the off-label or unlicensed use of pharmaceutical products due to lack of clinical data for this age group. The aerosol devices used are essentially those developed for adult patients that have been adapted to paediatric use. Facemasks should be used with nebulisers and spacers for infants and young children. An idealised throat that mimic the average particle deposition in paediatric throats has been designed to obtain more clinically relevant aerosol dispersion data in vitro. More effort should be spent on studying particle deposition in the paediatric lung and developing products specific for this subpopulation to meet their needs.

All-cause mortality and cancer incidence among adults exposed to blue asbestos during childhood

BACKGROUND

There are few data on the long-term health outcomes of exposure to asbestos in childhood. This study investigated cancer and mortality of adults exposed to blue asbestos as children.

METHODS

Data linkage to relevant health registries was used to identify cancers and mortality in a cohort of adults (n = 2,460) that had lived in an asbestos mining town during their childhood (<15 years).

RESULTS

There were 217 (93 female) incident cancers and 218 (70 female) deaths among the cohort. Compared with the Western Australian population females had elevated mesothelioma, ovarian and brain cancers, and increased "all cause" and "all cancer" mortality. Males had elevated mesothelioma, leukemia, prostate, brain, and colorectal cancers, and excess mortality from "all causes," "all cancers," circulatory disease, diseases of the nervous system, and accidents.

CONCLUSION

Exposure to blue asbestos in childhood is associated with an increased risk of cancer and mortality in adults.

Health risk from the use of roof-harvested rainwater in Southeast Queensland, Australia, as potable or nonpotable water, determined using quantitative microbial risk assessment

A total of 214 rainwater samples from 82 tanks were collected in urban Southeast Queensland (SEQ) in Australia and analyzed for the presence and numbers of zoonotic bacterial and protozoal pathogens using binary PCR and quantitative PCR (qPCR). Quantitative microbial risk assessment (QMRA) analysis was used to quantify the risk of infection associated with the exposure to potential pathogens from roof-harvested rainwater used as potable or nonpotable water. Of the 214 samples tested, 10.7%, 9.8%, 5.6%, and 0.4% were positive for the Salmonella invA, Giardia lamblia β-giardin, Legionella pneumophila mip, and Campylobacter jejuni mapA genes, respectively. Cryptosporidium parvum oocyst wall protein (COWP) could not be detected. The estimated numbers of Salmonella, G. lamblia, and L. pneumophila organisms ranged from 6.5 × 10¹ to 3.8 × 10² cells, 0.6 × 10⁰ to 3.6 × 10⁰ cysts, and 6.0 × 10¹ to 1.7 × 10² cells per 1,000 ml of water, respectively. Six risk scenarios were considered for exposure to Salmonella spp., G. lamblia, and L. pneumophila. For Salmonella spp. and G. lamblia, these scenarios were (i) liquid ingestion due to drinking of rainwater on a daily basis, (ii) accidental liquid ingestion due to hosing twice a week, (iii) aerosol ingestion due to showering on a daily basis, and (iv) aerosol ingestion due to hosing twice a week. For L. pneumophila, these scenarios were (i) aerosol inhalation due to showering on a daily basis and (ii) aerosol inhalation due to hosing twice a week. The risk of infection from Salmonella spp., G. lamblia, and L. pneumophila associated with the use of rainwater for showering and garden hosing was calculated to be well below the threshold value of one extra infection per 10,000 persons per year in urban SEQ. However, the risk of infection from ingesting Salmonella spp. and G. lamblia via drinking exceeded this threshold value and indicated that if undisinfected rainwater is ingested by drinking, then the incidences of the gastrointestinal diseases salmonellosis and giardiasis are expected to range from 9.8 × 10° to 5.4 × 10¹ (with a mean of 1.2 × 10¹ from Monte Carlo analysis) and from 1.0 × 10¹ to 6.5 × 10¹ cases (with a mean of 1.6 × 10¹ from Monte Carlo analysis) per 10,000 persons per year, respectively, in urban SEQ. Since this health risk seems higher than that expected from the reported incidences of gastroenteritis, the assumptions used to estimate these infection risks are critically examined. Nonetheless, it would seem prudent to disinfect rainwater for use as potable water.

Modelling particle deposition in human lungs: modelling concepts and comparison with experimental data

Deposition of inhaled particles in the human lung is determined by biological factors, such as lung morphology and respiratory physiology, as well as by physical factors, such as fluid dynamics of the inhaled air and physical deposition mechanisms acting upon inhaled particles. Different conceptual particle deposition models vary primarily with respect to lung morphometry and mathematical modelling technique, rather than by using different deposition equations. Current whole lung deposition models permit the prediction of particle deposition in single airway generations or defined regions of the human lung for any combination of particle size and breathing pattern. Although comparisons with experimental data in human subjects indicate that all presently available deposition models correctly predict total and regional deposition, they cannot be validated by comparison with experimental data at the single airway or airway generation level.

Alveolar duct expansion greatly enhances aerosol deposition: a three-dimensional computational fluid dynamics study

Obtaining in vivo data of particle transport in the human lung is often difficult, if not impossible. Computational fluid dynamics (CFD) can provide detailed information on aerosol transport in realistic airway geometries. This paper provides a review of the key CFD studies of aerosol transport in the acinar region of the human lung. It also describes the first ever three-dimensional model of a single fully alveolated duct with moving boundaries allowing for the cyclic expansion and contraction that occurs during breathing. Studies of intra-acinar aerosol transport performed in models with stationary walls (SWs) showed that flow patterns were influenced by the geometric characteristics of the alveolar aperture, the presence of the alveolar septa contributed to the penetration of the particles into the lung periphery and there were large inhomogeneities in deposition patterns within the acinar structure. Recent studies have now used acinar models with moving walls. In these cases, particles penetrate the alveolar cavities not only as a result of sedimentation and diffusion but also as a result of convective transport, resulting in a much higher deposition prediction than that in SW models. Thus, models that fail to incorporate alveolar wall motions probably underestimate aerosol deposition in the acinar region of the lung.

Effects of mesh style and grid convergence on particle deposition in bifurcating airway models with comparisons to experimental data

A number of research studies have employed a wide variety of mesh styles and levels of grid convergence to assess velocity fields and particle deposition patterns in models of branching biological systems. Generating structured meshes based on hexahedral elements requires significant time and effort; however, these meshes are often associated with high quality solutions. Unstructured meshes that employ tetrahedral elements can be constructed much faster but may increase levels of numerical diffusion, especially in tubular flow systems with a primary flow direction. The objective of this study is to better establish the effects of mesh generation techniques and grid convergence on velocity fields and particle deposition patterns in bifurcating respiratory models. In order to achieve this objective, four widely used mesh styles including structured hexahedral, unstructured tetrahedral, flow adaptive tetrahedral, and hybrid grids have been considered for two respiratory airway configurations. Initial particle conditions tested are based on the inlet velocity profile or the local inlet mass flow rate. Accuracy of the simulations has been assessed by comparisons to experimental in vitro data available in the literature for the steady-state velocity field in a single bifurcation model as well as the local particle deposition fraction in a double bifurcation model. Quantitative grid convergence was assessed based on a grid convergence index (GCI), which accounts for the degree of grid refinement. The hexahedral mesh was observed to have GCI values that were an order of magnitude below the unstructured tetrahedral mesh values for all resolutions considered. Moreover, the hexahedral mesh style provided GCI values of approximately 1% and reduced run times by a factor of 3. Based on comparisons to empirical data, it was shown that inlet particle seedings should be consistent with the local inlet mass flow rate. Furthermore, the mesh style was found to have an observable effect on cumulative particle depositions with the hexahedral solution most closely matching empirical results. Future studies are needed to assess other mesh generation options including various forms of the hybrid configuration and unstructured hexahedral meshes.

Effect of Oropharyngeal Length in Drug Lung Delivery via Suspension Pressurized Metered Dose Inhalers

PURPOSE

To determine the effect of the oropharyngeal length in adults on the lung dose of a suspension pressurized metered dose inhaler, and whether employing small volume spacers can alter this role.

METHODS

Depositions of Ventolin Evohaler (100) microg in the oropharyngeal models of two healthy adult subjects with 17.1 cm (short cast) and 19.9 cm (long cast) centerline lengths via three small volume spacers [two spacers with 3 cm effective length but one with 6.5 cm2 (L3) and the other with 24.6 cm2 (L3W) cross sections, and the Optimiser] were studied.

RESULTS

Without using spacers, lung dose of the long cast (19.52 +/- 2.32 microg, mean +/- standard deviation) was significantly larger than that for the short cast (8.08 +/- 1.01 microg, p < 0.006). However, using the L3 spacer with the short cast made the lung dose (18.59 +/- 3.33 microg) similar to that for the long cast alone. Lung doses of the short cast (20.43 +/- 1.42 microg) and the long cast (30.81 +/- 1.84 microg) with the L3W spacer were similar to those with the L3 spacer. However, using the Optimiser spacer increased the lung dose for the short cast (22.27 +/- 6.03 microg) and significantly for the long cast (35.61 +/- 2.19 microg, p < 0.006) compared to those for the L3 spacer. Using spacers increased drug deposition in the oropharynx part of the short cast, and this reduced the lung dose compared to that for the long cast.

CONCLUSION

The oropharyngeal length in adults may affect the lung dose via the pMDIs, which may not be eliminated by using small volume spacers.

Particle Deposition in Children's Lungs: Theory and Experiment

A mathematical model of inhaled aerosol particle deposition for children is presented and validated with data from two published experimental studies. The model accurately predicts deposition fraction (DF) in children as a function of particle size for particles in the size range 1-3 microns for both sedentary and exercise breathing conditions. When the experimental data are grouped according to age, the model is able to predict age-dependent trends in DF at the studied particle sizes under sedentary breathing conditions. The model predicts that when ventilatory conditions are held constant, age-dependent changes in morphology result in decreasing DF with age; however, under realistic conditions these changes may be masked by age-dependent changes in ventilation. Despite the fact that mean DF differs significantly from adult values only in children younger than 9, the model predicted that dose-per-surface area may still be greater in children due to smaller lung sizes.

Effect of water/fuel emulsions and a cerium-based combustion improver additive on HD and LD diesel exhaust emissions

One of the major technological challenges for the transport sector is to cut emissions of particulate matter (PM) and nitrogen oxides (NOx) simultaneously from diesel vehicles to meet future emission standards and to reduce their contribution to the pollution of ambient air. Installation of particle filters in all existing diesel vehicles (for new vehicles, the feasibility is proven) is an efficient but expensive and complicated solution; thus other short-term alternatives have been proposed. It is well known that water/diesel (W/ D) emulsions with up to 20% water can reduce PM and NOx emissions in heavy-duty (HD) engines. The amount of water that can be used in emulsions for the technically more susceptible light-duty (LD) vehicles is much lower, due to risks of impairing engine performance and durability. The present study investigates the potential emission reductions of an experimental 6% W/D emulsion with EURO-3 LD diesel vehicles in comparison to a commercial 12% W/D emulsion with a EURO-3 HD engine and to a Cerium-based combustion improver additive. For PM, the emulsions reduced the emissions with -32% for LD vehicles (mass/km) and -59% for the HD engine (mass/ kWh). However, NOx emissions remained unchanged, and emissions of other pollutants were actually increased forthe LD vehicles with +26% for hydrocarbons (HC), +18% for CO, and +25% for PM-associated benzo[a]pyrene toxicity equivalents (TEQ). In contrast, CO (-32%), TEQ (-14%), and NOx (-6%) were reduced by the emulsion for the HD engine, and only hydrocarbons were slightly increased (+16%). Whereas the Cerium-based additive was inefficient in the HD engine for all emissions except for TEQ (-39%), it markedly reduced all emissions for the LD vehicles (PM -13%, CO -18%, HC -26%, TEQ -25%) except for NOx, which remained unchanged. The presented data indicate a strong potential for reductions in PM emissions from current diesel engines by optimizing the fuel composition.

In VitroDetermination of the Optimal Particle Size for Nebulized Aerosol Delivery to Infants

We investigated the in vitro influence of breathing patterns on lung dose (LD) and particle size distribution in an infant upper airway cast model in order to determine the optimal particle size for nebulized aerosol delivery to infants. Budesol (nebulizer solution of budesonide) delivery from a perforated vibrating membrane nebulizer (eFlow Baby functional prototype) through an upper airway cast of a nine month old infant (SAINT-model) was measured at a fixed respiratory rate (RR) of 30 breaths per minute (bpm) and a tidal volume (Vt) of 50, 100, and 200 mL, respectively, and at a fixed Vt of 100 mL and a RR of 30, 60, and 78 bpm, respectively. LD expressed as a percentage of the nominal dose (ND; range, 5.8-30.3%) decreased with increasing Vt (p < 0.001) and with increasing RR (p < 0.001). Median mass aerodynamic diameter (MMAD) after passage (range, 2.4-3.4 microm) through the upper airway cast showed a negative correlation with increasing Vt (p < 0.001) and with increasing RR (p = 0.015). Particles available as LD for all simulated breathing pattern showed a particle size distribution with a MMAD of 2.4 microm and a geometric standard deviation (GSD) of 1.56. From our in vitro study, we conclude that the optimal particle size for nebulized aerosols for inhalation therapy for infants should have a MMAD of <2.4 microm.

Stochastic simulation of alveolar particle deposition in lungs affected by different types of emphysema

In the present study, disease-specific stochastic models were developed for the computation of particle deposition in lungs affected by COPD, emphysema, or both, distinguishing between four types of pulmonary emphysema-centriacinar, paraseptal, panacinar, and bullous. To simulate COPD, airway calibers of the tracheobronchial tree were randomly reduced between 20% and 50% in each airway. For the study of pure COPD ("blue bloaters"), alveolated airway dimensions of the healthy lung were used, while for the simulation of emphysema without COPD ("pink puffers"), normal conductive airway diameters were assumed. Deposition calculations in diseased lungs were carried out by assuming (a) identical inspiration and expiration times (no breath-hold time) and (b) a continuous increase of the functional residual capacity (from 3,300 to 5,000 mL), accompanied by a simultaneous drop of the tidal volume (from 1,000 to 500 mL). Independent of particle size, total alveolar deposition in emphysematous lungs was significantly decreased relative to normal lungs. In particular, the deposition maximum at large particle sizes, which is a characteristic for healthy subjects, completely disappeared. Among the various emphysema models, deposition was smallest in lungs with bullous emphysema due to strongly enhanced settling and diffusion distances within the alveolar structures. A change of the lung volume caused a further decrease in particle deposition. Alveolar deposition in "blue bloaters" and "pink puffers" was very similar to the deposition in patients suffering from COPD and emphysema. Alveolar deposition per acinar airway generation was also strongly reduced in diseased lungs compared to normal lungs. Besides this reduction, deposition patterns became more uniform throughout the alveolar region.

Modeling age-related particle deposition in humans

Inhalation of airborne material poses a potential health risk to various subpopulations one of which is children. Little is known about the fate of particles in the respiratory tracts of children. Modeling efforts have been limited due largely to the lack of adequate information on lung geometry during growth. Lung morphometry measurements in children and adults between 3 months and 21 years of age were used to create 5-lobe lung geometries. Each lobe had a dichotomous, symmetric branching structure and was structurally different from the other lobes. The lung geometries were used in a multiple-path particle deposition model to calculate particle deposition fractions in different regions, lobes and airway generations of the lungs. Simulated breathing patterns were representative of resting breathing. Age-dependent, semi-empirical expressions of particles losses in the nasal airways, which were based on fits to the available experimental measurements, showed larger nasal deposition in adults than in children. Predicted tracheobronchial deposition patterns were similar among different ages for a given particle size. In the alveolar region, the predicted deposition fraction varied with age such that a clear trend could not be identified. Deposition fraction in a lobe was proportional to the volume of air going to that lobe. Deposition fractions in the lower left and right lobes were similar but higher than those in the other lobes for a given particle diameter. Lobar deposition fraction adjusted for lobar lung volume or lung deposition fraction adjusted for lung volume was found to be a unique property for an individual and presented a means for age-dependent deposition comparisons. The adjusted tracheobronchial and pulmonary deposition fractions were greatest for infants and decreased with age. A similar trend was also observed for deposition fraction per unit area as a function of airway generation. The distribution of particle deposition fraction per unit surface area varied with particle size for an individual, with ultrafine particles being more uniformly distributed throughout the lungs and coarse particles depositing primarily in the first few tracheobronchial airways. The trend of particle deposition with age indicates that children, particularly infants, may be at a greater health risk from exposure to airborne particulate matter and noxious materials all other conditions being equal. The age-dependent predicted deposition fraction pattern per unit area of different size particles has implications in the calculation of inhaled reference concentrations as well as site-specific delivery of drugs and other therapeutic compounds to the lungs of patients.

Cough after inhalation of corticosteroids delivered from spacer devices in children with asthma

Children using a spacer device rather than another device for delivering inhaled corticosteroids (ICS) has been identified as a risk factor for cough immediately after inhalation. The aim of this study was to point out the different factors influencing the occurrence of such lateral side-effects. We studied this local side-effect in 402 asthmatic children (55.6 +/- 34.9 months; 65.6% boys) treated for at least 1 month with beclomethasone dipropionate (n = 331), budesonide (n = 47) or fluticasone propionate (n = 24) delivered from pressurized metered-dose inhalers and small (75.1%) or large volume (24.8%) spacer devices mainly used with face mask (90.7%). A total of 219 patients (54.5%), treated with either high doses of ICS or ICS and long-acting beta2-agonist, were considered as having severe asthma. Cough was reported after each inhalation of corticosteroids in 216 patients (53.7%). Among them, about 30% also complained of cough with beta2-agonists. Despite different propellants and dispersants, all corticosteroids induced cough similarly. Cough was not linked with asthma severity, but was significantly related to therapy duration and use of long-acting beta2-agonist. Type and volume of the spacer device, use of a face mask or mouthpiece were not influencing factors. Cough after inhalation of corticosteroids delivered from spacer devices is a frequent local side-effect in children with asthma. This side effect can greatly alter compliance. A practitioner must be sought at each visit.

Effect of body size on breathing pattern and fine-particle deposition in children

Interchild variability in breathing patterns may contribute to variability in fine particle lung deposition and morbidity in children associated with those particles. Fractional deposition (DF) of fine particles (2-microm monodisperse, carnauba wax particles) was measured in healthy children, age 6-13 yr (n = 36), while they followed a resting breathing pattern previously determined by respiratory inductance plethysmography. Interchild variation in DF, measured by photometry at the mouth, was most strongly predicted by their tidal volume (Vt) (r =0.79, P < 0.001). Multiple regression analysis further showed that, for any given height and age, Vt increased with increasing body mass index (BMI) (P < 0.001). The overweight children (> or =95th percentile BMI) (n = 8) had twice the DF of those in the lowest BMI quartile (<25th percentile) (n = 9; 0.28 +/- 0.13 vs. 0.15 +/- 0.06, respectively; P < 0.02). In the same groups, resting minute ventilation was also significantly higher in the overweight children (8.5 +/- 2.2 vs. 5.9 +/- 1.1 l/min; P < 0.01). Consequently, the rate of deposition (i.e., particles depositing/time) in the overweight children was 2.8 times that of the leanest children (P < 0.02). Among all children, the rate of deposition was significantly correlated with BMI (r = 0.46, P = 0.004). These results suggest that increased weight in children may be associated with increased risk from inhalation of pollutant particles in ambient air.

In silico modeling of asthma

The incidence of asthma is increasing throughout the world, especially among children, to the extent that it has become a medical issue of serious global concern. Appropriately, numerous pharmacologic drugs and clinical protocols for the treatment and prophylaxis of the disease have been reported. From a scientific perspective, a review of the literature suggests that the targeted delivery of an aerosol would, in a real sense, enhance the efficacy of an inhaled medicine. Therefore, in accordance with published data we have developed a mathematical description of disease-induced effects of disease on airway morphology. A morphological algorithm defining the heterogeneity of asthma has been integrated with a computer code that formulates the behavior and fate of inhaled drugs. In this work, predicted drug particle deposition patterns have been compared with SPECT images from experiments with healthy human subjects (controls) and asthmatic patients. The asthma drug delivery model simulations agree with observations from human testing. The results indicate that in silico modeling provides a technical foundation for addressing effects of disease on the administration of aerosolized drugs, and suggest that modeling should be used in a complementary manner with future inhalation therapy protocols.

Inhalation therapy for infants

Delivering aerosolised drugs to infants poses a number of challenges. It is clear that drug delivery is possible via the inhaled route but to date it has been difficult to demonstrate clearly therapeutic benefit from the use of any conventional therapy in the vast majority of infants. This is probably related to the nature of pulmonary disease in this age group. While most aerosol scientists focus on factors such as aerosol size and airways geometry drug delivery, as in all age groups, is most dependent upon patient behaviour. A small amount of drug reaches the lungs of distressed infants. Consideration of patient device interactions is vital if successful drug delivery is to be achieved and this includes consideration of mask design. Doses reaching the lungs are generally very low when considered in terms of the nominal dose but when considered in terms of dose delivered per kilogram body weight drug delivery to the lungs is generally similar to or greater than in adults. Upper airways deposition is relatively greater than in older subjects, in large part because of nasal breathing, and this will affect the 'therapeutic index' of some drugs.

Risk assessment dosimetry model for inhaled particulate matter: I. Human subjects

Pollutant particulate matter (PM) is a serious global problem, presenting a threat to the health and well being of human subjects. Inhalation exposures tests with surrogate animals can be performed to estimate the threat. However, it is difficult to extrapolate the findings of animal tests to human conditions. In this two-part series, interspecies dosimetry models especially designed for implementation with risk assessment protocols are presented. In Part I, the mathematical integrity of the source model per se was tested with data from human subjects, and theoretical predictions agreed well with experimental measurements. In Part II, for surrogate (rat) simulations, appropriate algorithms for morphologies and ventilatory parameters were used as subroutines in the validated model. We conducted a comprehensive series of computer simulations describing the behavior of a representative air pollutant, secondary cigarette smoke. For risk assessment interests, a range of states from rest to exercise was considered. PM hygroscopicity had a pronounced effect on deposition in a complex but systematic manner, in humans and rats: deposition was increased for particles larger than about 1 microm, but was decreased for particles smaller than about 0.1 microm. The results clearly indicate that dosimetry models can be effectively used to a priori determine the laboratory conditions necessary for animals tests to accurately mimic human conditions. Moreover, the use of interspecies models is very cost effective. We propose, therefore, that mathematical models be used in a complementary manner with inhalation exposure experiments and be actively integrated into PM risk assessment protocols.

Regional deposition of coarse particles and ventilation distribution in healthy subjects and patients with cystic fibrosis

The efficacy of inhaled pharmaceuticals depends, in part, on their site of respiratory deposition. Markedly nonuniform ventilation distribution may occur in persons with obstructive airways diseases and may affect particle deposition. We studied the relationship between regional deposition (RDep) and regional ventilation (RVent) in a group of 12 cystic fibrosis (CF) patients with mild to moderate airway obstruction (63 +/- 8% predicted FEV1) and 11 healthy nonsmoking volunteers (104 +/- 13% predicted FEV1) using planar scintigraphic methods. RDep was assessed from initial deposition and 24-h retention images for monodisperse technetium-99m-labeled iron oxide particles (5-microm MMAD). Regional volumes and RVent were assessed from xenon-133 equilibrium and washout, respectively. Six regions of interest per lung were established by dividing each lung into thirds by height and approximately half by width. The two lower regions of the left lung were not analyzed due to activity in the stomach. Remaining regions were categorized as central (two interior-most regions) and peripheral (eight exterior regions). RDep and RVent were computed for the eight peripheral regions. Tracheobronchial (TB) deposition was estimated for each of the peripheral regions as the difference between initial activity and decay-corrected 24-h retention or parenchymal deposition. RDep was computed as the fraction of material within a region normalized to regional volume. RVent for each region was determined by normalizing the xenon washout rate for that region by the total washout rate for the eight peripheral regions. Significant linear associations were found between RDep and RVent in both the healthy subjects and CF patients. In healthy subjects, RDep in the TB airways was positively associated with RVent (p = 0.03). In CF patients, RDep in the TB airways was negatively associated with RVent (p = 0.04) and RDep in the parenchyma was positively associated with RVent (p < 0.001). The initial pattern of RDep in the lung was not significantly associated with RVent in either group. These data suggest that significant coarse particle deposition may occur in the TB airways of poorly ventilated lung regions in CF patients, whereas, particle deposition in the TB airways of the healthy subjects follows ventilation.

In vitro aerosol delivery and regional airway surface liquid concentration of a liposomal cationic peptide

A liposome encapsulation was optimized for the entrapment and aerosol delivery of an alpha-helical cationic peptide, CM3, which had shown good antimicrobial and antiendotoxin activity in vitro. The encapsulation procedure and the phospholipids used were selected to maximize both the encapsulation and nebulization efficiencies, without compromising liposomal integrity during nebulization. The best compromise was found with dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol (3:1 molar ratio), which allowed for peptide encapsulation levels of 730 microg/mL using 30 mM lipid concentration. The aerosol produced with the selected liposomal formulation was subsequently analyzed for determination of size distribution and nebulizer efficiencies. These quantities were used as input for a mathematical lung deposition model, which predicted local lung depositions of the liposomal peptides for three models of lung geometry and breathing patterns: an adult, an 8-year-old child, and a 4-year-old child. The deposition results were then applied to a novel model of airway surface liquid in the lung to assess the concentration of the deposited peptide. The resulting concentration estimates indicate that the minimum inhibitory levels of CM3 can be reached over most part of the tracheobronchial region in the adult model, and can be exceeded throughout the same region in both pediatric model subjects, using a valved jet nebulizer with a 2.5mL volume fill.

Deposition and clearance: unique problems in the proximal airways and oral cavity in the young and elderly

Prospective longitudinal studies measuring aerosol behavior in the respiratory tract as humans age have not been performed. The present paper reviews observations related to aging of the respiratory tract and other effects more likely due primarily to disease and iatrogenic causes. Upper airway deposition was found to approximate 50% in children during inhalation of drugs thought to be designed primarily for deposition in the lower respiratory tract. In older subjects, aging per se did not have a major impact on the deposition of aerosols. Disease processes that develop with age were shown to be the primary cause of deposition abnormalities. Flow-limitation in central airways was proposed as a major factor responsible for central airway deposition as well as abnormal clearance in common obstructive lung diseases. The oral cavity, a source of pathogenic organisms causing pneumonia, was also studied in the elderly. Salivary clearance, often abnormal in the aged, was related to colonization with pathogenic bacteria. Salivary clearance was not obviously reduced by aging per se but by iatrogenic sources such as drug therapy for other diseases.

Methods for modeling particle deposition as a function of age

The purpose of this paper is to review the application of mathematical models of inhaled particle deposition to people of various ages. The basic considerations of aerosol physics, biological characteristics and model structure are presented along with limitations inherent in modern modeling techniques. Application of the models to children and senescent adults has been largely based on extrapolating anatomical and physiological data from young adults to match the changes observed during growth and aging. Sample results are included for total particle deposition and deposition in the bronchial and pulmonary regions. The models proposed provide particle deposition predictions that are consistent with the scant measurements available. The models discussed appear to be on firm theoretical grounds, but they are largely limited in application to simple aerosols and average individuals. Also, additional validation of the computational predictions is needed.