Particle Deposition in Children's Lungs: Theory and Experiment

Long-term inhalation exposure: A model for phthalate accumulation in the respiratory tract

BACKGROUND

Inhalation is a major pathway for phthalates (PAEs), an endocrine disruptor, to enter the human body. The actual internal exposure amount that participates in metabolism cannot be estimated by calculating total inhalation intake.

OBJECTIVE

To estimate the accumulation in each region of the respiratory tract after long-term exposure to PAEs in different populations.

METHODS

A mass transfer model was developed to simulate the long-term accumulation of PAEs in respiratory tract through inhalation. The model considered (1) mass transfer of PAEs in three phases across seven regions, (2) the effect of temperature differences on the mass transfer process. Based on this model, we simulated adult exposure to PAEs in a laboratory, identified key model parameters, and further simulated various scenarios for children, adults, and elders.

RESULTS

PAEs are not completely cleared from the respiratory tract after 16 hours, following 8 hours of daily exposure. Under regular laboratory environment, accumulation after 30 days is 3.8 times higher than that after the first day. The distribution of PAEs between the gas and mucus phases has a greater impact on the results than between the gas and particle phases. Children are at the highest risk to Diethyl phthalate (DEP) exposure compared with adults and elders. Nearly 80 % of DEP is exhaled, with 14 % accumulating in the alveolar region after an hour.

CONCLUSION

This model links indoor air PAEs to human internal exposure, showing that most PAEs are exhaled, while the remainder accumulates in the respiratory tract and may participate in human metabolism.

Investigation of the Exposure of Schoolchildren to Ultrafine Particles (PM0.1) during the COVID-19 Pandemic in a Medium-Sized City in Indonesia

The health risk of schoolchildren who were exposed to airborne fine and ultrafine particles (PM0.1) during the COVID-19 pandemic in the Jambi City (a medium-sized city in Sumatra Island), Indonesia was examined. A questionnaire survey was used to collect information on schoolchildren from selected schools and involved information on personal profiles; living conditions; daily activities and health status. Size-segregated ambient particulate matter (PM) in school environments was collected over a period of 24 h on weekdays and the weekend. The personal exposure of PM of eight selected schoolchildren from five schools was evaluated for a 12-h period during the daytime using a personal air sampler for PM0.1 particles. The schoolchildren spent their time mostly indoors (~88%), while the remaining ~12% was spent in traveling and outdoor activities. The average exposure level was 1.5~7.6 times higher than the outdoor level and it was particularly high for the PM0.1 fraction (4.8~7.6 times). Cooking was shown to be a key parameter that explains such a large increase in the exposure level. The PM0.1 had the largest total respiratory deposition doses (RDDs), particularly during light exercise. The high level of PM0.1 exposure by indoor sources potentially associated with health risks was shown to be important.

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.

Computational Fluid Dynamics Modeling of Respiratory Airflow in Tracheobronchial Airways of Infant, Child, and Adult

During human growth and development from infancy to adulthood, dramatic changes occur in the respiratory system. It is important to understand respiratory airflow in different age groups in age-specific treatment of respiratory disorders. This study numerically investigated the age-related effects on inspiratory and expiratory airflow dynamics in four-generation lung airway models under normal breathing conditions. Tracheobronchial airway models of infant (6 month old), child (5 years old), and adult (25 years old) from sixth to ninth generations were constructed for the study. Computational fluid dynamics (CFD) was used to solve the equations governing the airflow. Results of this study indicate that as age increases, airflow velocity, pressure, and wall shear stress decrease for both inspiration and expiration in this particular subregion of the respiratory tract. During inspiration, the splitting of velocity streamlines at bifurcations increases with age. The opposite situation merging happens during expiration, and it also increases with age. The level of splitting and merging of streamlines here reflects the influence of respiratory mechanics in the age groups. The computational models provide new information on characteristics and patterns of age-dependent respiratory airflow in the sixth to ninth generations of tracheobronchial airways and can be applied in other generations.

Particle deposition in tracheobronchial airways of an infant, child and adult

BACKGROUND

Particle deposition in human airways is important for assessing both health effects of inhaled particles and therapeutic efficacy of inhaled drug aerosols, but is not well understood for infants and children.

OBJECTIVE

We investigate particle deposition in infants and children by using computational fluid dynamics (CFD), and compare this with particle deposition in adults.

METHODS

We chose three population age groups: 7-month infant, 4-year old child, and 20-year old adult. Both airway structures and breathing conditions are considered to vary as a human grows from infancy to adulthood. We investigated deposition of micron-size particles (1-10μm) in both the upper (G3-G6) and lower (G9-G12) tracheobronchial (TB) airways under sedentary conditions.

RESULTS

We found that particle deposition in both upper and lower airways is the highest in an infant, next in a child, and lowest in an adult. As age increases, particle deposition decreases in the upper airways but increases in the lower. For infants, inertial impaction is the dominant deposition mechanism, thus particles are deposited more in the upper airways than in the lower. However, particles are deposited more in the lower airways than in the upper in adults, as gravitational sedimentation is the dominant deposition mechanism.

CONCLUSION

Given the differences in the airway structure and particle deposition mechanisms, particle deposition in infants and children differs from that in adults, not only in the efficiency of deposition but also in the site. Our findings provide evidence that "children are not small adults".

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.

Performance of dry powder inhalers with single dosed capsules in preschool children and adults using improved upper airway models

The pulmonary administration of pharmaceutical aerosols to patients is affected by age-dependent variations in the anatomy of the upper airways and the inhalation pattern. Considering this aspect, different upper airway models, representing the geometries of adults and preschool children, and a conventional induction port according to the European Pharmacopeia were used for in vitro testing of dry powder inhalers with single dosed capsules (Cyclohaler^®, Handihaler^® and Spinhaler^®). Deposition measurements were performed using steady flow rates of 30 and 60 L/min for the Handihaler^®/Spinhaler^® and 30, 60 and 75 L/min for the Cyclohaler^®. The inhalation volume was set at 1 L. For the Cyclohaler^®, the in vitro testing was supplemented by a pediatric inhalation profile. Slight differences of pulmonary deposition between the idealized adult (11%–15%) and pediatric (9%–11%) upper airway model were observed for the Cyclohaler^®. The applied pediatric inhalation profile resulted in a reduction of pulmonary deposition by 5% compared to steady conditions and indicated the influence of the inhalation pattern on the amount of pulmonary deposited particles. The comparison of two pediatric upper airway models showed no differences. The performance of the Handihaler^® was similar to the Cyclohaler^®. The Spinhaler^® showed an insufficient performance and limited reproducibility in our investigations.

Assessing the performance of two dry powder inhalers in preschool children using an idealized pediatric upper airway model

High prevalence of pulmonary diseases in childhood requires inhalable medication even for young children. Little is known about the efficiency of aerosol therapy especially in preschool children. One factor which limits the lung dose is the upper airway geometry. Based on clinical data a recently developed idealized pediatric upper airway model (children 4-5 years) was used to investigate the performance of two dry powder inhalers (Easyhaler and Novolizer). In vitro investigations were first examined using steady flow rates and an inhalation volume of 1L. Chosen flow rates were 28, 41 and 60L/min (Easyhaler) and 45, 60 and 75L/min (Novolizer). Afterwards inhalation profiles simulated by an electronic lung were included. The investigations showed high amounts of drug particles (up to 80%) which were deposited in the upper airway model. The pulmonary deposition in vitro using the Easyhaler was about 28% (28-60L/min) and 22% (inhalation profile). Using the Novolizer in vitro pulmonary doses of 8-12% (45-75L/min) and about 5% (inhalation profile) were observed. The idealized model shows good performance reproducibility of dry powder inhalers. We have shown that age-dependent models might be appropriate tools for formulation and device development in pediatric age groups.

New developments in aerosol dosimetry

Dosimetry provides information linking environmental exposures to sites of deposition, removal from these sites, and translocation of deposited materials. Dosimetry also aids in extrapolating laboratory animal and in vitro data to humans. Recent progress has shed light on: properties of particles in relation to their fates in the body; influence of age, gender, body size, and lung diseases on inhaled particle doses; particle movement to the brain via the olfactory nerves; and particle deposition hot spots in the respiratory tract. Ultrafine size has emerged as an important dosimetric characteristic. Particle count, composition, and surface properties are recognized as potentially important toxicology-related considerations. Differences in body size influence airway sizes, inhaled particle deposition, specific ventilation, and specific doses (e.g. per unit body mass). Related to body size, age, gender, species, and strain are also dosimetric considerations. Diseases, such as chronic obstructive pulmonary disease (COPD) and bronchitis, produce uneven doses within the respiratory tract. Traditional concepts of the translocation and clearance of deposited particles have been challenged. Ultrafine particles can translocate to the brain via olfactory nerves, and from the lung to other organs. The clearance rates of particles from tracheobronchial airways are slowed by respiratory tract infections, but newer evidence implies that slow particle clearance from this region also exists in healthy lungs. Finally, hot spots of particle deposition are seen in hollow models, lung tissue, and dosimetric simulations. Local doses to groups of epithelial cells can be much greater than those to surrounding cells. The new insights challenge dosimetry scientists.

Clinical evaluation of inhaled insulin

Diabetes affects over 18.2 million individuals in the United States alone. Current therapy to treat type 1 diabetes relies on subcutaneous insulin administration either by injection or continuous infusion. In addition, patients with type 2 diabetes who fail lifestyle intervention and oral therapy require subcutaneous insulin. Optimal injection protocols to achieve tight metabolic control often prove burdensome to patients. Thus, development of pulmonary insulin delivery to supplement and/or replace subcutaneous insulin injections may be an effective alternative, allowing patients to achieve intensive diabetes management. This review will discuss the devices in development for the delivery of inhaled insulin. In addition, the efficacy of inhaled insulin in both type 1 and type 2 diabetic populations will be discussed. Finally, the available safety data with respect to the unique pulmonary effects of inhaled insulin will be covered.

Three-Dimensional Computational Fluid Dynamics Simulations of Particle Deposition in the Tracheobronchial Tree

Simulation of the dynamics and disposition of inhaled particles within human lungs is an invaluable tool in both the development of inhaled pharmacologic drugs and the risk assessment of environmental particulate matter (PM). The goal of the present focused study was to assess the utility of three-dimensional computational fluid dynamics (CFD) models in studying the local deposition patterns of PM in respiratory airways. CFD models were validated using data from published experimental studies in human lung casts. The ability of CFD to appropriately simulate trends in deposition patterns due to changing ventilatory conditions was specifically addressed. CFD simulations of airflow and particle motion were performed in a model of the trachea and main bronchi using Fluent Inc.'s FIDAP CFD software. Particle diameters of 8 microm were considered for input flow rates of 15 and 60 L/min. CFD was able to reproduce the observed spatial heterogeneities of deposition within the modeled bifurcations, and correctly predicted the "hot-spots" of particle deposition on carinal ridges. The CFD methods also predicted observed differences in deposition for high-versus-low flow rates. CFD models may provide an efficient means of studying the complex effects of airway geometry, particle characteristics, and ventilatory parameters on particle deposition and therefore aid in the design of human subject experiments.