1
|
Kawamura T, Sekine Y, Sugai K, Yanagihara T, Saeki Y, Kitazawa S, Kobayashi N, Goto Y, Ichimura H, Ohigashi T, Maruo K, Sato Y. Three-dimensional analysis reveals a high incidence of lung adenocarcinoma in the upper region. Surg Today 2024; 54:634-641. [PMID: 38055104 DOI: 10.1007/s00595-023-02776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/08/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The lung is a unique organ with a ventilation-perfusion mismatch, which can cause inhomogeneous incidence rates of lung cancer depending on the location in the lung. We aimed to evaluate the incidence of lung adenocarcinoma in each lobe by analyzing the incidence per unit volume, to evaluate the incidence without being affected by differences in the size of each lobe or in the size of the lungs between individuals. METHODS The number of adenocarcinomas in each lobe was counted. Lung volumes were measured using a three-dimensional computer workstation. The tumor incidence per unit volume was analyzed based on the number of tumors in each lobe. RESULTS The number of tumors per unit volume was 0.467 in the right upper lobe (RUL), 0.182 in the right middle lobe, 0.209 in the right lower lobe, 0.306 in the left upper segment (LUS), 0.083 in the left lingular segment, and 0.169 in the left lower lobe. The tumor incidence rate of RUL + LUS was 2.269 times that of the other lobes, a value that was significantly higher when using the bootstrap method (p < 0.001). CONCLUSIONS The incidence of adenocarcinoma per unit volume in both upper lobes was higher than that in other lobes.
Collapse
Affiliation(s)
- Tomoyuki Kawamura
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Kazuto Sugai
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Takahiro Yanagihara
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Shinsuke Kitazawa
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan
| | - Tomohiro Ohigashi
- Department of Biostatistics, Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan.
| |
Collapse
|
2
|
Poorbahrami K, Allshouse MR, Oakes JM. Dosimetry Sensitivity in a Lower Dimensional Model of Patient-Specific Asthma Subjects. IEEE Trans Biomed Eng 2023; 70:2581-2591. [PMID: 37030850 DOI: 10.1109/tbme.2023.3255784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Experimental uncertainty will impact in silico model calculations of aerosol delivery and deposition. Patient-specific dosimetry models are often parameterized based on medical imaging data, which contain inherent experimental variability. METHODS Here, we created and parameterized 1D models of three subject-specific asthmatic subjects and randomly assigned perturbations of up to 15 % on airway diameter, segmental volume, and defected volume. Sensitivity of imaging data experimental variability on dosimetry metrics were quantified. RESULTS Lobar particle delivery primarily depended on the distal segmental volumes; 15 % range of noise resulted in delivery to the upper right lobe to vary at most from 15.2 and 18.2 % for one of the severe subjects. Particle deposition was most sensitive to airway diameter; 95 % confidence intervals spanned from 8 to 10.6 % in the mild/moderate subject for 15 % variation on input metrics for 5 [Formula: see text] diameter particles. While these results provide possible ranges of dosimetry calculations for a specific subject, the perturbations were not sufficient to model the large observed inter-subject variability (8.9, 19, and 14.5 % deposition, subjects 1--3, respectively, 5 [Formula: see text] diameter particles). CONCLUSION This study highlights that in silico model predictions are robust in the presence of experimental uncertainty and that it continues to be necessary to perform subject-specific simulations, especially within the presence of heterogeneous airway disease. SIGNIFICANCE Sensitivity analysis provides confidence in calculating deposition in the airways of asthmatic subjects within the presence of experimental uncertainty.
Collapse
|
3
|
Fleming JS. The Use of Single Photon Emission Computed Tomography in Aerosol Medicine. J Aerosol Med Pulm Drug Deliv 2023; 36:44-53. [PMID: 36594940 DOI: 10.1089/jamp.2023.29077.jsf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Imaging of radiolabeled aerosols provides useful in vivo data on both the initial site of deposition and its subsequent transport by mucociliary clearance and epithelial permeability. Single Photon Emission Computed Tomography (SPECT) uses a gamma camera with multiple rotating heads to produce three-dimensional (3D) images of inhaled radioaerosol labeled with technetium-99m. This enables total lung deposition and its 3D regional distribution to be quantified. Aligned 3D images of lung structure allow deposition data to be related to lung anatomy. Mucociliary clearance or epithelial permeability can be assessed from a time series of SPECT aerosol images. SPECT is slightly superior to planar imaging for measuring total lung deposition. However, it is more complex to use, and for studies where total lung deposition is the endpoint, planar imaging is recommended. However, SPECT has been shown to be clearly superior to planar imaging for assessing regional distribution of aerosol and is the method of choice for this purpose. It therefore has applications in studying the influence of regional deposition on clinical effectiveness and also in validating computer models of deposition. The inability to directly radiolabel drug molecules with 99mTc is a clear disadvantage of SPECT and limits its potential use for pharmacokinetic studies. SPECT provides a wealth of data on aerosol deposition, which has been relatively underused at present. Optimal methods of analyzing and interpreting the data need to be developed. SPECT can also, in principle, provide detailed information of mucociliary clearance and has the potential to significantly improve knowledge of this process and hence clarify the role of clearance as a biomarker.
Collapse
Affiliation(s)
- John S Fleming
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, National Institute of Health Research Biomedical Research Centre, Southampton, United Kingdom
| |
Collapse
|
4
|
Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
Collapse
|
5
|
Corcoran T. Carrier Gases and Their Effects on Aerosol Drug Delivery. J Aerosol Med Pulm Drug Deliv 2021; 34:71-78. [PMID: 33691471 DOI: 10.1089/jamp.2021.29035.tc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Carrier gases provide the medium for delivery of inhaled aerosol therapies. The physical properties of these gases substantially affect both fluid and aerosol mechanics in the lung. Gas density affects both the pressure/flow relationship in the airways and the extent of turbulence within the flow. These physical properties also affect the operation of some components of respiratory and aerosol drug delivery equipment. The lower resistance associated with breathing low density gases has prompted many studies of therapeutic applications. This includes the respiration of helium-oxygen gas mixtures to improve oxygenation and carbon dioxide removal, and the use of these gases to improve the delivery of inhaled medications. Results of these studies have been mixed but meta-analyses indicate a benefit of helium-oxygen respiration for croup and bronchiolitis and for bronchodilator delivery in obstructive disease. Some of the variability demonstrated in these studies is likely associated with specific technical aspects of how the gases are delivered. The utility of alternate carrier gases for aerosol delivery would be facilitated by simultaneous assessment of both aerosol deposition and clinical effect during studies. Previous successful applications may offer a basis for improved delivery system designs that fully realize the effects that might be available with these gases.
Collapse
Affiliation(s)
- Tim Corcoran
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania USA
| |
Collapse
|
6
|
Lim SH, Park S, Lee CC, Ho PCL, Kwok PCL, Kang L. A 3D printed human upper respiratory tract model for particulate deposition profiling. Int J Pharm 2021; 597:120307. [PMID: 33540019 DOI: 10.1016/j.ijpharm.2021.120307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
Pulmonary route is the main route of drug delivery for patients with asthma and chronic obstructive pulmonary diseases, offering several advantages over the oral route. Determining the amount of drug deposited onto various parts of the respiratory tract allows for a good correlation to clinical efficacy of inhalation drug devices. However, current in vitro cascade impactors measure only the aerodynamic particle size distribution, which does not truly represent the in vivo deposition pattern in human respiratory tract. In this study, a human upper respiratory tract model was fabricated using a 3D printer and subsequently characterized for its dimensional accuracy, surface finishing and air leaking. The effects of using a spacer and/or various airflow rates were also investigated. To assess this in vitro model, the deposition pattern of a model drug, namely, salbutamol sulphate, was tested. The resultant deposition pattern of salbutamol sulphate from a metered dose inhaler at 15 L per minute with the spacer, showed no significant difference from that of a published radiological in vivo study performed in adult humans. In addition, it was also found that the deposition pattern of salbutamol at 35 L per minute was comparable to the results of another published study in human. This in vitro model, showing reasonable in vitro-in vivo correlation, may provide opportunities for personalized medicine in special populations or disease states.
Collapse
Affiliation(s)
- Seng Han Lim
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Sol Park
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia
| | - Chun Chuan Lee
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Paul Chi Lui Ho
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Philip Chi Lip Kwok
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia
| | - Lifeng Kang
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia.
| |
Collapse
|
7
|
Häussermann S, Sommerer K, Scheuch G. Regional Lung Deposition: In Vivo Data. J Aerosol Med Pulm Drug Deliv 2020; 33:291-299. [PMID: 33021414 DOI: 10.1089/jamp.2020.29032.sh] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The method section of this chapter on in vivo regional lung deposition highlights a nonradioactive method to measure regional deposition, which uses a photometer to quantify inhaled and exhaled particles and in that way is able to estimate the lung region from which the particles are exhaled and to what amount. The radioactive methods cover the measurement of clearance of the deposited particles as well as different imaging techniques to determine regional deposition. The result section reviews in vivo trials in human subjects. It also addresses different parameters that influence the regional deposition in the lungs: particle size, inhalation maneuver, carrier gas, disease, and inhalation device. All of these factors can affect regional deposition significantly. By choosing specific values of these parameters, it should be feasible to target different regions of the lungs for the therapy of different diseases.
Collapse
|
8
|
Nousias S, Zacharaki EI, Moustakas K. AVATREE: An open-source computational modelling framework modelling Anatomically Valid Airway TREE conformations. PLoS One 2020; 15:e0230259. [PMID: 32243444 PMCID: PMC7122715 DOI: 10.1371/journal.pone.0230259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
This paper presents AVATREE, a computational modelling framework that generates Anatomically Valid Airway tree conformations and provides capabilities for simulation of broncho-constriction apparent in obstructive pulmonary conditions. Such conformations are obtained from the personalized 3D geometry generated from computed tomography (CT) data through image segmentation. The patient-specific representation of the bronchial tree structure is extended beyond the visible airway generation depth using a knowledge-based technique built from morphometric studies. Additional functionalities of AVATREE include visualization of spatial probability maps for the airway generations projected on the CT imaging data, and visualization of the airway tree based on local structure properties. Furthermore, the proposed toolbox supports the simulation of broncho-constriction apparent in pulmonary diseases, such as chronic obstructive pulmonary disease (COPD) and asthma. AVATREE is provided as an open-source toolbox in C++ and is supported by a graphical user interface integrating the modelling functionalities. It can be exploited in studies of gas flow, gas mixing, ventilation patterns and particle deposition in the pulmonary system, with the aim to improve clinical decision making.
Collapse
Affiliation(s)
- Stavros Nousias
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | |
Collapse
|
9
|
Poorbahrami K, Oakes JM. Regional flow and deposition variability in adult female lungs: A numerical simulation pilot study. Clin Biomech (Bristol, Avon) 2019; 66:40-49. [PMID: 29395490 DOI: 10.1016/j.clinbiomech.2017.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/18/2017] [Accepted: 12/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the promise of respiratory simulations improving diagnosis and treatment of pulmonary diseases, model predictions have yet to be translated into the clinical setting. Current state-of-the-art in silico models have not yet incorporated subject variability in their predictions of airflow distributions and extent of deposited particles. Until inter-subject variability is accounted for in lung modeling, it will remain impossible to translate model predictions into clinical practice. METHODS Airflow and particle trajectories (dp=1,3,5μm) are calculated in three subject-specific female adults by performing physiologically-based simulations. The computation framework features the ability to track air and particles throughout the respiration cycle and in the entire lung. Airway resistances, air velocities, and local deposition sites are correlated to airway anatomical features. FINDINGS Smaller airway diameters are correlated to larger airway resistances and pressure gradients in one subject compared to the other two. Irregular shape of the airway and flow direction (e.g. inspiration or expiration) correspond with peak velocities and secondary flow motions. Largest subject variability in deposition between conducting and respiratory zones is seen for 1 μm diameter particles. Little difference in total deposition is found among subjects. Localized deposited particle concentration hotspots are linked to airway anatomy and flow motion. INTERPRETATION Simulation predictions provide a first look into the correlation of anatomical features with airflow characteristics and deposited particle concentrations. Global deposition percentages ranged (at most, by 20%) between subjects and variances in localized deposition hotspots are correlated to variances in flow characteristics.
Collapse
Affiliation(s)
- Kamran Poorbahrami
- Department of Mechanical and Industrial Engineering, Northeastern University, USA.
| | | |
Collapse
|
10
|
Kwok PCL, Wallin M, Dolovich MB, Chan HK. Studies of Radioaerosol Deposition in the Respiratory Tract. Semin Nucl Med 2019; 49:62-70. [PMID: 30545519 DOI: 10.1053/j.semnuclmed.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deposition of aerosols in the respiratory tract can be quantitatively and qualitatively studied by scintigraphy. The most commonly used radionuclide for this purpose is technetium-99m. The effects of various factors on particle deposition have been investigated by using radiolabeled aerosols in the past decade. Most of these studies were in vivo but some were in vitro or ex vivo. The factors examined include particle size, formulation, inhaler design, inhalation flowrate, body posture, and gravity. They have been shown to influence pulmonary deposition, nasal high flow nebulization, and intranasal delivery. A thorough understanding of the various factors is required for the advancement of respiratory-drug delivery. Scintigraphy is a powerful technique that can assist in this regard.
Collapse
Affiliation(s)
- Philip Chi Lip Kwok
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Martin Wallin
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Myrna B Dolovich
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Hak-Kim Chan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
11
|
Longest PW, Bass K, Dutta R, Rani V, Thomas ML, El-Achwah A, Hindle M. Use of computational fluid dynamics deposition modeling in respiratory drug delivery. Expert Opin Drug Deliv 2019; 16:7-26. [PMID: 30463458 PMCID: PMC6529297 DOI: 10.1080/17425247.2019.1551875] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Respiratory drug delivery is a surprisingly complex process with a number of physical and biological challenges. Computational fluid dynamics (CFD) is a scientific simulation technique that is capable of providing spatially and temporally resolved predictions of many aspects related to respiratory drug delivery from initial aerosol formation through respiratory cellular drug absorption. AREAS COVERED This review article focuses on CFD-based deposition modeling applied to pharmaceutical aerosols. Areas covered include the development of new complete-airway CFD deposition models and the application of these models to develop a next-generation of respiratory drug delivery strategies. EXPERT OPINION Complete-airway deposition modeling is a valuable research tool that can improve our understanding of pharmaceutical aerosol delivery and is already supporting medical hypotheses, such as the expected under-treatment of the small airways in asthma. These complete-airway models are also being used to advance next-generation aerosol delivery strategies, like controlled condensational growth. We envision future applications of CFD deposition modeling to reduce the need for human subject testing in developing new devices and formulations, to help establish bioequivalence for the accelerated approval of generic inhalers, and to provide valuable new insights related to drug dissolution and clearance leading to microdosimetry maps of drug absorption.
Collapse
Affiliation(s)
- P. Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Karl Bass
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Rabijit Dutta
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Vijaya Rani
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Morgan L. Thomas
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Ahmad El-Achwah
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
12
|
Ventilation/perfusion SPECT/CT in patients with severe and rigid scoliosis: An evaluation by relationship to spinal deformity and lung function. Clin Neurol Neurosurg 2018; 176:97-102. [PMID: 30553172 DOI: 10.1016/j.clineuro.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Structural changes of the spine and chest wall associated with SRS result in poor cardiopulmonary function. Comprehensive assessment of pulmonary function is extremely important for patients with SRS before a correction operation. We explore the changes of distribution of lung ventilation and perfusion function in patients with SRS using SPECT/CT and describe the relation between these changes with Cobb angle and FVC%. PATIENTS AND METHODS From March 2015 to August 2016, 16 consecutive SRS patients with a mean age of 20.1 years(range 11-36 years) were included in the study. Scoliotic parameters on radiographs were analyzed. FVC% were obtained by spirometry test. Lungs ventilation/perfusion single photon emission computed tomography scans was performed preoperatively in all patients to explore pulmonary ventilation and perfusion function changes. These changes were measured as the deviation form the normal perfusion and ventilation function distribution in right and left lung and correlated with the Cobb angle of main curve and FVC%. RESULTS The regional lung ventilation and perfusion function defects were not found in all SRS patients. Ventilation function deviation was a mean 5.7%(range, -3.6% to 10.1%), significantly less than perfusion function deviation of 8.2%(range, -0.3% to 22.2%) (P = 0.015, t = -2.732). Lung ventilation and/or perfusion function deviation did not correlated with Cobb angle and FVC%, respectively. There was significant correlation between lungs ventilation and perfusion function deviation(P = 0.001, r = 0.753). CONCLUSION The ventilation and perfusion function distribution were favourable in convex and concave side lung of SRS. Deformity bring about greater lungs perfusion function changes than ventilation function. The measurement of lung ventilation and perfusion function changes may represents an additional functional feature to assess pulmonary function of SRS more comprehensively.
Collapse
|
13
|
Dugernier J, Ehrmann S, Sottiaux T, Roeseler J, Wittebole X, Dugernier T, Jamar F, Laterre PF, Reychler G. Aerosol delivery during invasive mechanical ventilation: a systematic review. Crit Care 2017; 21:264. [PMID: 29058607 PMCID: PMC5651640 DOI: 10.1186/s13054-017-1844-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review aimed to assess inhaled drug delivery in mechanically ventilated patients or in animal models. Whole lung and regional deposition and the impact of the ventilator circuit, the artificial airways and the administration technique for aerosol delivery were analyzed. METHODS In vivo studies assessing lung deposition during invasive mechanical ventilation were selected based on a systematic search among four databases. Two investigators independently assessed the eligibility and the risk of bias. RESULTS Twenty-six clinical and ten experimental studies were included. Between 30% and 43% of nominal drug dose was lost to the circuit in ventilated patients. Whole lung deposition of up to 16% and 38% of nominal dose (proportion of drug charged in the device) were reported with nebulizers and metered-dose inhalers, respectively. A penetration index inferior to 1 observed in scintigraphic studies indicated major proximal deposition. However, substantial concentrations of antibiotics were measured in the epithelial lining fluid (887 (406-12,819) μg/mL of amikacin) of infected patients and in sub-pleural specimens (e.g., 197 μg/g of amikacin) dissected from infected piglets, suggesting a significant distal deposition. The administration technique varied among studies and may explain a degree of the variability of deposition that was observed. CONCLUSIONS Lung deposition was lower than 20% of nominal dose delivered with nebulizers and mostly occurred in proximal airways. Further studies are needed to link substantial concentrations of antibiotics in infected pulmonary fluids to pulmonary deposition. The administration technique with nebulizers should be improved in ventilated patients in order to ensure an efficient but safe, feasible and reproducible technique.
Collapse
Affiliation(s)
- Jonathan Dugernier
- Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. .,Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. .,Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Stephan Ehrmann
- Université François Rabelais, UMR 1100, F-37032, Tours, France.,INSERM, Centre d'étude des Pathologies Respiratoires, UMR 1100, F-37032, Tours, France.,CHRU de Tours, Réanimation polyvalente, F-37044, Tours, France
| | - Thierry Sottiaux
- Soins Intensifs, Clinique Notre-Dame de Grace, Chaussée de Nivelles 212, 6041, Charleroi, Belgium
| | - Jean Roeseler
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Xavier Wittebole
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Dugernier
- Soins Intensifs, Clinique Saint-Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium
| | - François Jamar
- Médecine Nucléaire, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Pierre-François Laterre
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Pneumologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| |
Collapse
|
14
|
van der Wiel E, Lexmond AJ, van den Berge M, Postma DS, Hagedoorn P, Frijlink HW, Farenhorst MP, de Boer AH, Ten Hacken NHT. Targeting the small airways with dry powder adenosine: a challenging concept. Eur Clin Respir J 2017; 4:1369328. [PMID: 29057065 PMCID: PMC5642194 DOI: 10.1080/20018525.2017.1369328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 12/04/2022] Open
Abstract
Background: Small-particle inhaled corticosteroids (ICS) provide a higher small airway deposition than large-particle ICS. However, we are still not able to identify asthma patients who will profit most from small-particle treatment. Objective: We aimed to identify these patients by selectively challenging the small and large airways. We hypothesized that the airways could be challenged selectively using small- and large-particle adenosine, both inhaled at a high and a low flow rate. Design: In this cross-over study 11 asthma subjects performed four dry powder adenosine tests, with either small (MMAD 2.7 µm) or large (MMAD 6.0 µm) particles, inhaled once with a low flow rate (30 l min–1) and once with a high flow rate (60 l min–1). Spirometry and impulse oscillometry were performed after every bronchoprovocation step. We assumed that FEV1 reflects the large airways, and FEF25–75%, R5-R20 and X5 reflect the small airways. Results: The four adenosine tests were not significantly different with respect to the threshold values of FEV1 (p = 0.12), FEF25–75% (p = 0.37), R5-R20 (p = 0.60) or X5 (p = 0.46). Both small- and large-particle adenosine induced a response in the small airways in the majority of the tests. Conclusions: In contrast to our hypothesis, all four adenosine tests provoked a response in the small airways and we could not identify different large- or small-airway responders. Interestingly, even the test with large particles and a high flow rate induced a small-airway response, suggesting that selective challenging of the small airways is not necessary. Future studies should investigate the relation between particle deposition and the site of an airway response.
Collapse
Affiliation(s)
- Erica van der Wiel
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne J Lexmond
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Maarten van den Berge
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirkje S Postma
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Martijn P Farenhorst
- Lung Function Department, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne H de Boer
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Nick H T Ten Hacken
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
15
|
Dugernier J, Hesse M, Jumetz T, Bialais E, Roeseler J, Depoortere V, Michotte JB, Wittebole X, Ehrmann S, Laterre PF, Jamar F, Reychler G. Aerosol Delivery with Two Nebulizers Through High-Flow Nasal Cannula: A Randomized Cross-Over Single-Photon Emission Computed Tomography-Computed Tomography Study. J Aerosol Med Pulm Drug Deliv 2017; 30:349-358. [PMID: 28463044 DOI: 10.1089/jamp.2017.1366] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High-flow nasal cannula use is developing in ICUs. The aim of this study was to compare aerosol efficiency by using two nebulizers through a high-flow nasal cannula: the most commonly used jet nebulizer (JN) and a more efficient vibrating-mesh nebulizer (VN). METHODS Aerosol delivery of diethylenetriaminepentaacetic acid labeled with technetium-99m (4 mCi/4 mL) to the lungs by using a VN (Aerogen Solo®; Aerogen Ltd., Galway, Ireland) and a constant-output JN (Opti-Mist Plus Nebulizer®; ConvaTec, Bridgewater, NJ) through a high-flow nasal cannula (Optiflow®; Fisher & Paykel, New Zealand) was compared in six healthy subjects. Flow rate was set at 30 L/min through the heated humidified circuit. Pulmonary and extrapulmonary deposition was measured by single-photon emission computed tomography combined with a low-dose computed tomographic scan and by planar scintigraphy. RESULTS Lung deposition was only 3.6 (2.1-4.4) and 1 (0.7-2)% of the nominal dose with the VN and the JN, respectively (p < 0.05). The JN showed higher retained doses than the VN. However, both nebulizers were associated with substantial deposition in the single limb circuit, the humidification chamber, and the nasal cannula [58.2 (51.6-61.6)% of the nominal dose with the VN versus 19.2 (15.8-22.9)% of the nominal dose with the JN, p < 0.05] and in the upper respiratory tract [17.6 (13.4-27.9)% of the nominal dose with the VN and 8.6 (6.0-11.0)% of the nominal dose with the JN, p < 0.05], especially in the nasal cavity. CONCLUSIONS In the specific conditions of the study, pulmonary drug delivery through the high-flow nasal cannula is about 1%-4% of the initial amount of drugs placed in the nebulizer, despite the higher efficiency of the VN as compared with the JN.
Collapse
Affiliation(s)
- Jonathan Dugernier
- 1 Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL and Dermatologie, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,2 Soins Intensifs, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,3 Médecine Physique, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Michel Hesse
- 4 Médecine Nucléaire, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | | | - Emilie Bialais
- 1 Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL and Dermatologie, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,2 Soins Intensifs, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,3 Médecine Physique, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Jean Roeseler
- 2 Soins Intensifs, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Virginie Depoortere
- 4 Médecine Nucléaire, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Jean-Bernard Michotte
- 5 Haute Ecole de Santé Vaud, Filière Physiothérapie, University of Applied Sciences and Arts Western Switzerland , Lausanne, Switzerland
| | - Xavier Wittebole
- 2 Soins Intensifs, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Stephan Ehrmann
- 6 Université François Rabelais , Tours, France .,7 INSERM, Centre d'étude des Pathologies Respiratoires , Tours, France .,8 CHRU de Tours, Réanimation Polyvalente , Tours, France
| | | | - François Jamar
- 4 Médecine Nucléaire, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| | - Gregory Reychler
- 1 Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL and Dermatologie, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,3 Médecine Physique, Cliniques Universitaires Saint-Luc , Brussels, Belgium .,9 Pneumologie, Cliniques Universitaires Saint-Luc , Brussels, Belgium
| |
Collapse
|
16
|
Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes: a systematic literature review and meta-analysis. BMC Pulm Med 2017; 17:31. [PMID: 28173781 PMCID: PMC5294816 DOI: 10.1186/s12890-016-0348-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Inhaled corticosteroids (ICS) are the primary treatment for persistent asthma. Currently available ICS have differing particle size due to both formulation and propellant, and it has been postulated that this may impact patient outcomes. This structured literature review and meta-analysis compared the effect of small and standard particle size ICS on lung function, symptoms, rescue use (when available) and safety in patients with asthma as assessed in head-to-head randomized controlled trials (RCTs). Methods A systematic literature search of MEDLINE was performed to identify RCTs (1998–2014) evaluating standard size (fluticasone propionate-containing medications) versus small particle size ICS medication in adults and children with asthma. Efficacy outcomes included forced expiratory volume in 1 s (FEV1), morning peak expiratory flow (PEF), symptom scores, % predicted forced expiratory flow between 25 and 75% of forced vital capacity (FEF25–75%), and rescue medication use. Safety outcomes were also evaluated when available. Results Twenty-three independent trials that met the eligibility criteria were identified. Benefit-risk plots did not demonstrate any clinically meaningful differences across the five efficacy endpoints considered and no appreciable differences were noted for most safety endpoints. Meta-analysis results, using a random-effects model, demonstrated no significant difference between standard and small size particle ICS medications in terms of effects on mean change from baseline FEV1 (L) (−0.011, 95% confidence interval [CI]: −0.037, 0.014 [N = 3524]), morning PEF (L/min) (medium/low doses: −3.874, 95% CI: −10.915, 3.166 [N = 1911]; high/high-medium doses: 5.551, 95% CI: −1.948, 13.049 [N = 749]) and FEF25–75% predicted (−2.418, 95% CI: −6.400; 1.564 [N = 115]). Conclusions Based on the available literature, no clinically significant differences in efficacy or safety were observed comparing small and standard particle size ICS medications for the treatment of asthma. Trial registration GSK Clinical Study Register No: 202012.
Collapse
|
17
|
Montesantos S, Katz I, Pichelin M, Caillibotte G. The Creation and Statistical Evaluation of a Deterministic Model of the Human Bronchial Tree from HRCT Images. PLoS One 2016; 11:e0168026. [PMID: 27977730 PMCID: PMC5157997 DOI: 10.1371/journal.pone.0168026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/25/2016] [Indexed: 02/03/2023] Open
Abstract
A quantitative description of the morphology of lung structure is essential prior to any form of predictive modeling of ventilation or aerosol deposition implemented within the lung. The human lung is a very complex organ, with airway structures that span two orders of magnitude and having a multitude of interfaces between air, tissue and blood. As such, current medical imaging protocols cannot provide medical practitioners and researchers with in-vivo knowledge of deeper lung structures. In this work a detailed algorithm for the generation of an individualized 3D deterministic model of the conducting part of the human tracheo-bronchial tree is described. Distinct initial conditions were obtained from the high-resolution computed tomography (HRCT) images of seven healthy volunteers. The algorithm developed is fractal in nature and is implemented as a self-similar space sub-division procedure. The expansion process utilizes physiologically realistic relationships and thresholds to produce an anatomically consistent human airway tree. The model was validated through extensive statistical analysis of the results and comparison of the most common morphological features with previously published morphometric studies and other equivalent models. The resulting trees were shown to be in good agreement with published human lung geometric characteristics and can be used to study, among other things, structure-function relationships in simulation studies.
Collapse
Affiliation(s)
| | - Ira Katz
- Medical R&D, Air Liquide Santé International, Paris Saclay, France
- Department of Mechanical Engineering, Lafayette College, Easton, PA, United States of America
| | - Marine Pichelin
- Medical R&D, Air Liquide Santé International, Paris Saclay, France
| | | |
Collapse
|
18
|
Verbanck S, Ghorbaniasl G, Biddiscombe MF, Dragojlovic D, Ricks N, Lacor C, Ilsen B, de Mey J, Schuermans D, Underwood SR, Barnes PJ, Vincken W, Usmani OS. Inhaled Aerosol Distribution in Human Airways: A Scintigraphy-Guided Study in a 3D Printed Model. J Aerosol Med Pulm Drug Deliv 2016; 29:525-533. [DOI: 10.1089/jamp.2016.1291] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ghader Ghorbaniasl
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Martyn F. Biddiscombe
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
- Nuclear Medicine Department, Royal Brompton Hospital, London, United Kingdom
| | - Dusica Dragojlovic
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nathan Ricks
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Chris Lacor
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Ilsen
- Radiology Department, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan de Mey
- Radiology Department, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Peter J. Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Omar S. Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
19
|
SPECT-CT Comparison of Lung Deposition using a System combining a Vibrating-mesh Nebulizer with a Valved Holding Chamber and a Conventional Jet Nebulizer: a Randomized Cross-over Study. Pharm Res 2016; 34:290-300. [PMID: 27822851 DOI: 10.1007/s11095-016-2061-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare in vivo the total and regional pulmonary deposition of aerosol particles generated by a new system combining a vibrating-mesh nebulizer with a specific valved holding chamber and constant-output jet nebulizer connected to a corrugated tube. METHODS Cross-over study comparing aerosol delivery to the lungs using two nebulizers in 6 healthy male subjects: a vibrating-mesh nebulizer combined with a valved holding chamber (Aerogen Ultra®, Aerogen Ltd., Galway, Ireland) and a jet nebulizer connected to a corrugated tube (Opti-Mist Plus Nebulizer®, ConvaTec, Bridgewater, NJ). Nebulizers were filled with diethylenetriaminepentaacetic acid labelled with technetium-99 m (99mTc-DTPA, 2 mCi/4 mL). Pulmonary deposition of 99mTc-DTPA was measured by single-photon emission computed tomography combined with a low dose CT-scan (SPECT-CT). RESULTS Pulmonary aerosol deposition from SPECT-CT analysis was six times increased with the vibrating-mesh nebulizer as compared to the jet nebulizer (34.1 ± 6.0% versus 5.2 ± 1.1%, p < 0.001). However, aerosol penetration expressed as the three-dimensional normalized ratio of the outer and the inner regions of the lungs was similar between both nebulizers. CONCLUSIONS This study demonstrated the high superiority of the new system combining a vibrating-mesh nebulizer with a valved holding chamber to deliver nebulized particles into the lungs as comparted to a constant-output jet nebulizer with a corrugated tube.
Collapse
|
20
|
Kolanjiyil AV, Kleinstreuer C, Sadikot RT. Computationally efficient analysis of particle transport and deposition in a human whole-lung-airway model. Part II: Dry powder inhaler application. Comput Biol Med 2016; 84:247-253. [PMID: 27836120 DOI: 10.1016/j.compbiomed.2016.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/04/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
Pulmonary drug delivery is becoming a favored route for administering drugs to treat both lung and systemic diseases. Examples of lung diseases include asthma, cystic fibrosis and chronic obstructive pulmonary disease (COPD) as well as respiratory distress syndrome (ARDS) and pulmonary fibrosis. Special respiratory drugs are administered to the lungs, using an appropriate inhaler device. Next to the pressurized metered-dose inhaler (pMDI), the dry powder inhaler (DPI) is a frequently used device because of the good drug stability and a minimal need for patient coordination. Specific DPI-designs and operations greatly affect drug-aerosol formation and hence local lung deposition. Simulating the fluid-particle dynamics after use of a DPI allows for the assessment of drug-aerosol deposition and can also assist in improving the device configuration and operation. In Part I of this study a first-generation whole lung-airway model (WLAM) was introduced and discussed to analyze particle transport and deposition in a human respiratory tract model. In the present Part II the drug-aerosols are assumed to be injected into the lung airways from a DPI mouth-piece, forming the mouth-inlet. The total as well as regional particle depositions in the WLAM, as inhaled from a DPI, were successfully compared with experimental data sets reported in the open literature. The validated modeling methodology was then employed to study the delivery of curcumin aerosols into lung airways using a commercial DPI. Curcumin has been implicated to possess high therapeutic potential as an antioxidant, anti-inflammatory and anti-cancer agent. However, efficacy of curcumin treatment is limited because of the low bioavailability of curcumin when ingested. Hence, alternative drug administration techniques, e.g., using inhalable curcumin-aerosols, are under investigation. Based on the present results, it can be concluded that use of a DPI leads to low lung deposition efficiencies because large amounts of drugs are deposited in the oral cavity. Hence, the output of a modified DPI has been evaluated to achieve improved drug delivery, especially needed when targeting the smaller lung airways. This study is the first to utilize CF-PD methodology to simulate drug-aerosol transport and deposition under actual breathing conditions in a whole lung model, using a commercial dry-powder inhaler for realistic inlet conditions.
Collapse
Affiliation(s)
- Arun V Kolanjiyil
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, United States
| | - Clement Kleinstreuer
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, United States; Joint UNC-NCSU Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695-7910, United States.
| | - Ruxana T Sadikot
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, School of Medicine, United States; Department of Veterans Affairs, Atlanta VAMC, United States
| |
Collapse
|
21
|
Kolanjiyil AV, Kleinstreuer C. Computationally efficient analysis of particle transport and deposition in a human whole-lung-airway model. Part I: Theory and model validation. Comput Biol Med 2016; 79:193-204. [PMID: 27810625 DOI: 10.1016/j.compbiomed.2016.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 01/18/2023]
Abstract
Computational predictions of aerosol transport and deposition in the human respiratory tract can assist in evaluating detrimental or therapeutic health effects when inhaling toxic particles or administering drugs. However, the sheer complexity of the human lung, featuring a total of 16 million tubular airways, prohibits detailed computer simulations of the fluid-particle dynamics for the entire respiratory system. Thus, in order to obtain useful and efficient particle deposition results, an alternative modeling approach is necessary where the whole-lung geometry is approximated and physiological boundary conditions are implemented to simulate breathing. In Part I, the present new whole-lung-airway model (WLAM) represents the actual lung geometry via a basic 3-D mouth-to-trachea configuration while all subsequent airways are lumped together, i.e., reduced to an exponentially expanding 1-D conduit. The diameter for each generation of the 1-D extension can be obtained on a subject-specific basis from the calculated total volume which represents each generation of the individual. The alveolar volume was added based on the approximate number of alveoli per generation. A wall-displacement boundary condition was applied at the bottom surface of the first-generation WLAM, so that any breathing pattern due to the negative alveolar pressure can be reproduced. Specifically, different inhalation/exhalation scenarios (rest, exercise, etc.) were implemented by controlling the wall/mesh displacements to simulate realistic breathing cycles in the WLAM. Total and regional particle deposition results agree with experimental lung deposition results. The outcomes provide critical insight to and quantitative results of aerosol deposition in human whole-lung airways with modest computational resources. Hence, the WLAM can be used in analyzing human exposure to toxic particulate matter or it can assist in estimating pharmacological effects of administered drug-aerosols. As a practical WLAM application, the transport and deposition of asthma drugs from a commercial dry-powder inhaler is discussed in Part II.
Collapse
Affiliation(s)
- Arun V Kolanjiyil
- Department of Mechanical & Aerospace Engineering, North Carolina State University Raleigh, NC 27695, USA
| | - Clement Kleinstreuer
- Department of Mechanical & Aerospace Engineering, North Carolina State University Raleigh, NC 27695, USA; Joint UNC-NCSU Department of Biomedical Engineering, North Carolina State University Raleigh, NC 27695, USA.
| |
Collapse
|
22
|
Dugernier J, Reychler G, Wittebole X, Roeseler J, Depoortere V, Sottiaux T, Michotte JB, Vanbever R, Dugernier T, Goffette P, Docquier MA, Raftopoulos C, Hantson P, Jamar F, Laterre PF. Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study. Ann Intensive Care 2016; 6:73. [PMID: 27447788 PMCID: PMC4958090 DOI: 10.1186/s13613-016-0169-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volume-controlled ventilation has been suggested to optimize lung deposition during nebulization although promoting spontaneous ventilation is targeted to avoid ventilator-induced diaphragmatic dysfunction. Comparing topographic aerosol lung deposition during volume-controlled ventilation and spontaneous ventilation in pressure support has never been performed. The aim of this study was to compare lung deposition of a radiolabeled aerosol generated with a vibrating-mesh nebulizer during invasive mechanical ventilation, with two modes: pressure support ventilation and volume-controlled ventilation. METHODS Seventeen postoperative neurosurgery patients without pulmonary disease were randomly ventilated in pressure support or volume-controlled ventilation. Diethylenetriaminepentaacetic acid labeled with technetium-99m (2 mCi/3 mL) was administrated using a vibrating-mesh nebulizer (Aerogen Solo(®), provided by Aerogen Ltd, Galway, Ireland) connected to the endotracheal tube. Pulmonary and extrapulmonary particles deposition was analyzed using planar scintigraphy. RESULTS Lung deposition was 10.5 ± 3.0 and 15.1 ± 5.0 % of the nominal dose during pressure support and volume-controlled ventilation, respectively (p < 0.05). Higher endotracheal tube and tracheal deposition was observed during pressure support ventilation (27.4 ± 6.6 vs. 20.7 ± 6.0 %, p < 0.05). A similar penetration index was observed for the right (p = 0.210) and the left lung (p = 0.211) with both ventilation modes. A high intersubject variability of lung deposition was observed with both modes regarding lung doses, aerosol penetration and distribution between the right and the left lung. CONCLUSIONS In the specific conditions of the study, volume-controlled ventilation was associated with higher lung deposition of nebulized particles as compared to pressure support ventilation. The clinical benefit of this effect warrants further studies. Clinical trial registration NCT01879488.
Collapse
Affiliation(s)
- Jonathan Dugernier
- Soins Intensifs, Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. .,Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Université catholique de Louvain, 1200, Brussels, Belgium.
| | - Gregory Reychler
- Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Université catholique de Louvain, 1200, Brussels, Belgium
| | - Xavier Wittebole
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Jean Roeseler
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Virginie Depoortere
- Médecine Nucléaire, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Sottiaux
- Soins Intensifs, Clinique Notre-Dame de Grâce, Chaussée de Nivelles 212, Gosselies, Belgium
| | - Jean-Bernard Michotte
- Haute Ecole de Santé Vaud, Filière physiothérapie, University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland
| | - Rita Vanbever
- Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Dugernier
- Soins Intensifs, Clinique Saint-Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium
| | - Pierre Goffette
- Radiologie Interventionnelle, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Marie-Agnes Docquier
- Anesthésiologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Christian Raftopoulos
- Neurochirurgie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Philippe Hantson
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - François Jamar
- Médecine Nucléaire, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Pierre-François Laterre
- Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| |
Collapse
|
23
|
Youngren-Ortiz SR, Gandhi NS, España-Serrano L, Chougule MB. Aerosol Delivery of siRNA to the Lungs. Part 1: Rationale for Gene Delivery Systems. KONA : POWDER SCIENCE AND TECHNOLOGY IN JAPAN 2016; 33:63-85. [PMID: 27081214 PMCID: PMC4829385 DOI: 10.14356/kona.2016014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This article reviews the pulmonary route of administration, aerosol delivery devices, characterization of pulmonary drug delivery systems, and discusses the rationale for inhaled delivery of siRNA. Diseases with known protein malfunctions may be mitigated through the use of siRNA therapeutics. The inhalation route of administration provides local delivery of siRNA therapeutics for the treatment of various pulmonary diseases, however barriers to pulmonary delivery and intracellular delivery of siRNA exists. siRNA loaded nanocarriers can be used to overcome the barriers associated with the pulmonary route, such as anatomical barriers, mucociliary clearance, and alveolar macrophage clearance. Apart from naked siRNA aerosol delivery, previously studied siRNA carrier systems comprise of lipidic, polymeric, peptide, or inorganic origin. Such siRNA delivery systems formulated as aerosols can be successfully delivered via an inhaler or nebulizer to the pulmonary region. Preclinical animal investigations of inhaled siRNA therapeutics rely on intratracheal and intranasal siRNA and siRNA nanocarrier delivery. Aerosolized siRNA delivery systems may be characterized using in vitro techniques, such as dissolution test, inertial cascade impaction, delivered dose uniformity assay, laser diffraction, and laser Doppler velocimetry. The ex vivo techniques used to characterize pulmonary administered formulations include the isolated perfused lung model. In vivo techniques like gamma scintigraphy, 3D SPECT, PET, MRI, fluorescence imaging and pharmacokinetic/pharmacodynamics analysis may be used for evaluation of aerosolized siRNA delivery systems. The use of inhalable siRNA delivery systems encounters barriers to their delivery, however overcoming the barriers while formulating a safe and effective delivery system will offer unique advances to the field of inhaled medicine.
Collapse
Affiliation(s)
- Susanne R. Youngren-Ortiz
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, Hawaii 96720, USA
| | - Nishant S. Gandhi
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, Hawaii 96720, USA
| | - Laura España-Serrano
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, Hawaii 96720, USA
| | - Mahavir B. Chougule
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, Hawaii 96720, USA
- Natural Products and Experimental Therapeutics Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii 96813, USA
| |
Collapse
|
24
|
Fleming J, Conway J, Majoral C, Katz I, Caillibotte G, Pichelin M, Montesantos S, Bennett M. Controlled, Parametric, Individualized, 2-D and 3-D Imaging Measurements of Aerosol Deposition in the Respiratory Tract of Asthmatic Human Subjects for Model Validation. J Aerosol Med Pulm Drug Deliv 2015; 28:432-51. [PMID: 25859710 DOI: 10.1089/jamp.2014.1191] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Computer modeling is used to predict inhaled aerosol deposition in the lung based on definition of the aerosol characteristics and the breathing pattern and airway anatomy of the subject. Validation of the models is limited by the lack of detailed experimental data. Three-dimensional imaging provides an opportunity to address this unmet need. METHODS Radioactive aerosol was administered to six male asthmatic subjects on two occasions under carefully monitored input conditions. Input parameters varied in particle size, depth of breathing, and carrier gas. The aerosol distribution was measured by combined single photon emission computed tomography and x-ray computer tomography (SPECT/CT) and airway anatomy by high resolution CT. The deposition distribution was measured by both a 2D and 3D analysis and described in terms of the percentage of inhaled aerosol deposited in sections of the respiratory tract and in both spatial and anatomical subdivisions within each lung. The percentage deposition in the conducting airways was also assessed by 24 h clearance. RESULTS A set of imaging data of aerosol deposition has thus been produced in which the input parameters of inhalation are well described. The results in asthmatics were compared to previous measurements in healthy controls using an identical inhalation protocol. The percentages of deposition in extra-thoracic and thoracic compartments of the airways were not significantly affected by disease, but the regional pulmonary deposition pattern was, with asthma leading to increased deposition in the conducting airways. CONCLUSIONS The dataset acquired in this study will be useful in validating computer models of aerosol deposition in asthmatic subjects. Asthma did not affect the fraction of inhaled aerosol depositing in the lungs, but gave rise to a more central deposition pattern. The use of 3D SPECT imaging in combination with 24 h clearance measurements enables differentiation of deposition between bronchial and bronchiolar airways.
Collapse
Affiliation(s)
- John Fleming
- 1 National Institute of Health Research Biomedical Research Unit in Respiratory Disease , Southampton, United Kingdom .,2 Department of Medical Physics and Bioengineering, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom .,4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France
| | - Joy Conway
- 1 National Institute of Health Research Biomedical Research Unit in Respiratory Disease , Southampton, United Kingdom .,3 Faculty of Health Sciences, University of Southampton , Southampton, United Kingdom
| | - Caroline Majoral
- 4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France
| | - Ira Katz
- 4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France .,5 Department of Mechanical Engineering, Lafayette College , Easton, Pennsylvania
| | - Georges Caillibotte
- 4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France
| | - Marine Pichelin
- 4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France
| | - Spyridon Montesantos
- 4 Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center , Les Loges-en-Josas, France
| | - Michael Bennett
- 1 National Institute of Health Research Biomedical Research Unit in Respiratory Disease , Southampton, United Kingdom
| |
Collapse
|
25
|
Oakes JM, Breen EC, Scadeng M, Tchantchou GS, Darquenne C. MRI-based measurements of aerosol deposition in the lung of healthy and elastase-treated rats. J Appl Physiol (1985) 2014; 116:1561-8. [PMID: 24790020 PMCID: PMC4064380 DOI: 10.1152/japplphysiol.01165.2013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aerosolized drugs are increasingly being used to treat chronic lung diseases or to deliver therapeutics systemically through the lung. The influence of disease, such as emphysema, on particle deposition is not fully understood. With the use of magnetic resonance imaging (MRI), the deposition pattern of iron oxide particles with a mass median aerodynamic diameter of 1.2 μm was assessed in the lungs of healthy and elastase-treated rats. Tracheostomized rats were ventilated with particles, at a tidal volume of 2.2 ml, and a breathing frequency of 80 breaths/min. Maximum airway pressure was significantly lower in the elastase-treated (Paw = 7.71 ± 1.68 cmH2O) than in the healthy rats (Paw = 10.43 ± 1.02 cmH2O; P < 0.01). This is consistent with an increase in compliance characteristic of an emphysema-like lung structure. Following exposure, lungs were perfusion fixed and imaged in a 3T MR scanner. Particle concentration in the different lobes was determined based on a relationship with the MR signal decay rate, R2*. Whole lung particle deposition was significantly higher in the elastase-treated rats (CE,part = 3.03 ± 0.61 μm/ml) compared with the healthy rats (CH,part = 1.84 ± 0.35 μm/ml; P < 0.01). However, when particle deposition in each lobe was normalized by total deposition in the lung, there was no difference between the experimental groups. However, the relative dispersion [RD = standard deviation/mean] of R2* was significantly higher in the elastase-treated rats (RDE = 0.32 ± 0.02) compared with the healthy rats (RDH = 0.25 ± 0.02; P < 0.01). These data show that particle deposition is higher and more heterogeneously distributed in emphysematous lungs compared with healthy lungs.
Collapse
Affiliation(s)
- Jessica M Oakes
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, California
| | - Ellen C Breen
- Department of Medicine, Division of Physiology, University of California, San Diego, California
| | - Miriam Scadeng
- Department of Radiology, University of California, San Diego, California; and
| | | | - Chantal Darquenne
- Department of Medicine, Division of Physiology, University of California, San Diego, California;
| |
Collapse
|