Prediction of Aerosol Deposition in the Human Respiratory Tract via Computational Models: A Review with Recent Updates

Pulmonary Delivery of Antibiotics to the Lungs: Current State and Future Prospects

This paper presents a comprehensive review of the current literature, clinical trials, and products approved for the delivery of antibiotics to the lungs. While there are many literature reports describing potential delivery systems, few of these have translated into marketed products. Key challenges remaining are the high doses required and, for powder formulations, the ability of the inhaler and powder combination to deliver the dose to the correct portion of the respiratory tract for maximum effect. Side effects, safety concerns, and disappointing clinical trial results remain barriers to regulatory approval. In this review, we describe some possible approaches to address these issues and highlight prospects in this area.

Multi-scale modeling of aerosol transport in a mouth-to-truncated bronchial tree system

Computational fluid particle dynamics (CFPD) is widely employed to predict aerosol transport in a truncated bronchial tree model on account of its capacity to reveal details of flow field and particle movement. However, setting a physiologically consistent boundary condition in the CFPD for the idealized or image-based truncated bronchial tree model is still a challenge. This paper proposes a multi-scale modeling method, which contains an Extend-Bronchial tree-Network (EBN) boundary condition for a mouth-to-truncated bronchi system. The comparison between EBN boundary condition and a commonly used uniform pressure (UP) boundary condition is conducted. Subsequently, EBN method is used to study the nano-micron (100 nm-10 μm) particles transport in the mouth-to-truncated bronchi model at different inhalation volume rates (15, 60, 90 L/min). Results show that EBN method is more physiologically rational and two methods differ in flow distribution in lobes, vortex structure, and particle transport. The maximum difference in flow rate distribution in lobes between two methods is about 20 %, while the maximum relative disparity of particle penetration fraction from lobes and deposition fraction in the TLB is about 93 % and 30 %, respectively. Meanwhile, this paper reveals the variation of deposition fraction and penetration fraction with the changes in particle diameter and inhalation volume. Deposition efficiency, deposition hotspots and deposition mechanism are also analyzed with inlet Stokes number (Stk) and Reynolds number (Re). This research establishes a foundation for the simulation of aerosol transport in a whole respiratory tract and provides references for inhalation drug delivery and air pollutant management.

A quasi-realistic computational model development and flow field study of the human upper and central airways

The impact of drug delivery and particulate matter exposure on the human respiratory tract is influenced by various anatomical and physiological factors, particularly the structure of the respiratory tract and its fluid dynamics. This study employs computational fluid dynamics (CFD) to investigate airflow in two 3D models of the human air conducting zone. The first model uses a combination of CT-scan images and geometrical data from human cadaver to extract the upper and central airways down to the ninth generation, while the second model develops the lung airways from the first Carina to the end of the ninth generation using Kitaoka's deterministic algorithm. The study examines the differences in geometrical characteristics, airflow rates, velocity, Reynolds number, and pressure drops of both models in the inhalation and exhalation phases for different lobes and generations of the airways. From trachea to the ninth generation, the average air flowrates and Reynolds numbers exponentially decay in both models during inhalation and exhalation. The steady drop is the case for the average air velocity in Kitaoka's model, while that experiences a maximum in the 3rd or 4th generation in the quasi-realistic model. Besides, it is shown that the flow field remains laminar in the upper and central airways up to the total flow rate of 15 l/min. The results of this work can contribute to the understanding of flow behavior in upper respiratory tract.

Deposition of airborne cyanobacteria and microalgae in the human respiratory tract (Baltic Sea coastal zone, Poland)

Scientific research confirms the harmful effects of airborne cyanobacteria and microalgae. However, determining human exposure to these microorganisms remains a challenge. The six-stage Tisch impactor was used to collect bioaerosols from April to September 2020 in the coastal zone of the southern Baltic. The MPPD model was used for estimation of regional, lobar, and generation deposition of microorganisms in human respiratory tract. The mass deposition fraction of cyanobacteria and microalgae in the head region gradually increased with the aerosol size. The maximum deposition fractions in the trachea, bronchial, and the pulmonary region were found for particles between 2.1 and 3.3 μm. The contribution of cyanobacteria and microalgae was the highest in the head region. The majority of microorganisms found in pulmonary region dominated in particles smaller than 2.1 μm. Exposure to the ambient bioaerosols may have an adverse impact on the human health in the region of southern Baltic Sea.

The role of puff volume in vaping emissions, inhalation risks, and metabolic perturbations: a pilot study

Secondhand vaping exposure is an emerging public health concern that remains understudied. In this study, saliva and exhaled emissions from ENDS users (secondhand) and non-ENDS users (baseline) were collected, firsthand emissions were generated using an automated ENDS aerosol generation system programmed to simulate puffing topography profiles collected from ENDS users. Particulate concentrations and sizes along with volatile organic compounds were characterized. We revealed puffing topography metrics as potential mediators of firsthand and secondhand particle and chemical exposures, as well as metabolic and respiratory health outcomes. Particle deposition modeling revealed that while secondhand emissions displayed smaller deposited mass, total and pulmonary particle deposition fractions were higher than firsthand deposition levels, possibly due to smaller secondhand emission particle diameters. Lastly, untargeted metabolomic profiling of salivary biomarkers of lung injury due to firsthand ENDS exposures revealed potential early indicators of respiratory distress that may also be relevant in bystanders exposed to secondhand vaping scenarios. By leveraging system toxicology, we identified 10 metabolites, including leukotriene D4, that could potentially serve as biomarkers for ENDS use, exposure estimation, and the prediction of vaping-related disease. This study highlights characterization of vaping behavior is an important exposure component in advancing our understanding of potential health effects in ENDS users and bystanders.

A review on vulnerable atmospheric aerosol nanoparticles: Sources, impact on the health, ecosystem and management strategies

The Earth's atmosphere contains ultrafine particles known as aerosols, which can be either liquid or solid particles suspended in gas. These aerosols originate from both natural sources and human activities, termed primary and secondary sources respectively. They have significant impacts on the environment, particularly when they transform into ultrafine particles or aerosol nanoparticles, due to their extremely fine atomic structure. With this context in mind, this review aims to elucidate the fundamentals of atmospheric-derived aerosol nanoparticles, covering their various sources, impacts, and methods for control and management. Natural sources such as marine, volcanic, dust, and bioaerosols are discussed, along with anthropogenic sources like the combustion of fossil fuels, biomass, and industrial waste. Aerosol nanoparticles can have several detrimental effects on ecosystems, prompting the exploration and analysis of eco-friendly, sustainable technologies for their removal or mitigation.Despite the adverse effects highlighted in the review, attention is also given to the generation of aerosol-derived atmospheric nanoparticles from biomass sources. This finding provides valuable scientific evidence and background for researchers in fields such as epidemiology, aerobiology, and toxicology, particularly concerning atmospheric nanoparticles.

Assessing the in vitro toxicity of airborne (nano)particles to the human respiratory system: from basic to advanced models

Several studies have been conducted to address the potential adverse health risks attributed to exposure to nanoscale materials. While in vivo studies are fundamental for identifying the relationship between dose and occurrence of adverse effects, in vitro model systems provide important information regarding the mechanism(s) of action at the molecular level. With a special focus on exposure to inhaled (nano)particulate material toxicity assessment, this review provides an overview of the available human respiratory models and exposure systems for in vitro testing, advantages, limitations, and existing investigations using models of different complexity. A brief overview of the human respiratory system, pathway and fate of inhaled (nano)particles is also presented.

Deposition and Clinical Impact of Inhaled Particles in the Lung

Particles suspended in the air we breathe are deposited in the airways as a function of the properties of the particle itself (shape, size and hydration), inspiratory air flow, airway anatomy, breathing environment, and mucociliary clearance. The scientific study of the deposition of inhaled particles in the airways has been conducted using traditional mathematical models and imaging techniques with particle markers. In recent years, the integration of statistical and computer methods, giving rise to a new discipline called digital microfluidics, has led to significant advances. In routine clinical practice, these studies are of great use for optimizing inhaler devices in line with particular characteristics of the drug to be inhaled and the pathology of the patient.

Co-Exposure of Ambient Particulate Matter and Airborne Transmission Pathogens: The Impairment of the Upper Respiratory Systems

Recent evidence has pinpointed the positive relevance between air particulate matter (PM) pollution and epidemic spread. However, there are still significant knowledge gaps in understanding the transmission and infection of pathogens loaded on PMs, for example, the interactions between pathogens and pre-existing atmospheric PM and the health effects of co-exposure on the inhalation systems. Here, we unraveled the interactions between fine particulate matter (FPM) and Pseudomonas aeruginosa (P. aeruginosa) and evaluated the infection and detrimental effects of co-exposure on the upper respiratory systems in both in vitro and in vivo models. We uncovered the higher accessibility and invasive ability of pathogens to epithelial cells after loading on FPMs, compared with the single exposure. Furthermore, we designed a novel laboratory exposure model to simulate a real co-exposure scenario. Intriguingly, the co-exposure induced more serious functional damage and longer inflammatory reactions to the upper respiratory tract, including the nasal cavity and trachea. Collectively, our results provide a new point of view on the transmission and infection of pathogens loaded on FPMs and uncover the in vivo systematic impairments of the inhalation tract under co-exposure through a novel laboratory exposure model. Hence, this study sheds light on further investigations of the detrimental effects of air pollution and epidemic spread.

Numerical Investigation of Ultrafine Aerosol Deposition inside a Needle Charger without Applied Voltage

The deposition of ultrafine aerosols with a size range of 3–20 nm in a needle charger has been studied numerically by simulating the flow field and the particle trajectory. The calculation model explored the particle deposition in the needle charger without applied voltage for various particle diameters, flow rates, entrance radial positions and deposition axial distances. It is first quantitatively proposed that most of the particles are attached to the outer electrode wall instead of the needle electrode wall for different flow rates and particle diameters. It is found that the numerical results of the particle deposition of the needle charger are consistent with previous experimental data. Moreover, the results demonstrate that reducing the flow rate increases the particle deposition of the needle charger. The numerical models explain and quantify the particle deposition and its attachment position for the needle charger without applied voltage.

A roadmap to pulmonary delivery strategies for the treatment of infectious lung diseases

Pulmonary drug delivery is a highly attractive topic for the treatment of infectious lung diseases. Drug delivery via the pulmonary route offers unique advantages of no first-pass effect and high bioavailability, which provides an important means to deliver therapeutics directly to lung lesions. Starting from the structural characteristics of the lungs and the biological barriers for achieving efficient delivery, we aim to review literatures in the past decade regarding the pulmonary delivery strategies used to treat infectious lung diseases. Hopefully, this review article offers new insights into the future development of therapeutic strategies against pulmonary infectious diseases from a delivery point of view.

Numerical Modeling of Droplet Aerosol Coagulation, Condensation/Evaporation and Deposition Processes

The differentially weighted operator-splitting Monte Carlo (DWOSMC) method is further developed to describe the droplet aerosol dynamic behaviors, including coagulation, deposition, condensation, and evaporation processes. It is first proposed that the droplet aerosols will experience firstly condensation and then evaporation, and this phenomenon is first implemented into the Monte Carlo method and sectional method with considering coagulation, deposition, and condensation/evaporation processes in both single-component and two-component aerosol particle systems. It is found that the calculated results of the DWOSMC method agree well with both the analytical solutions and the sectional method. The further developed DWOSMC method can predict the variation of particle number density, total particle volume, mean particle diameter, particle size distributions, and the component-related particle volume densities in both single component and two-component droplet aerosol systems considering coagulation, deposition, and condensation/evaporation processes.

Associations between lung-deposited dose of particulate matter and culture-positive pulmonary tuberculosis pleurisy

Epidemiological studies identified the relationship between air pollution and pulmonary tuberculosis. Effects of lung-deposited dose of particulate matter (PM) on culture-positive pulmonary tuberculosis remain unclear. This study investigates the association between lung-deposited dose of PM and pulmonary tuberculosis pleurisy. A case-control study of subjects undergoing pleural effusion drainage of pulmonary tuberculosis (case) and chronic heart failure (control) was conducted. Metals and biomarkers were quantified in the pleural effusion. The air pollution exposure was measured and PM deposition in the head, tracheobronchial, alveolar region, and total lung region was estimated by Multiple-path Particle Dosimetry (MPPD) Model. We performed multiple logistic regression to examine the associations of these factors with the risk of tuberculosis. We observed that 1-μg/m³ increase in PM₁₀ was associated with 1.226-fold increased crude odds ratio (OR) of tuberculosis (95% confidence interval (CI): 1.023-1.469, p<0.05), 1-μg/m³ increase in PM_2.5-10 was associated with 1.482-fold increased crude OR of tuberculosis (95% CI: 1.048-2.097, p < 0.05), 1-ppb increase in NO₂ was associated with 1.218-fold increased crude OR of tuberculosis (95% CI: 1.025-1.447, p < 0.05), and 1-ppb increase in O₃ was associated with 0.735-fold decreased crude OR of tuberculosis (95% CI: 0.542 0.995). We observed 1-μg/m³ increase in PM deposition in head and nasal region was associated with 1.699-fold increased crude OR of tuberculosis (95% CI: 1.065-2.711, p < 0.05), 1-μg/m³ increase in PM deposition in tracheobronchial region was associated with 1.592-fold increased crude OR of tuberculosis (95% CI: 1.095-2.313, p < 0.05), 1-μg/m³ increase in PM deposition in alveolar region was associated with 3.981-fold increased crude OR of tuberculosis (95% CI: 1.280-12.386, p < 0.05), and 1-μg/m³ increase in PM deposition in total lung was associated with 1.511-fold increased crude OR of tuberculosis (95% CI: 1.050-2.173, p < 0.05). The results indicate that particle deposition in alveolar region could cause higher risk of pulmonary tuberculosis pleurisy than deposition in other lung regions.

Replacement Strategies for Animal Studies in Inhalation Testing

Animal testing is mandatory in drug testing and is the gold standard for toxicity and efficacy evaluations. This situation is expected to change in the future as the 3Rs principle, which stands for the replacement, reduction, and refinement of the use of animals in science, is reinforced by many countries. On the other hand, technologies for alternatives to animal testing have increased. The need to develop and use alternatives depends on the complexity of the research topic and also on the extent to which the currently used animal models can mimic human physiology and/or exposure. The lung morphology and physiology of commonly used animal species differs from that of human lungs, and the realistic inhalation exposure of animals is challenging. In vitro and in silico methods can assess important aspects of the in vivo effects, namely particle deposition, dissolution, action at, and permeation through, the respiratory barrier, and pharmacokinetics. This review discusses the limitations of animal models and exposure systems and proposes in vitro and in silico techniques that could, when used together, reduce or even replace animal testing in inhalation testing in the future.

A comparison of CFPD, compartment, and uniform distribution models for radiation dosimetry of radionuclides in the lung

Radioactive aerosols that arise from natural sources and nuclear accidents can be a long-term hazard to human health. Despite the heterogeneous particle deposition in the respiratory tract, uniform aerosol doses have long been assumed in respiratory radiation dosimetry predictions, such as in the compartment and uniform distribution models. It is unclear how these deposition patterns affect internal radiation doses, which are critical in the health assessment of radioactive hazards. This work seeks to quantify the radio-dosimetry sensitivity to initial deposition patterns by comparing computational and compartment/uniform models. A new approach was developed to implement the compartment model into voxel phantoms (e.g. VIP-man) for radiation dosimetry. The calculated radiation fluence, energy deposition density and organ doses were compared to those obtained from coupling computational fluid-particle dynamics (CFPD) with Monte Carlo radiation transport and to those obtained from uniform source distribution approximation. The results show that the source particle distribution within the respiratory system substantially influences the radiation dosimetry distribution. The compartment and uniform models underestimated aerosol deposition in the crania ridge, leading to lower doses in the trachea and surrounding organs. For 0.5 MeV gammas, the CFPD-Monte Carlo N-particle (MCNP) model predicted a tracheal dose twice that of the compartment model and four times the uniform model. For 1 MeV betas, the CFPD-MCNP-predicted tracheal dose is 2.6 times that of the compartment model and 14 times the uniform model. Compared to the compartment/uniform models, the CFPD approach predicted a 50% lower beta dose in the lung but higher beta doses in the heart (six times), liver (four times) and stomach (2.5 times). It is suggested that including compartments for the lung periphery and tracheal carina ridge may improve the dosimetry accuracy of compartment models.

In vitro-in vivo correlation of cascade impactor data for orally inhaled pharmaceutical aerosols

In vitro-in vivo correlation is the establishment of a predictive relationship between in vitro and in vivo data. In the context of cascade impactor results of orally inhaled pharmaceutical aerosols, this involves the linking of parameters such as the emitted dose, fine particle dose, fine particle fraction, and mass median aerodynamic diameter to in vivo lung deposition from scintigraphy data. If the dissolution and absorption processes after deposition are adequately understood, the correlation may be extended to the pharmacokinetics and pharmacodynamics of the delivered drugs. Correlation of impactor data to lung deposition is a relatively new research area that has been gaining recent interest. Although few in number, experiments and meta-analyses have been conducted to examine such correlations. An artificial neural network approach has also been employed to analyse the complex relationships between multiple factors and responses. However, much research is needed to generate more data to obtain robust correlations. These predictive models will be useful in improving the efficiency in product development by reducing the need of expensive and lengthy clinical trials.

Deposition of Smoke Particles in Human Airways with Realistic Waveform

Exposure to toxic particles from smoke generated either from bush fire, stable burning, or direct smoking is very harmful to our health. The tiny particles easily penetrate deep into the lungs after exposure and damage the airways. Tobacco smoking causes the direct emission of 2.6 million tons of CO2 and 5.2 million tons of methane annually into the atmosphere. Nevertheless, it is one of the significant contributors to various respiratory diseases leading to lung cancer. These particles’ deposition in the human airway is computed in the present article for refining our understanding of the adverse health effects due to smoke particle inhalation, especially cigarette smoke. Until recently, little work has been reported to account for the transient flow pattern of cigarette smoking. Consideration of transient flow may change the deposition pattern of the particle. A high-resolution CT scan image of the respiratory tract model consisting of the oral cavity, throat, trachea, and first to sixth generations of the lungs helps predict cigarette smoke particle (CSP) deposition. With the same scan, a realistic geometric model of the human airways of an adult subject is used to simulate the transport of air and particle. The CSP deposition is determined at different locations from the oral cavity to the sixth generation of the bronchi. In addition, an unsteady breathing curve indicative of realistic smoking behavior is utilized to represent the breathing conditions accurately. The discrete phase model (DPM) technique is used to determine smoke particle deposition in the human airways. It is found that the deposition increases with the size of the smoke particle. Particles tend to deposit in the oral cavity around the bifurcation junction of the airways. The deposition fraction of CSP with the realistic waveform of smoking is found to be smaller compared to that during the stable flow condition. It is also observed that the fine particles (0.1–1.0 micron) escape to lower generations, leading to higher deposition of fine particles in the deeper airways. The outcome of the study is helpful for understanding smoke-related pulmonary complications.

Respirable Coal Mine Dust: A Review of Respiratory Deposition, Regulations, and Characterization

In the late 1990s, despite years of efforts to understand and reduce coal worker’s pneumoconiosis (CWP) prevalence from more than 30% in 1970 to less than 4.2%, the level of occurrence among the US coal miners increased unexpectedly. The recent resurgence of lung diseases has raised concerns in the scientific and regulatory communities. In 2014, the United States Mine Safety and Health Administration (MSHA) issued a new dust rule changing the respirable coal mine dust (RCMD) exposure limits, measurement technology, and sampling protocol. The analysis for probable causes for the substantial increase in the CWP incidence rate is rather complicated. This paper aims to conduct a review of RCMD respiratory deposition, health effects, monitoring, regulations, and particle characteristics. The primary sources of RCMD along with the health risks from potential exposure are highlighted, and the current RCMD exposure regulations of the major coal producer countries are compared. A summary of RCMD characterization studies from 1972 to the present is provided. A review of the literature revealed that numerous factors, including geological and mining parameters, advancements in mining practices, particle characteristics, and monitoring approaches are considered to contribute to the recent resurgence of RCMD lung diseases. However, the root causes of the problem are still unknown. The effectiveness of the new dust rules in the United States will probably take years to be correctly assessed. Therefore, future research is needed to understand the relationship between RCMD particle characteristics and lung deposition, and the efficacy of current monitoring practices to measure the true dose of RCMD exposure.

Mass dose rates of particle-bound organic pollutants in the human respiratory tract: Implications for inhalation exposure and risk estimations

To date, little is known about the effective doses of airborne particulate matter (PM) and PM-bound hazardous organic components to the human respiratory tract (HRT). In the light of this, here we provide particle mass dose rates (dose per hour of exposure) of PM and a suite of PM-bound hazardous organic compounds in the HRT for two population age groups (adults & children). More specifically, the mass dose rates of PM and PM-bound polycyclic aromatic hydrocarbons (PAHs), nitrated-PAH (NPAHs), polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and polybrominated diphenyl ethers (PBDEs) were estimated at two urban sites using a multiple path particle dosimetry model. We find that, in most cases, the total mass doses are following similar variations across sites and seasons as their ambient total concentrations, however their distribution in the HRT is a function of the particle size distributions and the physiological parameters of each age group. More specifically, the majority of the deposited mass of PM and all the chemical components investigated was accumulated in the upper airways instead of the lungs. We further show that children, due to their different physiology, are more susceptible and receive larger fraction of the total mass doses in the deepest parts of the lungs compared to the adults' group. Comparing the traditional method for estimating the inhalation risk, which is based on the ambient concentration of pollutants, and a modified version using the mass dose in the HRT, we find that the former may overestimate the reported risks. The results presented here provide a novel dataset composed by previously undetermined doses of hazardous airborne particulate organic components in the HRT and demonstrate that alternative health risk estimation approaches may capture some variabilities that are traditionally overlooked.

An overview of the effect of bioaerosol size in coronavirus disease 2019 transmission

The fast spread of coronavirus disease 2019 (COVID‐19) constitutes a worldwide challenge to the public health, educational and trade systems, affecting the overall well‐being of human societies. The high transmission and mortality rates of this virus, and the unavailability of a vaccine or treatment, resulted in the decision of multiple governments to enact measures of social distancing. Such measures can reduce the exposure to bioaerosols, which can result in pathogen deposition in the respiratory tract of the host causing disease and an immunological response. Thus, it is important to consider the validity of the proposal for keeping a distance of at least 2 m from other persons to avoid the spread of COVID‐19. This work reviews the effect of aerodynamic diameter (size) of particles carrying RNA copies of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). A SARS‐CoV‐2 carrier person talking, sneezing or coughing at distance of 2 m can still provide a pathogenic bioaerosol load with submicron particles that remain viable in air for up to 3 h for exposure of healthy persons near and far from the source in a stagnant environment. The deposited bioaerosol creates contaminated surfaces, which if touched can act as a path to introduce the pathogen by mouth, nose or eyes and cause disease.

Construction of a hybrid lung model by combining a real geometry of the upper airways and an idealized geometry of the lower airways

BACKGROUND AND OBJECTIVE

Health care costs represent a substantial an increasing percentage of global expenditures. One key component is treatment of respiratory diseases, which account for one in twelve deaths in Europe. Computational simulations of lung airflow have potential to provide considerable cost reduction and improved outcomes. Such simulations require accurate in silico modeling of the lung airway. The geometry of the lung is extremely complex and for this reason very simple morphologies have primarily been used to date. The objective of this work is to develop an effective methodology for the creation of hybrid pulmonary geometries combining patient-specific models obtained from CT images and idealized pulmonary models, for the purpose of carrying out experimental and numerical studies on aerosol/particle transport and deposition in inhaled drug delivery.

METHODS

For the construction of the hybrid numerical model, lung images obtained from computed tomography were exported to the DICOM format to be treated with a commercial software to build the patient-specific part of the model. At the distal terminus of each airway of this portion of the model, an idealization of a single airway path is connected, extending to the sixteenth generation. Because these two parts have different endings, it is necessary to create an intermediate solid to link them together. Physically realistic treatment of truncated airway boundaries in the model was accomplished by mapping of the flow velocity distribution from corresponding conducting airway segments.

RESULTS

The model was verified using two sets of simulations, steady inspiration/expiration and transient simulation of forced spirometry. The results showed that the hybrid model is capable of providing a realistic description of air flow dynamics in the lung while substantially reducing computational costs relative to models of the full airway tree.

CONCLUSIONS

The model development outlined here represents an important step toward computational simulation of lung dynamics for patient-specific applications. Further research work may consist of investigating specific diseases, such as chronic bronchitis and pulmonary emphysema, as well as the study of the deposition of pollutants or drugs in the airways.