Particulate matter deposition and its impact on tuberculosis severity: A cross-sectional study in Taipei

The objective of this study was to examine the association between the lung lobe-deposited dose of inhaled fine particulate matter (PM2.5) and chest X-ray abnormalities in different lung lobes of pulmonary tuberculosis (TB), multidrug-resistant tuberculosis (MDR-TB), and non-tuberculosis mycobacteria infections (NTM). A cross-sectional study was conducted between 2014 and 2022, comprising 1073 patients who were recruited from chest department clinic in a tertial refer hospital in Taipei City, Taiwan. Ambient 1-, 7-, and 30-day PM2.5 exposure and the deposition of PM2.5 in different lung lobes were estimated in each subject. The β coefficient for PM2.5 and deposited PM2.5 in lungs with the outcome variables (pulmonary TB, MDR-TB, and NTM infection) was derived through regression analysis and adjusted for age, gender, BMI, smoking status, and family income. We observed that a 1 μg/m3 increase in ambient PM2.5 was associated with an increase of MDR-TB infections of 0.004 times (95%CI: 0.001-0.007). A 1 μg/m3 increase in 1-day and 7-day PM2.5 deposition in left upper lobe and left lower lobe was associated with an increase in chest X-ray abnormalities of 9.19 % and 1.18 % (95%CI: 0.87-17.51 and 95%CI: 0.08-2.28), and 4.52 % and 5.20 % (95%CI: 0.66-8.38 and 95%CI: 0.51-9.89) in left lung of TB patients, respectively. A 1 μg/m3 increase in 30-day PM2.5 deposition in alveolar region was associated with an increase in percent abnormality of 2.50 % (95%CI: 0.65-4.35) in left upper lobe and 3.33 % (95%CI: 0.65-6.01) in right middle lobe, while in total lung was 0.63 % (95%CI: 0.01-1.27) in right upper lobe and 0.37 % (95%CI, 0.06-0.81) in right lung of MDR-TB patients. Inhaled PM2.5 deposition in lungs was associated with an exacerbation of the radiographic severity of pulmonary TB, particularly in pulmonary MDR-TB patients in upper and middle lobes. Particulate air pollution may potentially exacerbate the radiographic severity and treatment resistance in individuals with pulmonary TB.

A narrative review on the Synchrobreathe™: A novel breath-actuated pressurised metered-dose inhaler for the treatment of obstructive airway diseases

Pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), are widely used to deliver drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Incorrect use of inhalers is one of the main obstacles to achieving better clinical control. Indeed, with pMDIs, patients fail to synchronise actuation with inhalation due to a lack of coordination and with DPIs insufficient inspiratory effort compromises drug deposition in lungs. More than 50% of patients desire to switch their pMDIs and DPIs for a better device. This led to the development of pressurised breath-actuated inhalers (BAIs) with the aim of combining the beneficial features of pMDIs and DPIs and mitigating their problems. BAIs, e.g., Synchrobreathe™, are designed such that they are activated by a low inhalation effort and mechanically actuate the dose in synchrony to inspiration, thereby resolving the need to coordinate actuation with inspiration. BAIs have advantages, including ease of use, high lung deposition of medication, and greater patient preference. We discussed the design features, operating procedure, and clinical evidence of the Synchrobreathe™ device (Cipla Ltd, India), a BAI available with a wide range of drug combinations. Studies have shown that a higher number of patients (68.19%) used the Synchrobreathe™ without any error than the pMDI (56.21%), and that the vast majority of them (92%) found it easy to understand and use. The Synchrobreathe™ is an innovative, easy-to-use inhaler that may overcome many limitations associated with pMDIs and DPIs, thus potentially improving management of obstructive airway diseases and patients' quality of life.

An experimental study on lung deposition of inhaled 2 μm particles in relation to lung characteristics and deposition models

BACKGROUND

The understanding of inhaled particle respiratory tract deposition is a key link to understand the health effects of particles or the efficiency for medical drug delivery via the lung. However, there are few experimental data on particle respiratory tract deposition, and the existing data deviates considerably when comparing results for particles > 1 μm.

METHODS

We designed an experimental set-up to measure deposition in the respiratory tract for particles > 1 μm, more specifically 2.3 μm, with careful consideration to minimise foreseen errors. We measured the deposition in seventeen healthy adults (21-68 years). The measurements were performed at tidal breathing, during three consecutive 5-minute periods while logging breathing patterns. Pulmonary function tests were performed, including the new airspace dimension assessment (AiDA) method measuring distal lung airspace radius (rAiDA). The lung characteristics and breathing variables were used in statistical models to investigate to what extent they can explain individual variations in measured deposited particle fraction. The measured particle deposition was compared to values predicted with whole lung models. Model calculations were made for each subject using measured variables as input (e.g., breathing pattern and functional residual capacity).

RESULTS

The measured fractional deposition for 2.3 μm particles was 0.60 ± 0.14, which is significantly higher than predicted by any of the models tested, ranging from 0.37 ± 0.08 to 0.53 ± 0.09. The multiple-path particle dosimetry (MPPD) model most closely predicted the measured deposition when using the new PNNL lung model. The individual variability in measured particle deposition was best explained by breathing pattern and distal airspace radius (rAiDA) at half inflation from AiDA. All models underestimated inter-subject variability even though the individual breathing pattern and functional residual capacity for each participant was used in the model.

CONCLUSIONS

Whole lung models need to be tuned and improved to predict the respiratory tract particle deposition of micron-sized particles, and to capture individual variations - a variation that is known to be higher for aged and diseased lungs. Further, the results support the hypothesis that the AiDA method measures dimensions in the peripheral lung and that rAiDA, as measured by the AiDA, can be used to better understand the individual variation in the dose to healthy and diseased lungs.

Modeled small airways lung deposition of two fixed-dose triple therapy combinations assessed with in silico functional respiratory imaging

BACKGROUND

Small airways disease plays a key role in the pathogenesis of chronic obstructive pulmonary disease (COPD) and is a major cause of obstruction; therefore, it is a critical pharmacotherapy target. This study evaluated lung deposition of two inhaled corticosteroid (ICS)/long-acting β2-agonist/long-acting muscarinic antagonist single-inhaler triple therapies using in silico functional respiratory imaging (FRI). Deposition was assessed using real-world inhalation profiles simulating everyday use where optimal inhalation may be compromised.

METHODS

Three-dimensional airway models were produced from 20 patients with moderate-to-very severe COPD. Total, central, and regional small airways deposition as a percentage of delivered dose of budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) 160/7.2/5 µg per actuation and fluticasone furoate/umeclidinium/vilanterol (FF/UM/VI) 100/62.5/25 µg were evaluated using in silico FRI based on in vitro aerodynamic particle size distributions of each device. Simulations were performed using multiple inhalation profiles of varying durations and flow rates representing patterns suited for a pressurized metered-dose inhaler or dry-powder inhaler (four for BGF, two for FF/UM/VI, with one common profile). For the common profile, deposition for BGF versus FF/UM/VI was compared post-hoc using paired t-tests.

RESULTS

Across inhalation profiles, mean total lung deposition was consistently higher with BGF (47.0-54.1%) versus FF/UM/VI (20.8-22.7%) and for each treatment component, with greater deposition for BGF also seen in the central large airways. Mean regional small airways deposition was also greater across inhalation profiles with BGF (16.9-23.6%) versus FF/UM/VI (6.8-8.7%) and for each treatment component. For the common profile, total, central, and regional small airways deposition were significantly greater for BGF versus FF/UM/VI (nominal p < 0.001), overall and for treatment components; notably, regional small airways deposition of the ICS components was approximately five-fold greater with budesonide versus fluticasone furoate (16.1% vs. 3.3%).

CONCLUSIONS

BGF was associated with greater total, central, and small airways deposition for all components versus FF/UM/VI. Importantly, using an identical inhalation profile, there was an approximately five-fold difference in small airways deposition for the ICS components, with only a small percentage of the ICS from FF/UM/VI reaching the small airways. Further research is needed to understand if the enhanced delivery of BGF translates to clinical benefits.

Overhead AC powerlines and rain can alter the electric charge distribution on airborne particles - Implications for aerosol dispersion and lung deposition

Corona ions from high voltage power lines (HVPL) can increase electrostatic charge on airborne pollutant particulates, possibly increasing received dose upon inhalation. To investigate the potential increased risk of childhood leukemia associated with residence near alternating current (AC) HVPL, we measured the particle charge state and atmospheric electricity parameters upwind, downwind and away from HVPL. Although we observed noticeable charge state alteration from background levels, most HVPL do not significantly increase charge magnitude. Particular HVPL types are shown to have most effect, increasing net charge to 15 times that at background. However, the magnitude of charge alteration during rainfall is comparable with the most extreme HVPL measurement. On current evidence, based on the current adult lung model, we suggest that although charge is sometimes enhanced to levels which may alter atmospheric particle dynamics, increased lung deposition is unlikely.

A quasi-one-dimensional model for ion-aerosol interactions and aerosol charge state downwind of corona-producing alternating current (AC) HVPL under stable atmospheric conditions

Corona ions produced by high voltage power lines (HVPL) can alter the local atmospheric electrical environment downwind, potentially increasing electrostatic charge on airborne particulates via ion-aerosol attachment. However, previous epidemiological assessments attempting to assess this 'corona ion hypothesis' have used proxies e.g. ion concentration or distance from HVPL, rather than aerosol charge state directly, due to difficulties in modeling this quantity. We present a quasi-1D model incorporating both Gaussian plume dynamics and ion-aerosol and ion-ion interaction microphysics which could be applied to future studies of charged aerosol near HVPL. The response of the model to changes in a range of input parameters is characterized, and validation is attempted by means of comparison with previous work where ion- and aerosol concentrations and properties (including electrical mobility and electric charge states) upwind and downwind of HVPL are measured.

Predicting in vitro lung deposition behavior of combined dry powder inhaler via rheological properties

Dry powder inhaler (DPI) for pulmonary delivery is currently the primary treatment for asthma and COPD (chronic obstructive pulmonary disease), an increasing number of combined DPIs (containing two or more drugs in one inhaler) have been developed to complement the effect of single DPIs. Based on our previous studies, the rheological properties can be a potential tool used to predict the in vitro lung deposition behavior of DPI formulations. However, it is unknown whether such a prediction model is suitable for combination systems. Therefore, this study aimed to verify the applicability of using powder rheological properties to predict in vitro drug deposition behavior in combined DPI formulations. Two drugs (fluticasone propionate and salmeterol xinafoate) and their combination of DPI formulations were prepared using fine lactose content (in the range of 1%-20%) as a variable. The physicochemical properties of the powder mixtures such as particle size and content uniformity were characterized. The rheological properties of the powder mixtures were measured by FT4 rheometer, the aerodynamic behavior of the DPI formulations was evaluated by a new generation impactor (NGI), and the effect of flowability and adhesion on the deposition of the fine particle fraction (FPF) was investigated by principal component analysis (PCA). The results showed that the combined DPI formulations with larger particle interaction forces have certain differences from the aerodynamic behavior of the single DPI formulations. The regularity of rheological properties affecting FPF revealed in single DPI is still applicable to combined DPI, the parameters basic flowability energy (BFE), representing flowability, and flow factor (ff), Cohesion representing adhesion, can be well linearly related to the FPF. The results of the principal component analysis showed that better flowability and suitable adhesion contributed to higher in vitro deposition of the drug in the formulation, and the contribution of adhesion (75.42%) was greater than that of flowability (24.58%). In conclusion, rheological properties is an effective tool for predicting the deposition behavior of DPI not only in single but also in combined DPIs.

Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting

Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient's activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm²/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).

Lung-deposited dose of particulate matter from residential exposure to smoke from wood burning

Residential settings are of utmost importance for human exposure, as it is where people spend most of their time. Residential wood combustion is a widespread practice known as a source of indoor particulate matter (PM). Nevertheless, research on the risks of exposure associated with this source is scarce, and a better understanding of respiratory deposition of smoke particles is needed. The dosimetry model ExDoM2 was applied to determine the deposited dose of inhalable particulate matter (PM₁₀) from residential biomass combustion in the human respiratory tract (HRT) of adults and children. The dose was estimated using PM₁₀ exposure concentrations obtained from a field campaign carried out in two households during the operation of an open fireplace and a woodstove. Simultaneously, PM₁₀ levels were monitored outside to investigate the outdoor dose in a rural area strongly impacted by biomass burning emissions. Indoors, the 8-h average PM₁₀ concentrations ranged from 88.3 to 489 μg m^-3 and from 69.4 to 122 μg m^-3 for the operation of the fireplace and the woodstove, respectively, while outdoor average PM₁₀ concentrations ranged from 17.3 to 94.2 μg m^-3. The highest amount of the deposited particles was recorded in the extrathoracic region (68-79%), whereas the deposition was much lower in the tracheobronchial tree (5-6%) and alveolar-interstitial region (16-21%). The total dose received while using the fireplace was more than twofold the one received in the room with a woodstove and more than 10 times higher than in the absence of the source. Overall, indoor doses were higher than the ones received by a subject exposed outdoors, especially at the alveolar-interstitial region. After 24 h of exposure, it was estimated that approximately 35 to 37% of the particles deposited in the HRT were transferred to the gastrointestinal tract, while approximately 2.0-2.5% were absorbed into the blood. The results from exposure and dose of indoor particles gathered in this work suggest that homeowners should be encouraged to upgrade the wood burning technology to reduce the PM levels inside their residences. This study also provides biologically relevant results on the lung deposition of particles from residential biomass burning that can be used as a reference for future research.

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.

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.

Visualizing the spatial localization of ciclesonide and its metabolites in rat lungs after inhalation of 1-μm aerosol of ciclesonide by desorption electrospray ionization-time of flight mass spectrometry imaging

Inhaled ciclesonide (CIC), a corticosteroid used to treat asthma that is also being investigated for the treatment of corona virus disease 2019, hydrolyzes to desisobutyryl-ciclesonide (des-CIC) followed by reversible esterification when exposed to fatty acids in lungs. While previous studies have described the distribution and metabolism of the compounds after inhalation, spatial localization in the lungs remains unclear. We visualized two-dimensional spatial localization of CIC and its metabolites in rat lungs after administration of a single dose of a CIC aerosol (with the mass median aerodynamic diameter of 0.918-1.168 μm) using desorption electrospray ionization-time of flight mass spectrometry imaging (DESI-MSI). In the analysis, CIC, des-CIC, and des-CIC-oleate were imaged in frozen lung sections at high spatial and mass resolutions in negative-ion mode. MSI revealed the coexistence of CIC, des-CIC, and des-CIC-oleate on the airway epithelium, and the distribution of des-CIC and des-CIC-oleate in peripheral lung regions. In addition, a part of CIC independently localized on the airway epithelium. These results suggest that distribution of CIC and its metabolites in lungs is related to both the intended delivery of aerosols to pulmonary alveoli and peripheral regions, and the potential deposition of CIC particles on the airway epithelium.

Quantifying respiratory tract deposition of airborne graphene nanoplatelets: The impact of plate-like shape and folded structure

The booming development of commercial products containing graphene nanoplatelets (GNPs) triggers growing concerns over their release into the air. Precise prediction of human respiratory system deposition of airborne GNPs, especially in alveolar region, is very important for inhalation exposure assessment. In this study, the pulmonary deposition of airborne GNPs was predicted by the multiple-path particle dosimetry (MPPD) model with consideration of GNPs plate-like shape and folded structure effect. Different equivalent diameters of GNPs were derived and utilized to describe different deposition mechanisms in the MPPD model. Both of small GNPs (geometric lateral size d_g < 0.1 μm) and large GNPs (d_g > 10 μm) had high deposition fractions in human respiratory system. The total deposition fractions for 0.1 and 30 μm GNPs were 41.6% and 75.6%, respectively. Most of the small GNPs deposited in the alveolar region, while the large GNPs deposited in the head airways. The aerodynamic diameter of GNPs was much smaller than the geometric lateral dimension due to the nanoscale thickness. For GNPs with geometric lateral size of 30 μm, the aerodynamic diameter was 2.98 μm. The small aerodynamic diameter of plate-like GNPs enabled deposition in the alveolar region, and folded GNPs had higher alveolar deposition than planar GNPs. Heavy breathing led to higher GNPs deposition fraction in head airways and lower deposition fractions in the alveolar region than resting breathing.

In vitro-in vivo correlations (IVIVCs) of deposition for drugs given by oral inhalation

Conventional in vitro tests to assess the aerodynamic particle size distribution (APSD) from inhaler devices use simple right-angle inlets ("mouth-throats", MTs) to cascade impactors, and air is drawn through the system at a fixed flow for a fixed time. Since this arrangement differs substantially from both human oropharyngeal airway anatomy and the patterns of air flow when patients use inhalers, the ability of in vitro tests to predict in vivo deposition of pharmaceutical aerosols has been limited. MTs that mimic the human anatomy, coupled with simulated breathing patterns, have yielded estimates of lung dose from in vitro data that closely match those from in vivo gamma scintigraphic or pharmacokinetic studies. However, different models of MTs do not always yield identical data, and selection of an anatomical MT and representative inhalation profiles remains challenging. Improved in vitro - in vivo correlations (IVIVCs) for inhaled drug products could permit increased reliance on in vitro data when developing new inhaled drug products, and could ultimately result in accelerated drug product development, together with reduced research and development spending.

Amorphous solid dispersion dry powder for pulmonary drug delivery: Advantages and challenges

Amorphous solid dispersion (ASD) is commonly used in pharmaceutical industry. It has been mainly employed to enhance the oral bioavailability of poorly water-soluble drugs that belong to class II and IV of the biopharmaceutical classification system but has showed promise in other areas of pharmaceutical research. In this review, the potential and limitations of ASD dry powder for inhalation are discussed. ASD powder for inhalation (ASD-IP) is commonly prepared by spray drying technique. The physicochemical characteristics of ASD-IP could be tailored to achieve effective lung deposition. ASD-IP could also attain rapid dissolution behavior to achieve therapeutically effective concentration either locally or systemically before particle clearance in the lung. The key challenges of using ASD powder for inhalation include the possible chemical and/or physical instability of the amorphous phase during manufacturing and in vivo, and the moisture and temperature sensitivity of ASD-IP that affects its storage stability.

Assessment of indoor air exposure at residential homes: Inhalation dose and lung deposition of PM10, PM2.5 and ultrafine particles among newborn children and their mothers

Accurate assessment of particulate matter (PM) dose and respiratory deposition is essential to better understand the risks of exposure to PM and, consequently, to develop the respective risk-control strategies. In homes, this is especially relevant in regards to ultrafine particles (UFP; <0.1 μm) which origin in these environments is mostly due to indoor sources. Thus, this study aimed to estimate inhalation doses for different PM mass/number size fractions (i.e., PM₁₀, PM_2.5 and UFP) in indoor air of residential homes and to quantify the deposition (total, regional and lobar) in human respiratory tract for both newborn children and mothers. Indoor real-time measurements of PM₁₀, PM_2.5 and UFP were conducted in 65 residential homes situated in Oporto metropolitan area (Portugal). Inhalation doses were estimated based on the physical characteristics of individual subjects and their activity patterns. The multi-path particle dosimetry model was used to quantify age-specific depositions in human respiratory tract. The results showed that 3-month old infants exhibited 4-fold higher inhalation doses than their mothers. PM₁₀ were primarily deposited in the head region (87%), while PM_2.5 and UFP depositions mainly occurred in the pulmonary area (39% and 43%, respectively). Subject age affected the pulmonary region and the total lung deposition; higher deposition being observed among the newborns. Similarly, lower lobes (left lobe: 37% and right lobe: 30%) received higher PM deposition than upper and middle lobes; right lobes lung are prone to be more susceptible to respiratory problems, since asymmetric deposition was observed. Considering that PM-related diseases occur at specific sites of respiratory system, quantification of site-specific particle deposition should be predicted in order to better evidence the respective health outcomes resulting from inhaled PM.

Dataset on part replacement of dipalmitoylphophatidylcholine with locust bean on stimulated tracheobronchial fluid, in vitro bioaccessibility test and modeling of lung deposition of trace elements bound to airborne particulates

The data presented in this article are related to our work on development of tracheobronchial fluid, in vitro bioaccessibility test and modeling of lung deposition of trace elements bound to airborne particulates [1]. In this article, a neutral modeled tracheobronchial fluid was formulated by partial replacement of some constituents in recipes of previously used lung epithelium fluids with local materials and was used in in vitro bioaccessibility extraction of elements-bound to airborne particulates. Dataset of particulate matters-bound trace elements collected in selected locations Ado - Ekiti is presented and the deposition of elements in different regions of respiratory tracts is estimated using Multiple-path particle deposition (MPPD) mathematic model. The data reveals that the formulated fluid has physical characteristics with superior properties to the existing fluids. The data also shows that bioaccessibility of elements were generally low (<30%) except for Cd and As with relatively moderate values (between 45 and 50%). Additionally, the lung deposition modeling shows that greater percentage of Cd (about 40% of inhaled dose) deposition in the lower alveolar part of the respiratory tract while tracheobronchial and extra-thoracic had 33% and 27% respectively. The data sets can be used as references to analyze data obtained using other formulation.

Characteristics of biological particulate matters at urban and rural sites in the North China Plain

Depending on their concentrations, sizes, and types, particulate matters of biological origins (bioPM) significantly affect human health. However, for different air environments, they are not well characterized and can vary considerably. As an example, we investigated the bioPM differences at an urban (Beijing) site and a rural (Wangdu) site in the North China Plain (NCP) using an online monitoring instrument, an ultraviolet aerodynamic particle sizer (UV-APS), the limulus amebocyte lysate (LAL) assay, and a high-throughput sequencing method. Generally, lower concentrations of viable bioPM (hourly mean: 1.3 × 10³ ± 1.6 × 10³ m^-3) and endotoxin (0.66 ± 0.16 EU/m³) in Beijing were observed compared to viable bioPM (0.79 × 10⁵ ± 1.4 × 10⁵ m^-3) and endotoxin (15.1 ± 23.96 EU/m³) at the Wangdu site. The percentage of viable bioPM number concentration in the total PM was 3.1% in Beijing and 6.4% in Wangdu. Approximately 80% of viable bioPM was found to be in the range from 1 to 2.5 μm. Nevertheless, the size distribution patterns for viable bioPM at the Beijing and Wangdu sites differed and were affected by PM pollution, leading to distinct lung deposition profiles. Moreover, the distinct diurnal variations in viable bioPM on clean days were dimmed by the PM pollution at both sites. Distinct bacterial community structures were found in the air from the Beijing and Wangdu sites. The bacterial community in urban Beijing was dominated by genus Lactococcus (49.5%) and Pseudomonas (15.1%), while the rural Wangdu site was dominated by Enterococcus (65%) and Paenibacillus (10%). Human-derived genera, including Myroides, Streptococcus, Propionibacterium, Dietzia, Helcococcus, and Facklamia, were higher in Beijing, suggesting bacterial emission from humans in the urban air environment. Our results show that different air harbors different biological species, and people residing in different environments thus could have very different biological particle exposure.

Evaluation of patients' real-world post-dispensing use and storage environments of tiotropium bromide Respimat® soft mist inhaler on its in vitro dose delivery and lung deposition

BACKGROUND

Oral inhalation is the main drug delivery route for treating obstructive lung conditions. Thus, many inhaler devices with various design and pharmaceutical formulation have been introduced. The fine particle dose (FPD) and mass median aerodynamic diameter (MMAD ≤ 5 μm) of the aerosol delivered dose (DD) dictate the therapeutically effective peripheral lung deposition. This study evaluated the in vitro aerosol emission performance of tiotropium bromide emitted from Spiriva® Respimat® soft mist inhalers (R) after living under patients' real-world, post-dispensing handling environments.

METHODS

This was a two-stage investigation. In the first clinical stage, research ethical approval was obtained to enrol patients already been using R for at least 3 months. Those who signed consent were given both new R to use and temperature and relative humidity (RH) handheld, portable data loggers to keep in the vicinity of the given R. The participants returned the given R and data loggers after 2 weeks. Patient recruitment took place in Amman, Jordan, during the summer (RS) and winter (RW). Subsequently, in the second laboratory stage, other R were strictly stored at an average of 21.0 °C and 46.9% RH as control (RC). The Next Generation Impactor (NGI) was used to evaluate the RS, RW and RC. The NGI was operated at a flow rate of 30 L/min.

RESULTS

The RS were exposed to an average (range) 23.6 °C (18.2-37.5 °C) and 43.8% RH (21.4-60.0% RH) that were statistically comparable (p > 0.05) to that of the RW; 17.3 °C (13.2-26.7 °C) and 52.8% RH (26.3-69.1% RH). The RW and RC retention environments were statistically different (p < 0.05), whilst the RS and RC had comparable (p > 0.05) conditions. No significant differences (p > 0.05) were found in the tiotropium bromide DD (2.39 vs 2.43 μg), FPD (0.88 vs 0.90 μg) and MMAD (5.1 vs 4.98 μm) between the RS and RW, respectively. Compared to the RC inhalers, both the RS and RW devices had significantly higher FPD and relatively smaller tiotropium bromide particles.

CONCLUSIONS

Using the R under the fluctuating summer and winter environments of our patients would not affect its overall tiotropium bromide emission performance. The significant increase in the respirable mass of the RS and RW might be offset by the increase in particles <1 μm particularly in patients with poor inhaler technique.

Side lying during nebulisation can significantly improve apical deposition in healthy adults and adults with mild cystic fibrosis lung disease: a randomised crossover trial

Background

In people with and without Cystic Fibrosis (CF), does side lying during nebulisation change: the proportion of the dose loaded in the nebuliser that is deposited in the lungs; the uniformity of deposition throughout the lungs; or the apical drug density as a percentage of the drug density in the remaining lung? Do these effects differ depending on the degree of lung disease present?

Methods

A randomised crossover trial with concealed allocation, intention-to-treat analysis and blinded assessors, involving 39 adults: 13 healthy, 13 with mild CF lung disease (FEV₁ > 80%pred), and 13 with more advanced CF lung disease (FEV₁ < 80%pred). In random order, 4 mL of nebulised radioaerosol was inhaled in upright sitting and in alternate right and left side lying at 2-min intervals, for 20 min.

Results

Compared to sitting upright, lung deposition and the uniformity of deposition were not significantly altered by side lying in any of the three groups. In sitting, the density of the deposition was significantly less in the apical regions than in the rest of the lung in all participants. Side lying significantly improved apical deposition in healthy adults (MD, 13%; 95% CI, 7 to 19), and in minimal CF lung disease (MD, 4%; 95% CI, 1 to 7) but not in advanced disease (MD, 4%; 95% CI, − 2 to 9).

Conclusion

Alternating between right and left side lying during nebulisation significantly improves apical deposition in healthy adults and in adults with mild CF lung disease, without substantial detriment to overall deposition.

Trial registration

ACTRN12611000674932 (Healthy), ACTRN12611000672954 (CF)

Retrospectively registered 4/7/2011.

Electronic supplementary material

The online version of this article (10.1186/s12890-019-0886-7) contains supplementary material, which is available to authorized users.

Biophysical model to predict lung delivery from a dual bronchodilator dry-powder inhaler

A biophysical lung model was designed to predict inhaled drug deposition in patients with obstructive airway disease, and quantitatively investigate sources of deposition variability. Different mouth-throat anatomies at varying simulated inhalation flows were used to calculate the lung dose of indacaterol/glycopyrronium [IND/GLY] 110/50 µg (QVA149) from the dry-powder inhaler Breezhaler^®. Sources of variability in lung dose were studied using computational fluid dynamics, supported by aerosol particle sizing measurements, particle image velocimetry and computed tomography. Anatomical differences in mouth-throat geometries were identified as a major source of inter-subject variability in lung deposition. Lung dose was similar across inhalation flows of 30–120 L/min with a slight drop in calculated delivery at high inspiratory flows. Delivery was relatively unaffected by inhaler inclination angle. The delivered lung dose of the fixed-dose combination IND/GLY matched well with corresponding monotherapy doses. This biophysical model indicates low extra-thoracic drug loss and consistent lung delivery of IND/GLY, independent of inhalation flows. This is an important finding for patients across various ages and lung disease severities. The model provides a quantitative, mechanistic simulation of inhaled therapies that could provide a test system for estimating drug delivery to the lung and complement traditional clinical studies.

The impact of patients' real-life environmental temperature and humidity use conditions of tiotropium dry powder inhaler on its aerosol emission characteristics

INTRODUCTION

Many factors can affect dry powder inhalers' (DPIs) aerosol emission and lung deposition. The fluctuation of environmental temperature and relative humidity (RH) that inhalers experience in realistic daily use has not been extensively evaluated. This work aimed to evaluate the delivered dose (DD) and aerodynamic particle size distribution (APSD) of tiotropium Handihaler DPI (H) after exposure to patients' real-life use environments.

METHODS

Ethical approval was obtained to enrol adult patients already using H. Patients who gave written consent were given new H to use and HygroLog temperature and RH data loggers to keep in the vicinity of the given inhaler. The H and HygroLog were returned after 2 weeks. Patient recruitment was done during the summer (HS) and winter (HW). As control, other HC were stored as per the leaflet storage instructions. The Next Generation Impactor was used to evaluate the inhalers.

RESULTS

The HC were stored under an average of 21.0 °C and 46.9% RH. The patients' HS and HW lived in an average (range) temperature (°C) 23.2 (18.3-38.2) and 17.8 (13.5-24.6), respectively, and RH 50.8% (24.3-65.3%) and 50.4% (30.6-72.4%), respectively. All H groups had comparable environments (p > 0.05). The HC, HS and HW gave similar tiotropium DD (μg) 7.60, 8.01 and 7.61, respectively (p > 0.05). Moreover, the fine particle dose μg (median diameter (μm)) were HC 2.41 (3.84), HS 2.55 (3.81) and HW 2.37 (3.83) (p > 0.05).

CONCLUSIONS

The aerosol emission behaviour of tiotropium Handihaler was tolerant to real-life retention environments of patients in Amman, Jordan.

Mice-to-men comparison of inhaled drug-aerosol deposition and clearance

Part of the effective prediction of the pharmacokinetics of drugs (or toxic particles) requires extrapolation of experimental data sets from animal studies to humans. As the respiratory tracts of rodents and humans are anatomically very different, there is a need to study airflow and drug-aerosol deposition patterns in lung airways of these laboratory animals and compare them to those of human lungs. As a first step, interspecies computational comparison modeling of inhaled nano-to-micron size drugs (50 nm < d<15μm) was performed using mouse and human upper airway models under realistic breathing conditions. Critical species-specific differences in lung physiology of the upper airways and subsequently in local drug deposition were simulated and analyzed. In addition, a hybrid modeling methodology, combining Computational Fluid-Particle Dynamics (CF-PD) simulations with deterministic lung deposition models, was developed and predicted total and regional drug-aerosol depositions in lung airways of both mouse and man were compared, accounting for the geometric, kinematic and dynamic differences. Interestingly, our results indicate that the total particle deposition fractions, especially for submicron particles, are comparable in rodent and human respiratory models for corresponding breathing conditions. However, care must be taken when extrapolating a given dosage as considerable differences were noted in the regional particle deposition pattern. Combined with the deposition model, the particle retention and clearance kinetics of deposited nanoparticles indicates that the clearance rate from the mouse lung is higher than that in the human lung. In summary, the presented computer simulation models provide detailed fluid-particle dynamics results for upper lung airways of representative human and mouse models with a comparative analysis of particle lung deposition data, including a novel mice-to-men correlation as well as a particle-clearance analysis both useful for pharmacokinetic and toxicokinetic studies.

Submicron particle number doses in the human respiratory tract: implications for urban traffic and background environments

The deposition of ambient submicron particles in the different parts of the human respiratory tract (HRT) was, for the first time, estimated for males and females from different age classes (children-adults-seniors) of urban population in the city of Thessaloniki, northern Greece, during the cold and the warm period of the year. Outdoor daily and hourly particle number doses in the different regions of the HRT, i.e., the extra-thoracic (ET), tracheobronchial (TB), and the acinar (AC) regions, were calculated by employing the Multiple-Path Particle Dosimetry (MPPD) model. Because of the absence of information being available for the hygroscopic properties of particles, three different particle hygroscopicity scenarios were considered: (i) non-hygroscopic (i.e., raw model estimations), (ii) nearly hydrophobic, and (iii) hygroscopic particles. When hygroscopic properties were considered, we found a remarkable reduction (up to ~ 55%) in the estimated total particle number doses in comparison to the non-hygroscopic particle scenario. Furthermore, we found that the size distribution pattern of the particle doses within the different parts of the HRT was strongly affected by particles' hygroscopic properties with the non-hygroscopic particle scenario significantly overestimating the particle doses in the sub-100-nm range, while underestimating the doses of larger particles. On the contrary, the deposition density appeared to be negligibly affected by the particles' hygroscopic properties, implying the existence of a possible threshold in the number of particles deposited per airway surface area. Similarly, the lobar particle number deposition fraction was unaffected by the hygroscopic properties of particles, as well as the ambient particle size distribution and the individuals' physiological parameters. The total particle number deposition doses estimated here are within the range of the corresponding values reported for other urban environments. It is hoped that our findings could contribute to better understanding of submicron particle exposure and add to the development of more sufficient methods to evaluate the related health impacts.

Characterization particulate matter from several Chinese cooking dishes and implications in health effects

Cooking fume produced by oil and food at a high temperature releases large amount of fine particulate matter (PM) which have a potential hazard to human health. This chamber study investigated particle emission characteristics originated from using four types of oil (soybean oil, olive oil, peanut oil and lard) and different kinds of food materials (meat and vegetable). The corresponding emission factors (EFs) of number, mass, surface area and volume for particles were discussed. Temporal variation of size-fractionated particle concentration showed that olive oil produced the highest number PM concentration for the entire cooking process. Multiple path particle dosimetry (MPPD) model was performed to predict deposition in the human respiratory tract. Results showed that the pulmonary airway deposition fraction was the largest. It was also found that particles produced from olive oil led to the highest deposition. We strongly recommend minimizing the moisture content of ingredients before cooking and giving priority to the use of peanut oil instead of olive oil to reduce human exposure to PM.

Altered deposition of inhaled nanoparticles in subjects with chronic obstructive pulmonary disease

Background

Respiratory tract deposition of airborne particles is a key link to understand their health impact. Experimental data are limited for vulnerable groups such as individuals with respiratory diseases. The aim of this study is to investigate the differences in lung deposition of nanoparticles in the distal lung for healthy subjects and subjects with respiratory disease.

Methods

Lung deposition of nanoparticles (50 and 100 nm) was measured after a 10 s breath-hold for three groups: healthy never-smoking subjects (n = 17), asymptomatic (active and former) smokers (n = 15) and subjects with chronic obstructive pulmonary disease (n = 16). Measurements were made at 1300 mL and 1800 mL volumetric lung depth. Each subject also underwent conventional lung function tests, including post bronchodilator FEV₁, VC, and diffusing capacity for carbon monoxide, D_L,CO. Patients with previously diagnosed respiratory disease underwent a CT-scan of the lungs. Particle lung deposition fraction, was compared between the groups and with conventional lung function tests.

Results

We found that the deposition fraction was significantly lower for subjects with emphysema compared to the other subjects (p = 0.001–0.01), but no significant differences were found between healthy never-smokers and smokers. Furthermore, the particle deposition correlated with pulmonary function tests, FEV_1%Pred (p < 0.05), FEV₁/VC_%Pred (p < 0.01) and D_L,CO (p < 0.0005) when all subjects were included. Furthermore, for subjects with emphysema, deposition fraction correlated strongly with D_L,CO (Pearson’s r = 0.80–0.85, p < 0.002) while this correlation was not found within the other groups.

Conclusions

Lower deposition fraction was observed for emphysematous subjects and this can be explained by enlarged distal airspaces in the lungs. As expected, deposition increases for smaller particles and deeper inhalation. The observed results have implications for exposure assessment of air pollution and dosimetry of aerosol-based drug delivery of nanoparticles.

Fine and ultrafine particle doses in the respiratory tract from digital printing operations

In this study, we report for the first time particle number doses in different parts of the human respiratory tract and real-time deposition rates for particles in the 10 nm to 10 μm size range emitted by digital printing operations. Particle number concentrations (PNCs) and size distribution were measured in a typical small-sized printing house using a NanoScan scanning mobility particle sizer and an optical particle sizer. Particle doses in human lung were estimated applying a multiple-path particle dosimetry model under two different breathing scenarios. PNC was dominated by the ultrafine particle fractions (UFPs, i.e., particles smaller than 100 nm) exhibiting almost nine times higher levels in comparison to the background values. The average deposition rate fοr each scenario in the whole lung was estimated at 2.0 and 2.9 × 10⁷ particles min^-1, while the respective highest particle dose in the tracheobronchial tree (2.0 and 2.9 × 10⁹ particles) was found for diameter of 50 nm. The majority of particles appeared to deposit in the acinar region and most of them were in the UFP size range. For both scenarios, the maximum deposition density (9.5 × 10⁷ and 1.5 × 10⁸ particles cm^-2) was observed at the lobar bronchi. Overall, the differences in the estimated particle doses between the two scenarios were 30-40% for both size ranges.

Physical properties and lung deposition of particles emitted from five major indoor sources

The physical properties of indoor particles were measured with an Scanning Mobility Particle Sizer (SMPS) system (14.6-850 nm), an Aerodynamic Particle Sizer (APS, 0.54-18 μm) and an Hygroscopic Tandem Differential Mobility Analyzer (H-TDMA) in an apartment located in an urban background site in Prague (Czech Republic) from 15 August to 8 September, 2014. The total particle maximum number concentration was 9.38 × 10⁴, 1.46 × 10⁵, 2.89 × 10⁴, 2.25 × 10⁵ and 1.57 × 10⁶ particles cm^-3 for particles released from vacuum cleaning, soap/W5 cleaning spray, smoking, incense burning and cooking (frying) activities, respectively. Particles emitted from cleaning activities showed unimodal number size distributions, with the majority of particles (>98.2 %) in the ultrafine size range (Dp <100 nm) and modes at a diameter of 19.8 nm for vacuum cleaning and 30.6 nm for soap/W5 cleaning. Smoking and incense burning predominantly generated particles in the accumulation mode with a count median diameter around 90-150 nm while cooking emissions showed a bimodal structure with a main mode at 47.8 nm. Particles from vacuum cleaning, incense burning, smoking and cooking emissions were found to be "nearly hydrophobic" with an average growth factor (G_f) around 1.01-1.10, while particles emitted from desk cleaning using organic compounds were found to be "less-hygroscopic" (G_f ∼1.12-1.16). Based on an adjusted MPPD model with a consideration of the hygroscopic properties of particles, the total lung deposition fractions of these particles by number when they penetrate into the human lung were 0.73 ± 0.02, 0.62 ± 0.03, 0.37 ± 0.03, 0.32 ± 0.03 and 0.49 ± 0.02 for vacuum cleaning, desk cleaning, smoking, incense burning and cooking, respectively.

Lung deposition and clearance of microparticle and nanoparticle C60 fullerene aggregates in B6C3F1 mice and Wistar Han rats following nose-only inhalation for 13 weeks

C60 fullerenes (C60) are spherical structures consisting of 60 carbon atoms that are generated via combustion from both natural and anthropogenic sources. C60 are also synthesized intentionally for industrial applications. Individual C60 structures have an approximate diameter of 1nm; however, C60 readily forms aggregates and typically exist as larger particles that range from nanometers to micrometers in diameter. In this report, lung and extrapulmonary tissue deposition and lung clearance of C60 nanoparticles (nano-C60, 50nm) and microparticles (micro-C60, 1μm) were examined in Wistar Han rats and B6C3F1/N mice after nose-only inhalation for 90 days. Exposure concentrations were 0.5 and 2mg/m(3) (nano-C60) and 2, 15, and 30mg/m(3) (micro-C60). For both C60 particle sizes, the C60 lung burden increased proportionally to exposure concentration. The C60 lung burden was greater in both species at all time points following exposure to nano-C60 particle exposure compared to micro-C60 exposure at the common exposure concentration 2mg/m(3). The calculated C60 particle lung retention half-times were similar for both nano-C60 and micro-C60 exposure at 2mg/m(3) in male mice (15-16 days). In contrast, in male rats, the half-time of C60 particles following nano-C60 exposure (61 days) was roughly twice as long as the half-time following micro-C60 exposure (27 days) at the same exposure concentration (2mg/m(3)) and was similar to the clearance following micro-C60 exposure at higher exposure concentrations (15 and 30mg/m(3)). C60 was detected in bronchial lymph nodes but the burden was not quantified due to the high variability in the data. C60 concentrations were below the experimental limit of quantitation (ELOQ) in liver, spleen, blood, brain and kidney tissues. These tissue burden data provide information for comparison between nanometer and micrometer sized C60 particle exposure and will aid in the interpretation of toxicity data.

Toxicity and Pharmacokinetic Studies of Aerosolized Clinical Grade Azacitidine

BACKGROUND

Azacitidine as an effective epigenetic therapeutic agent has not been used as an aerosol form to treat lung cancer patients. We aerosolized clinical grade azacitidine (Aza), optimized the formulation, and studied its pharmacokinetics and toxicity in mice.

METHODS

Extrusion-precipitation method and DNA methyltransferase inhibition rate were used to measure the aerodynamic size and aerosolized Aza activity. In the single dose pharmacokinetic study, Aza concentrations in peripheral blood and lungs were measured by LC-MS method. In the multiple-dose toxicity studies, histo-pathological evaluation was used to determine the organ and bone marrow toxicities.

RESULTS

In pharmacokinetic study, aerosolized Aza was found to deposit mainly into the lung with very little drug detected in the circulation. In contrast, intravenously injected (IV) Aza resulted in a high Aza concentration in the peripheral blood, with trace amounts of drug in the lung, and it was associated with significant myelosuppression. No significant myelosuppression, pulmonary toxicity, hepatotoxicity, or nephrotoxicity were observed at a daily dose of 2.5 mg/m(2) for 7 days. Reversible lung inflammation was found in mice treated with 7.5 mg/m(2) aerosolized Aza at 3 but not 6 weeks after treatment.

CONCLUSIONS

Aerosol Aza aerodynamic size favors deposition of the drug to the human lower airways. The aerosol process do not compromise the drug activity. Aerosolized Aza has higher lung deposition and much less systemic toxicity than IV drug. The safe starting dose for clinical phase I trials should be 2.5 mg/m(2) for 5 to 7 days.

Can 'extrafine' dry powder aerosols improve lung deposition?

There is increasing interest in the use of so-called 'extrafine' aerosols to target the small airways in the management of asthma and COPD. Using previously presented deposition data, we assessed whether submicron (<1μm) particles can improve central and deep lung deposition. Our data show instead that particles in the range 1-3μm are much more relevant in this respect. Based on this finding the Symbicort Turbuhaler, Seretide Diskus, Rolenium Elpenhaler and Foster (Fostair) NEXThaler ICS/LABA combination DPIs were tested in vitro as a function of the pressure drop (2, 4 and 6kPa) across the inhaler. Obtained fine particle fractions (FPFs) <5μm (as percent of label claim) were divided into subfractions <1, 1-3 and 3-5μm. Differences of up to a factor of 4 were found between the best (Turbuhaler) and worst performing DPI (Elpenhaler), particularly for the FPF in the size range 1-3μm. The NEXThaler, described as delivering 'extrafine' particles, did not appear to be superior in this size range. The marked differences in amount and size distribution of the aerosols between the devices in this study must cause significant differences in the total lung dose and drug distribution over the airways.

Determinants of aerosol lung-deposited surface area variation in an urban environment

Ultrafine particles are characterized by a high surface area per mass. Particle surface has been reported to play a significant role in determining the toxicological activity of ultrafine particles. In light of this potential role, the time variation of lung deposited surface area (LDSA) concentrations in the alveolar region was studied at the urban background environment of Barcelona (Spain), aiming to asses which processes and sources govern this parameter. Simultaneous data on Black Carbon (BC), total particle number (N) and particle number size distribution were correlated with LDSA. Average LDSA concentrations in Barcelona were 37 ± 26 μm(2)cm(-3), levels which seem to be characteristic for urban environments under traffic influence across Europe. Results confirm the comparability between LDSA data provided by the online monitor and those calculated based on particle size distributions (by SMPS), and reveal that LDSA concentrations are mainly influenced by particles in the size range 50-200 nm. A set of representative daily cycles for LDSA concentrations was obtained by means of a k-means cluster technique. The contribution of traffic emissions to daily patterns was evidenced in all the clusters, but was quantitatively different. Traffic events under stable atmospheric conditions increased mean hourly background LDSA concentrations up to 6 times, attaining levels higher than 200 μm(2)cm(-3). However, under warm and relatively clean atmospheric conditions, the traffic rush hour contribution to the daily LDSA mean appeared to be lower and the contribution of new urban particle formation events (by photochemically induced nucleation) was detected. These nucleation events were calculated to increase average background LDSA concentrations by 15-35% (maximum LDSA levels=45-50 μm(2)cm(-3)). Thereby, it may be concluded that in the urban background of Barcelona road traffic is the main source increasing the aerosol surface area which can deposit on critical regions of the human lung, followed by nucleation episodes.

A study on particles and some microbial markers in waterpipe tobacco smoke

Waterpipe smoking is becoming increasingly popular worldwide. Research has shown that cigarette smoke, in addition to hundreds of carcinogenic and otherwise toxic compounds, may also contain compounds of microbiological origin. In the present study we analyzed waterpipe smoke for some microbial compounds. Both of the two markers studied, viz 3-hydroxy fatty acids of bacterial lipopolysaccharide (LPS) and ergosterol of fungal biomass, were found in waterpipe tobacco, in amounts similar as previously found in cigarette tobacco, and in smoke. Waterpipe mainstream smoke contained on average 1800 pmol LPS and 84.4 ng ergosterol produced per session. An average concentration of 2.8 pmol/m(3) of LPS was found in second hand smoke during a 1-2-h waterpipe smoking session while ergosterol was not detected; corresponding concentrations from smoking five cigarettes were 22.2 pmol/m(3) of LPS and 87.5 ng/m(3) of ergosterol. This is the first time that waterpipe smoking has been shown to create a bioaerosol. In the present study we also found that waterpipe smoking generated several polycyclic aromatic hydrocarbons, carbon monoxide, and high fraction of small (<200 nm) particles that may have adverse effects on human health upon inhalation.

Theoretical deposition of carcinogenic particle aggregates in the upper respiratory tract

BACKGROUND

Numerous particles suspended in the atmosphere are composed of smaller particular components that form aggregates with highly irregular shape. Such aggregates, among which dusts and soot are the most prominent examples, may be taken up into the respiratory tract and, in the worst case, initiate a malignant transformation of lung cells.

METHODS

Particle aggregates were theoretically modelled by using small spheres with equal diameters (1 nm) and arranging them randomly. This procedure resulted in the generation of various aggregate shapes (chain-like, loose, compact), for which essential parameters such as dynamic shape factors, χ, and aerodynamic diameters, dae , were computed. Deposition of aggregates consisting of 10, 50, 100, and 1,000 nano-spheres was simulated for the uppermost parts of the human respiratory system (extrathoracic region and airway generation 0 to 4), thereby distinguishing between sitting and light-work breathing as well as between nasal and oral inhalation.

RESULTS

Based upon the modelling results, aggregate deposition in the human respiratory system can be described as a function of (I) aerodynamic diameter; (II) inhaled particle position within the airway system; and (III) breathing conditions. Therefore, highest deposition values were obtained for nano-scale aggregates (<10 nm), whereas larger aggregates exhibited slightly to significantly reduced deposition probabilities. Extrathoracic regions and uppermost bronchi (generations 0 to 1) were marked by most effective particle capture. Any increase of inhaled air volumes and reduction of breathing times resulted in an enhancement of deposition probabilities of larger particles.

CONCLUSIONS

Based on the results derived from this study it may be concluded that small particle aggregates are accumulated in the uppermost compartments of the human respiratory tract, where they may unfold their unwholesome potential. In the case of carcinogenic particles being stored in epithelial cells for a longer time span, malignant transformations starting with the formation of cancerous cells and ending with the growth of a tumour have to be assumed.

The clinical relevance of dry powder inhaler performance for drug delivery

BACKGROUND

Although understanding of the scientific basis of aerosol therapy with dry powder inhalers (DPIs) has increased, some misconceptions still persist. These include the beliefs that high resistance inhalers are unsuitable for some patients, that extra fine (<1.0 μm) particles improve peripheral lung deposition and that inhalers with flow rate-independent fine particle fractions (FPFs) produce a more consistent delivered dose to the lungs.

OBJECTIVES

This article aims to clarify the complex inter-relationships between inhaler design and resistance, inspiratory flow rate (IFR), FPF, lung deposition and clinical outcomes, as a better understanding may result in a better choice of DPI for individual patients.

METHODS

The various factors that determine the delivery of drug particles into the lungs are reviewed. These include aerodynamic particle size distribution, the inspiratory manoeuvre, airway geometry and the three basic principles that determine the site and extent of deposition: inertial impaction, sedimentation and diffusion. DPIs are classed as either dependent or independent of inspiratory flow rate and vary in their internal resistance to inspiration. The effects of these characteristics on drug deposition in the airways are described using data from studies directly comparing currently available inhaler devices.

RESULTS

Clinical experience shows that most patients can use a high resistance DPI effectively, even during exacerbations. Particles in the aerodynamic size range from 1.5-5 μm are shown to be optimal, as particles <1.0 μm are very likely to be exhaled again while those >5 μm may impact on the oropharynx. For DPIs with a constant FPF at all flow rates, less of the delivered dose reaches the central and peripheral lung when the flow rate increases, risking under-dosing of the required medication. In contrast, flow rate-dependent inhalers increase their FPF output at higher flow rates, which compensates for the greater impaction on the upper airways as flow rate increases.

CONCLUSIONS

The technical characteristics of different inhalers and the delivery and deposition of the fine particle dose to the lungs may be important additional considerations to help the physician to select the most appropriate device for the individual patient to optimise their treatment.

Comparison of particulate matter dose and acute heart rate variability response in cyclists, pedestrians, bus and train passengers

Exposure to airborne particulate matter (PM) has been linked to cardiovascular morbidity and mortality. Heart rate variability (HRV) is a measure of the change in cardiac autonomic function, and consistent links between PM exposure and decreased HRV have been documented in studies. This study quantitatively assesses the acute relative variation of HRV with predicted PM dose in the lungs of commuters. Personal PM exposure, HR and HRV were monitored in 32 young healthy cyclists, pedestrians, bus and train passengers. Inhaled and lung deposited PM doses were determined using a numerical model of the human respiratory tract which accounted for varying ventilation rates between subjects and during commutes. Linear mixed models were used to examine air pollution dose and HRV response relationships in 122 commutes sampled. Elevated PM2.5 and PM10 inhaled and lung deposited doses were significantly (p<0.05) associated with decreased HRV indices. Percent declines in SDNN (standard deviation of normal RR intervals) relative to resting, due to an inter-quartile range increase in PM10 lung deposited dose were stronger in cyclists (-6.4%, 95% CI: -11.7, -1.3) and pedestrians (-5.8%, 95% CI: -11.3, -0.5), in comparison to bus (-3.2%, 95% CI: -6.4, -0.1) and train (-1.8%, -7.5, 3.8) passengers. A similar trend was observed in the case of PM2.5 lung deposited dose and results for rMSSD (the square root of the squared differences of successive normal RR intervals) followed similar trends to SDNN. Inhaled and lung deposited doses accounting for varying ventilation rates between modes, individuals and during commutes have been neglected in other studies relating PM to HRV. The findings here indicate that exercise whilst commuting has an influence on inhaled PM and PM lung deposited dose, and these were significantly associated with acute declines in HRV, especially in pedestrians and cyclists.