Abstract
In response to the unmet need for effective treatments for symptomatic patients, research efforts of inhaled therapy for COVID-19 patients have been pursued since the pandemic began. However, inhalation drug delivery to the lungs is sensitive to the lung anatomy and physiology, which can be significantly altered due to the viral infection. The ensued ventilation heterogeneity will change distribution and thus dosimetry of inhaled medications, rendering previous correlations concepts? of pulmonary drug delivery in healthy lungs less reliable. In this study, we first reviewed the recent developments of inhaled therapeutics and vaccines, as well as the latest knowledge of the lung structural variations documented by CT of COVID-19 patients' lungs. We then quantified the volume ratios of the poorly aerated lungs and non-aerated lungs in eight COVID-19 patients, which ranged 2-8% and 0.5-3%, respectively. The need to consider the diseased lung physiologies in estimating pulmonary delivery was emphasized. Diseased lung geometries with varying lesion sites and complexities were reconstructed using Statistical Shape Modeling (SSM). A new segmentation method was applied that could generate patient-specific lung geometries with an increased number of branching generations. The synergy of the CT-based lung segmentation and SSM-based airway variation showed promise for developing representative COVID-infected lung morphological models and investigating inhalation therapeutics in COVID-19 patients. Doi: 10.28991/SciMedJ-2021-0303-1 Full Text: PDF
Highlights
The SARS CoV-2 virus has caused the worst pandemic worldwide in nearly a century, which up to date (June 6, 2021) has led to 173.01 million confirmed cases and 3.727 million deaths, according to WHO Coronavirus (COVID19) Dashboard [1]
We first reviewed the recent developments of inhaled therapeutics and vaccines, as well as the latest knowledge of the lung structural variations documented by computed tomography (CT) of COVID-19 patients' lungs
The following sections will present the recent developments of inhaled therapies for COVID-19 patients, the physiological variations in COVID-19 patient’s lungs, the new need to intergrade these variations into the estimation of pulmonary dosimetry, and some latest developments in simulating lung structural remodeling and patient-specific lung reconstruction
Summary
The SARS CoV-2 virus has caused the worst pandemic worldwide in nearly a century, which up to date (June 6, 2021) has led to 173.01 million confirmed cases and 3.727 million deaths, according to WHO Coronavirus (COVID19) Dashboard [1]. The International Society of Aerosol Medicine (ISAM) deemed it an urgent need to rapidly develop inhaled therapies for COVID-19, which should consider the initial infection site, the disease progression route, and in particular the pulmonary alveoli where “cytokine storms” can cause a fatal cascade, including respiratory failure [2]. The following sections will present the recent developments of inhaled therapies for COVID-19 patients, the physiological variations in COVID-19 patient’s lungs, the new need to intergrade these variations into the estimation of pulmonary dosimetry, and some latest developments in simulating lung structural remodeling and patient-specific lung reconstruction
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