Aerosol Medicine Research Articles

Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation.

Many aerosol delivery devices are available on the market that have different features, characteristics, and operating requirements that need to be considered for the effective treatment of patients with pulmonary diseases. Device selection in aerosol medicine is largely patient dependent. Since there is no aerosol device that suits all patient populations, device selection and successful integration of the prescribed aerosol device to patients is essential. This article explores key issues in differential device selection in spontaneously breathing adults with or without artificial airways, as well as critically ill patients receiving invasive and noninvasive ventilation, with discussion of considerations for integration of aerosol devices to each of these patient populations.

Abstracts from The Aerosol Society Drug Delivery to the Lungs 25Edinburgh International Conference Centre Edinburgh, Scotland, UK December 10–12, 2014

Abstracts from The Aerosol Society Drug Delivery to the Lungs 25Edinburgh International Conference Centre Edinburgh, Scotland, UK December 10–12, 2014

Assessing New Technologies in Aerosol Medicine: Strengths and Limitations.

Aerosols are the mainstay of treatment for pulmonary diseases such as asthma, cystic fibrosis, and COPD. In addition, aerosols are also being used for systemic drug delivery. Patients need devices that are safe, reliable, portable, and easy to use; have few steps in their operation; help them keep track of the remaining doses; are not expensive; and provide age-appropriate positive reinforcement and feedback. Computational fluid dynamics, human factor sciences, and quality by design are now applied to device development. Matching patient, drug, and device remains a challenge. Formulary restrictions, the current status of the industry-academia relationship, and the need to use multiple platforms hinder the process. Patients and families need to participate in the selection of a device that is appropriate for them. Practitioners need comparative data to help them choose the right device. New devices and drugs can be compared with the existing technology using in vitro and in vivo methods (lung imaging, pharmacokinetic and pharmacodynamics studies). Drug manufacturers need to be able to justify coverage of new products by third-party payers by showing a positive cost/benefit relationship. Finally, post-market surveillance is necessary for old drugs with new devices or for new drugs and devices to ensure patient safety.

Imaging in Aerosol Medicine.

Imaging techniques have been used extensively to study the delivery of inhaled medications. Deposition scintigraphy involves the quantification of deposited aerosol dose and is performed using 2-dimensional planar or 3-dimensional positron emission tomography (PET) or single-photon-emission computed tomography (SPECT) imaging techniques. Planar techniques have an extensive history of use, and quantification methods are well established. SPECT and PET techniques can provide better dose localization, but quantification is more complex, and the techniques are in more limited use. Aerosols have also been used to deliver radiopharmaceutical probes for the imaging of lung physiology. These studies include measurements of ventilation, mucus and cough clearance, and, more recently, liquid absorption in the airways. Clearance measurements have been used to assess therapeutic response in conditions such as cystic fibrosis. Future directions in aerosol-based imaging are likely to include use of novel probes to measure new physiological processes in the lung, more thorough integration of anatomical imaging, and use of multiple probes to simultaneously image drug and disease or interacting physiological processes.

Aerosol Therapy in Pulmonary Critical Care.

Aerosolized medications are routinely used for the treatment of critically ill patients. This paper reviews aerosol delivery devices with a focus on issues related to their performance in pulmonary critical care. Factors affecting aerosol drug delivery to mechanically ventilated adults and spontaneously breathing patients with artificial airways are reviewed. Device selection, optimum device technique, and unmet medical needs of aerosol medicine in pulmonary critical care are also discussed.

Abstracts from The Aerosol Society Drug Delivery to the Lungs 22Edinburgh International Conference CentreEdinburgh, Scotland, UKDecember 7–9, 2011

Summary Background: In bronchial challenge testing lung deposition of the stimulus may be poorly controlled due to incorrect use of nebulisers. Furthermore, the need for freshly prepared solutions burdens personnel and budget. In this study we aim to develop a dry powder alternative with higher reproducibility, better stability and lower costs than the current nebulisation test. Methods: Different pharmacological stimuli in the solid state were characterised on physico-chemical properties to determine the optimal conditions for processing and storage and were tested on their potential for dry powder inhalation. Adenosine and methacholine were micronised and dispersed with the Twincer ™ dry powder inhaler (DPI). Laser diffraction technique was applied to measure particle size distributions in the aerosol clouds. Results: Adenosine allows processing under ambient conditions. It was mixed with a lactose carrier in various mass ratios to produce adhesive mixtures and nucleus agglomerates. With three formulations, almost the entire dose range could be delivered with the Twincer ™ DPI. However, the process of preparing nucleus agglomerates might not be suitable for upscaling. Currently, spherical pellets are investigated as a more robust alternative. Methacholine is very hygroscopic and should therefore not be exposed to a high relative humidity. The methacholine particles leaving the Twincer ™ had an appropriate particle size distribution for inhalation. However, inhaler retention was high and should be reduced by controlling processing and storage conditions. Conclusions: Dry powder adenosine and methacholine seem promising alternatives for nebulisation. Methacholine must be handled under dry conditions. The highest doses of adenosine require further fine tuning.

Standards for Lung Imaging Techniques

Journal of Aerosol Medicine and Pulmonary Drug DeliveryVol. 25, No. S1 Standardization of Lung Imaging Techniques for Aerosol Deposition Assessment of Orally Inhaled ProductsGuest Editor: Beth L.Laube, Ph.D.EditorialStandards for Lung Imaging TechniquesBeth L. Laube, Timothy E. Corcoran, Sunalene G. Devadason, Myrna B. Dolovich, John Fleming, and Stephen NewmanBeth L. LaubeJohns Hopkins University School of Medicine, Baltimore, Maryland.Search for more papers by this author, Timothy E. CorcoranUniversity of Pittsburgh, Pittsburgh, Pennsylvania.Search for more papers by this author, Sunalene G. DevadasonSchool of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.Search for more papers by this author, Myrna B. DolovichFaculty of Sciences, Michael de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada.Search for more papers by this author, John FlemingSouthampton University Hospitals NHS Trust, Southampton, United Kingdom.Search for more papers by this author, and Stephen NewmanScientific Consultant, Hunstanton, Norfolk, United Kingdom.Search for more papers by this authorPublished Online:5 Dec 2012https://doi.org/10.1089/jamp.2012.1Su1AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Standards for Lung Imaging Techniques." , 25(S1), pp. S-1–S-2FiguresReferencesRelatedDetailsCited byDesign of In Vivo Deposition and Clearance Experiments William D. Bennett11 October 2022 | Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 35, No. 5Controlled inhalation improves central and peripheral deposition in cystic fibrosis patients with moderate lung disease17 February 2022 | Journal of Paediatrics and Child Health, Vol. 58, No. 6Inhaled aerosols: Emerging clinical methodsDry powder inhalation: past, present and future30 August 2016 | Expert Opinion on Drug Delivery, Vol. 14, No. 4Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung Chantal Darquenne, John S. Fleming, Ira Katz, Andrew R. Martin, Jeffry Schroeter, Omar S. Usmani, Jose Venegas, and Otmar Schmid8 April 2016 | Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 29, No. 2Bioequivalence of inhaled drugs: fundamentals, challenges and perspectivesTherapeutic Delivery, Vol. 4, No. 3 Volume 25Issue S1Dec 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Beth L. Laube, Timothy E. Corcoran, Sunalene G. Devadason, Myrna B. Dolovich, John Fleming, and Stephen Newman.Standards for Lung Imaging Techniques.Journal of Aerosol Medicine and Pulmonary Drug Delivery.Dec 2012.S-1-S-2.http://doi.org/10.1089/jamp.2012.1Su1Published in Volume: 25 Issue S1: December 5, 2012PDF download

Lung Physiology and Aerosol Deposition Imaged with Positron Emission Tomography

Physiological conditions and pathophysiological changes in the lungs may affect many applications in aerosol medicine and pulmonary drug delivery. In the diseased lung, spatial heterogeneity in function and structure may cause substantial changes in aerosol transport and local deposition among different lung regions. Non-uniform aerosol deposition affects airway or tissue pharmacological dosing, which could reduce the therapeutic effectiveness of inhalation therapy. This review article presents examples of pulmonary imaging using PET and PET-CT in lung physiology with an emphasis on their implications for aerosol medicine. Measurements of regional ventilation, perfusion, and ventilation/perfusion ratio, by imaging local kinetics of intravenously injected Nitrogen-13 in saline solution, and of pulmonary inflammation, by assessing the regional uptake of the radiotracer (18)F-FDG, are presented. These examples demonstrate that it is possible to access both preexisting conditions, such as heterogeneity of ventilation, perfusion, and/or inflammatory stimuli, which may affect inhalation therapy, and the functional effects of inhaled medications or inflammatory agents on lung regional function. The imaging techniques described could be efficient tools to evaluate quantitatively and noninvasively these processes in vivo. Furthermore, it can be expected that imaging of respiratory structure and function will yield sensitive biomarkers of disease, which will help and speed drug discovery, and the evaluation of novel inhalation therapies.

Conference Report: the 18th Congress of the International Society for Aerosols in Medicine

The 18th biennial Congress of ISAM was held for 4 days at the De Doelen Congress Centre, Rotterdam, Netherlands, at which approximately 350 delegates, including 60 session chairs and speakers, attended. The abstracts of the 49 podium talks and the 126 posters that were presented have been published in the society's technical journal (journal of Aerosol Medicine and Pulmonary Delivery), and the detailed program can be found on the ISAM website (www.isam.org). Postgraduate courses on the topics: 'Inhalation Therapy at the Intensive Care Unit'; 'Walking the Standards Maze: Standards for Device Development, Device Performance and Regulatory Approval'; and 'Nuts and Bolts of Aerosol Delivery: Theory, Guidelines and Practice', were offered to participants prior to the Congress itself.

Knowledge of Oxygen Administration, Aerosol Medicine, and Chest Physiotherapy Among Pediatric Healthcare Workers in Italy

Oxygen administration, aerosol devices and drugs, or the use of chest physiotherapy are common practices in pediatrics; however, little is known about the knowledge of pediatric healthcare workers concerning the right utilization of these tools. The aim of this study was to fill this gap as a preliminary step in the implementation of appropriate educational programs. This cross-sectional survey of a nationally representative sample of Italian pediatricians and nurses was carried out between September 1 and October 8, 2008. A self-administered, anonymous questionnaire concerning the approach to respiratory disease in infants and children was distributed to all of the participants at the Annual Congress of the Italian Society of Pediatrics, together with a stamped envelope addressed to the trained study researchers. Of the 900 distributed questionnaires, 76.7% were completed and returned by 606 physicians (199 primary care pediatricians, 245 hospital pediatricians, and 162 pediatric residents) and 84 pediatric nurses. The vast majority of the respondents did not know the percentage of hemoglobin saturation indicating hypoxemia that requires oxygen administration. Most of the nurses admitted to overusing mucolytics and inhalatory corticosteroids, did not know the role of ipratropium bromide, were unable to indicate the first-line drug for respiratory distress, and did not know the correct dose of salbutamol. Only a minority of the respondents were able to specify the indications for chest physiotherapy. The nurses gave the fewest correct answers regardless of their age, gender, work setting, or the frequency with which they cared for children with respiratory distress in a year cared. The knowledge of primary care pediatricians, hospital pediatricians, and pediatric nurses in Italy concerning the use of pulse oximetry, aerosol devices and drugs, and chest physiotherapy is far from satisfactory and should be improved. Educational programs are therefore required for both nurses and pediatricians.

Introduction 1000 Years of Pharmaceutical Aerosols: What Remains to Be Done?

Introduction 1000 Years of Pharmaceutical Aerosols: What Remains to Be Done?

Personalizing Aerosol Medicine: Development of Delivery Systems Tailored to the Individual

Inhalation of drugs for therapeutic effects is not a recent innovation as illicit drugs have been 'smoked' for millennia. Nicotine delivery 'devices' in convenient packaged cartons of cigarettes are simple to use, inexpensive per dose and accessible to people of most ages and lung function, but of course their use leads to increased cancer, emphysema, heart disease and other medical and societal problems. In contrast, many inhalation pharmaceutical medical devices are expensive, nonportable, inconvenient, and/or are used improperly thus leading to poor therapeutic benefit. We review the current state of the art with respect to aerosol delivery, inhalation devices and the ability to personalize the treatment and management of lung disease. The confluence of many drivers will lead to more programmable and flexible devices in the future: the transition from the blockbuster model to customized therapy, technological advancements (e.g., smartphones) and cultural changes including social networking.

Nanoparticles in Medicine and Environment: Inhalation and Health Effects

Journal of Aerosol Medicine and Pulmonary Drug DeliveryVol. 23, No. 5 Book ReviewNanoparticles in Medicine and Environment: Inhalation and Health EffectsJan Marijnissen and Leon GradońJan MarijnissenSearch for more papers by this author and Leon GradońSearch for more papers by this authorPublished Online:12 Oct 2010https://doi.org/10.1089/jamp.2010.br01AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byToxicity and Regulatory Concerns for Nanoformulations in Medicine19 March 2020Preparation of Nanoscale Pulmonary Drug Delivery Formulations by Spray Drying10 March 2014Determination of exposure to engineered carbon nanoparticles using a self-sensing piezoresistive silicon cantilever sensor6 January 2012 | Microsystem Technologies, Vol. 18, No. 7-8Cleaning of structured templates from nanoparticle accumulation using silicone16 November 2011 | Microsystem Technologies, Vol. 18, No. 7-8Low-weight electrostatic sampler for airborne nanoparticlesA resonant cantilever sensor for monitoring airborne nanoparticles Volume 23Issue 5Oct 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Jan Marijnissen and Leon Gradoń.Nanoparticles in Medicine and Environment: Inhalation and Health Effects.Journal of Aerosol Medicine and Pulmonary Drug Delivery.Oct 2010.339-341.http://doi.org/10.1089/jamp.2010.br01Published in Volume: 23 Issue 5: October 12, 2010Online Ahead of Print:August 30, 2010PDF download

The Pharmaceutical Aerosol Deposition Device on Cell Cultures (PADDOCC) In Vitro System: Design and Experimental Protocol

The development of aerosol medicines typically involves numerous tests on animals, due to the lack of adequate in vitro models. A new in vitro method for testing pharmaceutical aerosol formulations on cell cultures was developed, consisting of an aerosolisation unit fitting a commercial dry powder inhaler (HandiHaler(c), Boehringer Ingelheim, Germany), an air-flow control unit (Akita(c), Activaero, Germany) and a custom-made sedimentation chamber. This chamber holds three Snapwell(c) inserts with monolayers of pulmonary epithelial cells. The whole set-up, referred to as the Pharmaceutical Aerosol Deposition Device On Cell Cultures (PADDOCC) system, aims to mimic the complete process of aerosol drug delivery, encompassing aerosol generation, aerosol deposition onto pulmonary epithelial cells and subsequent drug transport across this biological barrier, to facilitate the investigation of new aerosol formulations in the early stages of development. We describe here, the development of the design and the protocol for this device. By testing aerosol formulations of budesonide and salbutamol sulphate, respectively, reproducible deposition of aerosol particles on, and the integrity of, the pulmonary cell monolayer could be demonstrated.

Medical aerosols: ins and outs of inhalation therapy

Summary The “Medical aerosols: ins and outs of inhalation therapy” ERS School Course was held in Amsterdam, the Netherlands in November 2009. The course aimed to provide state-of-the-art knowledge in understanding basic aerosol science, key issues of treating diseased airways, patient-related factors influencing efficacy of aerosol therapy and specific pharmacokinetic/dynamic issues related to aerosol medicine. The course also emphasised regulatory issues and important factors on how to instruct and monitor the technical skills of patients. ERS School Courses are aimed at all health professionals within the respiratory field and provide participants with high-quality information and hands-on session, leading to improvements in the daily clinical practice of all attendants. An important aspect of School Courses is the chance for delegates to meet and discuss their current clinical problems with experts in the field and also network with other delegates and make new contacts from around the world. This review gives the perspectives of two delegates from the course working in the field of aerosol medicine.

Metered-dose inhaler efficiency enhancement: A case study and novel design

The efficiency of the metered-dose inhaler (MDI) is a critical issue in aerosol medicine because it deals with delivering a life-saving medication to patients with various lung diseases. Mouthpiece diameter, air flow rate, and entrance angle are among many parameters that influence the MDI penetration efficiency. It is well known that inertial impaction accounts for the massive aerosol deposition in the oral airway. In this study, the authors present a novel simple modification of the inhaler mouthpiece using a wire-based jet depressor to reduce the inertial impaction of aerosols. A 0.5 mm diameter wire is placed inside the MDI mouthpiece at a distance of 2 mm in front of the MDI nozzle. Two mouthpieces were modified and employed in the experiments (16 and 20 mm). The penetration efficiencies are measured and the results of the modified mouthpiece are compared with the conventional mouthpiece. The experiments are conducted at three different air flow rates (30, 60, and 90 L/min) and five entrance/spray angles (0°, 10°, 20°, 30°, and 40°). The results show that the new modified mouthpiece has higher aerosol penetration efficiency than the ones with the conventional mouthpiece. A second type of experiment is conducted to evaluate the relative strength of the aerosol impaction.

Performance of PARI eFlow®To the Editor

Journal of Aerosol Medicine and Pulmonary Drug DeliveryVol. 23, No. 2 CorrespondencePerformance of PARI eFlow®To the EditorWalter PerkinsWalter PerkinsSearch for more papers by this authorPublished Online:12 Apr 2010https://doi.org/10.1089/jamp.2009.Cor1AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Performance of PARI eFlow®To the Editor." , 23(2), pp. 113–114FiguresReferencesRelatedDetailsCited byMesh nebulizers have become the first choice for new nebulized pharmaceutical drug developmentsTherapeutic Delivery, Vol. 9, No. 2Nebulized drug delivery in respiratory medicine: what does the future hold?Therapeutic Delivery, Vol. 8, No. 6Inhaled antimicrobial therapy – Barriers to effective treatmentAdvanced Drug Delivery Reviews, Vol. 85Personalizing aerosol medicine: development of delivery systems tailored to the individualTherapeutic Delivery, Vol. 1, No. 5 Volume 23Issue 2Apr 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Walter Perkins.Performance of PARI eFlow®To the Editor.Journal of Aerosol Medicine and Pulmonary Drug Delivery.Apr 2010.113-114.http://doi.org/10.1089/jamp.2009.Cor1Published in Volume: 23 Issue 2: April 12, 2010PDF download

Editor's Note

Journal of Aerosol Medicine and Pulmonary Drug DeliveryVol. 23, No. s1 The I-neb Adaptive Aerosol Delivery (AAD) System: Technology, In Vitro Characterization, and Results from Clinical StudiesFree AccessEditor's NoteG.C. SmaldoneG.C. SmaldoneSearch for more papers by this authorPublished Online:7 Apr 2010https://doi.org/10.1089/jamp.2010.Edn01AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This is the first supplement in the Journal since 2007. Supported by Philips Respironics, it focuses on the development and use of the I-neb Adaptive Aerosol Delivery (AAD) System, a so-called “smart nebulizer.” In the medical literature, supplements have often been used as forums for groups who want to make a specific point, and commonly by industry to focus readership on a drug or device. Articles could be ghost written, commercially biased, and published without peer review. Journal of Aerosol Medicine and Pulmonary Drug Delivery has always aspired to the highest standards of editorial excellence, and all supplements that have been published in the Journal have undergone careful editorial scrutiny.In the last few years, a national awareness of the potential for conflict of interest has grown, casting a pall over industry sponsorship. If we are to move forward and away from this environment, it seems short sighted to think that academic and scientific advancement must always be divorced from industry. The position of the Journal is that full disclosure and peer review are key components of any solution. The readership must be able to make informed choices, knowing who actually did the work, wrote the article, and, in the JAMPDD, the reader will know who reviewed the article. The articles in this supplement, like any publication offering information endorsed by this Editorial Office as original and important for our readership, are accompanied by full disclosure and peer review.Author Disclosure StatementThe Editor presently serves as a consultant to Pari, Philips Respironics, and Crosstex, and could benefit from licensed patents to Pari, Nektar, and Philips Respironics.FiguresReferencesRelatedDetails Volume 23Issue s1Apr 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:G.C. Smaldone.Editor's Note.Journal of Aerosol Medicine and Pulmonary Drug Delivery.Apr 2010.i-i.http://doi.org/10.1089/jamp.2010.Edn01Published in Volume: 23 Issue s1: April 7, 2010PDF download

International Society for Aerosols in Medicine, 17th Congress, 10 – 14 May 2009, Monterey, California, USA

The 17th biennial congress of the International Society for Aerosols in Medicine (ISAM) was held in Monterey, California, between 10 and 14 May 2009. The congress was attended by ∼ 300 delegates from 18 countries. Podium presentations were focused on advances in pulmonary drug delivery, but clearance of materials from the lungs by a variety of processes and the potential harmful effects of inhaled particles were also covered. There were > 100 proffered posters, and a commercial exhibition in which 20 companies displayed their products. There were excellent networking opportunities, and the inauguration of more formal networking groups will allow dialogue to continue. s of podium and poster presentations were provided in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, and it is likely that some of the podium presentations will appear as full papers in that journal in due course. The next conference in this series takes place in Rotterdam, The Netherlands, in June 2011.

Sizing Evaporative Aerosols: The “Man with Too Many Watches” Dilemma

Journal of Aerosol Medicine and Pulmonary Drug DeliveryVol. 22, No. 1 EditorialsSizing Evaporative Aerosols: The “Man with Too Many Watches” DilemmaWilliam D. Bennett and Kirby L. ZemanWilliam D. BennettSearch for more papers by this author and Kirby L. ZemanSearch for more papers by this authorPublished Online:6 Mar 2009https://doi.org/10.1089/jamp.2008.0732AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Sizing Evaporative Aerosols: The “Man with Too Many Watches” Dilemma." , 22(1), pp. 3–4FiguresReferencesRelatedDetailsCited byAerodynamic characteristics of nebulized terbutaline sulphate using the Andersen Cascade Impactor compared to the Next Generation Impactor25 January 2010 | Pharmaceutical Development and Technology, Vol. 16, No. 2International Society for Aerosols in Medicine, 17th Congress, 10 – 14 May 2009, Monterey, California, USA28 July 2009 | Expert Opinion on Drug Delivery, Vol. 6, No. 8 Volume 22Issue 1Mar 2009 InformationMary Ann Liebert, Inc.To cite this article:William D. Bennett and Kirby L. Zeman.Sizing Evaporative Aerosols: The “Man with Too Many Watches” Dilemma.Journal of Aerosol Medicine and Pulmonary Drug Delivery.Mar 2009.3-4.http://doi.org/10.1089/jamp.2008.0732Published in Volume: 22 Issue 1: March 6, 2009PDF download