Journal of aerosol medicine and pulmonary drug delivery
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J Aerosol Med Pulm Drug Deliv · Mar 2008
ReviewInhaled prostanoids in the therapy of pulmonary hypertension.
Prostacyclin and prostacyclin analogues are potent vasodilators and possess antithrombotic, anti-inflammatory and antiproliferative properties. These properties qualify them as efficient drugs for the treatment of pulmonary hypertension, a life-threatening illness characterized by an increase in artery pressure and vascular resistance in the pulmonary circulation. Diseased pulmonary vessels show specific remodeling with intimal fibrosis, medial hypertrophy, and adventitial thickening, as well as functional changes characterized by vasoconstriction and in situ thrombosis. ⋯ Strategies for further improvement of inhaled prostanoid therapy include use of prostacyclin analogues with longer half-life (e.g., treprostinil), combinations with oral drugs (e.g., phosphodiesterase inhibitors or endothelin receptor antagonists) and development of aerosolized controlled release formulations such as liposomes and nanoparticles. The therapy with prostacyclin and its analogues is a main pillar in the treatment of pulmonary hypertension, giving new hope to many patients suffering from this terrible disease. With inhaled iloprost, a new drug has enlarged the scope of aerosol therapies for treatment of pulmonary and systemic diseases.
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J Aerosol Med Pulm Drug Deliv · Mar 2008
ReviewAerosolized antibiotics for non-cystic fibrosis bronchiectasis.
There are strong data supporting using the use of aerosolized antibiotics for the treatment of Gram-negative infections in patients with cystic fibrosis (CF). The regular use of aerosol tobramycin or colistin can decrease exacerbations of lung disease, decrease bacteria counts, and improve pulmonary function in persons with CF and Pseudomonas aeruginosa airway infection. Bronchiectasis is caused by reoccurring or continuous presence of bacteria in association with airway obstruction. ⋯ There have been only a few small studies of aerosolized antibiotics to treat pseudomonas infection in subjects with non-CF bronchiectasis. Unlike the CF experience, there does not seem to be an improvement of pulmonary function after treatment with aerosol tobramycin in this population despite a decreased sputum bacterial density and a trend toward a decrease in risk of hospitalization. Furthermore, the risk of adverse events such as bronchospasm may be more common in adults with non-CF bronchiectasis than reported in the CF population.
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J Aerosol Med Pulm Drug Deliv · Mar 2008
ReviewAppropriate face models for evaluating drug delivery in the laboratory: the current situation and prospects for future advances.
The laboratory evaluation of inhalers with facemasks for patient interface is so complex that testing without a facemask is generally undertaken, a practice that has been advocated in one standard. However, the facemask itself can profoundly influence medication delivery. A systematic review of the literature was undertaken to establish the development history of face models for the evaluation of facemasks used with inhalers and accessories. ⋯ However, it is necessary either to apply sealants or to compress the facemask beyond normal to eliminate leakage with the rigid facial structure that is incomplete above the bridge of the nose. An oral-breathing infant full-face model (ADAM) intended to be used to quantify emitted mass at the patient interface incorporates flexible facial features to overcome this limitation. There is a need to extend the flexible face approach to other models that may be developed in the future for testing facemasks, whether or not they incorporate anatomically correct realizations of the upper respiratory tract.