Comparison of clearance of particles inhaled with bolus and extremely slow inhalation techniques

ICRP Publication 130: Occupational Intakes of Radionuclides: Part 1

This report is the first in a series of reports replacing Publications 30 and 68 to provide revised dose coefficients for occupational intakes of radionuclides by inhalation and ingestion. The revised dose coefficients have been calculated using the Human Alimentary Tract Model (Publication 100) and a revision of the Human Respiratory Tract Model (Publication 66) that takes account of more recent data. In addition, information is provided on absorption into blood following inhalation and ingestion of different chemical forms of elements and their radioisotopes. In selected cases, it is judged that the data are sufficient to make material-specific recommendations. Revisions have been made to many of the models that describe the systemic biokinetics of radionuclides absorbed into blood, making them more physiologically realistic representations of uptake and retention in organs and tissues, and excretion. The reports in this series provide data for the interpretation of bioassay measurements as well as dose coefficients, replacing Publications 54 and 78. In assessing bioassay data such as measurements of whole-body or organ content, or urinary excretion, assumptions have to be made about the exposure scenario, including the pattern and mode of radionuclide intake, physical and chemical characteristics of the material involved, and the elapsed time between the exposure(s) and measurement. This report provides some guidance on monitoring programmes and data interpretation.

Uncertainties on lung doses from inhaled plutonium

In a recent epidemiological study, Bayesian uncertainties on lung doses have been calculated to determine lung cancer risk from occupational exposures to plutonium. These calculations used a revised version of the Human Respiratory Tract Model (HRTM) published by the ICRP. In addition to the Bayesian analyses, which give probability distributions of doses, point estimates of doses (single estimates without uncertainty) were also provided for that study using the existing HRTM as it is described in ICRP Publication 66; these are to be used in a preliminary analysis of risk. To infer the differences between the point estimates and Bayesian uncertainty analyses, this paper applies the methodology to former workers of the United Kingdom Atomic Energy Authority (UKAEA), who constituted a subset of the study cohort. The resulting probability distributions of lung doses are compared with the point estimates obtained for each worker. It is shown that mean posterior lung doses are around two- to fourfold higher than point estimates and that uncertainties on doses vary over a wide range, greater than two orders of magnitude for some lung tissues. In addition, we demonstrate that uncertainties on the parameter values, rather than the model structure, are largely responsible for these effects. Of these it appears to be the parameters describing absorption from the lungs to blood that have the greatest impact on estimates of lung doses from urine bioassay. Therefore, accurate determination of the chemical form of inhaled plutonium and the absorption parameter values for these materials is important for obtaining reliable estimates of lung doses and hence risk from occupational exposures to plutonium.

Mucociliary and cough clearance as a biomarker for therapeutic development

A workshop/symposium on “Mucociliary and Cough Clearance (MCC/CC) as a Biomarker for Therapeutic Development” was held on October 21–22, 2008, in Research Triangle Park, NC, to discuss the methods for measurement of MCC/CC and how they may be optimized for assessing new therapies designed to improve clearance of airway secretions from the lungs. The utility of MCC/CC as a biomarker for disease progression and therapeutic intervention is gaining increased recognition as a valuable tool in the clinical research community. A number of investigators currently active in using MCC/CC for diagnostic or therapeutic evaluation presented details of their methodologies. Attendees participating in the workshop discussions included those interested in the physiology of MCC/CC, some of who use in vitro or animal methods for its study, pharmaceutical companies developing muco-active therapies, and many who were interested in establishing the methods in their own clinical laboratory. This review article summarizes the presentations for the in vivo human MCC/CC methods and the discussions both at and subsequent to the workshop between the authors to move forward on a number of questions raised at the workshop.

New developments in aerosol dosimetry

Dosimetry provides information linking environmental exposures to sites of deposition, removal from these sites, and translocation of deposited materials. Dosimetry also aids in extrapolating laboratory animal and in vitro data to humans. Recent progress has shed light on: properties of particles in relation to their fates in the body; influence of age, gender, body size, and lung diseases on inhaled particle doses; particle movement to the brain via the olfactory nerves; and particle deposition hot spots in the respiratory tract. Ultrafine size has emerged as an important dosimetric characteristic. Particle count, composition, and surface properties are recognized as potentially important toxicology-related considerations. Differences in body size influence airway sizes, inhaled particle deposition, specific ventilation, and specific doses (e.g. per unit body mass). Related to body size, age, gender, species, and strain are also dosimetric considerations. Diseases, such as chronic obstructive pulmonary disease (COPD) and bronchitis, produce uneven doses within the respiratory tract. Traditional concepts of the translocation and clearance of deposited particles have been challenged. Ultrafine particles can translocate to the brain via olfactory nerves, and from the lung to other organs. The clearance rates of particles from tracheobronchial airways are slowed by respiratory tract infections, but newer evidence implies that slow particle clearance from this region also exists in healthy lungs. Finally, hot spots of particle deposition are seen in hollow models, lung tissue, and dosimetric simulations. Local doses to groups of epithelial cells can be much greater than those to surrounding cells. The new insights challenge dosimetry scientists.

Plutonium worker dosimetry

Epidemiological studies of the relationship between risk and internal exposure to plutonium are clearly reliant on the dose estimates used. The International Commission on Radiological Protection (ICRP) is currently reviewing the latest scientific information available on biokinetic models and dosimetry, and it is likely that a number of changes to the existing models will be recommended. The effect of certain changes, particularly to the ICRP model of the respiratory tract, has been investigated for inhaled forms of (239)Pu and uncertainties have also been assessed. Notable effects of possible changes to respiratory tract model assumptions are (1) a reduction in the absorbed dose to target cells in the airways, if changes under consideration are made to the slow clearing fraction and (2) a doubling of absorbed dose to the alveolar region for insoluble forms, if evidence of longer retention times is taken into account. An important factor influencing doses for moderately soluble forms of (239)Pu is the extent of binding of dissolved plutonium to lung tissues and assumptions regarding the extent of binding in the airways. Uncertainty analyses have been performed with prior distributions chosen for application in epidemiological studies. The resulting distributions for dose per unit intake were lognormal with geometric standard deviations of 2.3 and 2.6 for nitrates and oxides, respectively. The wide ranges were due largely to consideration of results for a range of experimental data for the solubility of different forms of nitrate and oxides. The medians of these distributions were a factor of three times higher than calculated using current default ICRP parameter values. For nitrates, this was due to the assumption of a bound fraction, and for oxides due mainly to the assumption of slower alveolar clearance. This study highlights areas where more research is needed to reduce biokinetic uncertainties, including more accurate determination of particle transport rates and long-term dissolution for plutonium compounds, a re-evaluation of long-term binding of dissolved plutonium, and further consideration of modeling for plutonium absorbed to blood from the lungs.

Uncertainty analysis of doses from inhalation of depleted uranium

Measurements of uranium excreted in urine have been widely used to monitor possible exposures to depleted uranium (DU). This paper describes a comprehensive probabilistic uncertainty analysis of doses determined retrospectively from measurements of DU in urine. Parametric uncertainties in the International Commission on Radiological Protection (ICRP) Human Respiratory Tract Model (HRTM) and ICRP systemic model for uranium were considered in the analysis, together with uncertainties in an alternative model for particle removal from the lungs. Probability distributions were assigned to HRTM parameters based on uncertainties documented in ICRP Publication 66 and elsewhere, including the Capstone study of aerosols produced after DU penetrator impacts. Uncertainties in the uranium systemic model were restricted to transfer rates having the greatest effect on urinary excretion, and hence retrospective dose assessments, over the measurement times considered (10-10(4) d). The overall uncertainty on dose (the ratio of the upper and lower quantiles, q0.975/q0.025) was estimated to be about a factor of 50 at 10 days after intake and about a factor of 10 at 10(3)-10(4) d. The dose to the lung dominated the committed effective dose, with the lung absorption parameters, particularly the slow dissolution rate, ss, dominating the overall uncertainty. The median dose determined from a measurement of 1 ng DU, collected in urine in a 24-h period, varied from 0.1 microSv at 10 d to about 1 mSv at 10(4) d. Despite the large uncertainties, the upper q0.975 quantile for the assessed dose was below 1 mSv up to 5,000 d.

Effect of particle size on slow particle clearance from the bronchial tree

The Human Respiratory Tract Model of the International Commission on Radiological Protection assumes that a fraction of particles deposited in the bronchial tree clears slowly, this fraction decreasing with increasing particle geometric diameter. To test this assumption, volunteers inhaled 5-microm aerodynamic diameter 111In-polystyrene and 198Au-gold particles simultaneously, as a 'bolus' at the end of each breath to minimize alveolar deposition. Because of the different densities (1.05 versus 19.3 g cm3), geometric diameters were about 5 and 1.2 microm, respectively, and corresponding predicted slowly cleared fractions were about 10% and 50%. However, lung retention of the 2 particles was similar in each subject. Retention at 24 hours, as a percentage of initial lung deposit (mean +/- SD) was 34 +/- 12 for polystyrene and 31 +/- 11 for the gold particles.

The Effect of Biphasic Inhalation Profiles on The Deposition And Clearance of Coarse (6.5 μ m) Bolus Aerosols

The influence of particle size upon deposition in the human airways is well understood. Pharmaceutical aerosol formulators strive to generate fine aerosols with the potential to penetrate into the deep lung. However, flow rate can also have a major influence on deposition, particularly with coarse aerosols. This study investigated the use of biphasic flow profiles with low flow in the proximal conducting airway as a means of effecting efficient delivery of a coarse aerosol. The study shows that 6.5-microm MMAD aerosol droplets can be deposited in the lung with high efficiency. The delivery technique achieved greater than 70% of the inhaled dose deposited in the whole lung and greater than 50% deposited in the lung periphery. Furthermore, the biphasic flow profiles used, with initial low flow segments of between 300 mL and 900 mL inhaled volume at 8 L/min, are practical flow regimens that should be acceptable to patients and that can be applied to single-breath dry powder inhalers. Twenty-four-hour clearance and Penetration Index measurements were used as a marker for peripheral deposition, and the data show a clear correlation between Penetration Index and 24-h retention.

Long-term clearance from small airways in subjects with ciliary dysfunction

The objective of this study was to investigate if long-term clearance from small airways is dependent on normal ciliary function.

Six young adults with primary ciliary dyskinesia (PCD) inhaled ¹¹¹ Indium labelled Teflon particles of 4.2 μm geometric and 6.2 μm aerodynamic diameter with an extremely slow inhalation flow, 0.05 L/s. The inhalation method deposits particles mainly in the small conducting airways. Lung retention was measured immediately after inhalation and at four occasions up to 21 days after inhalation. Results were compared with data from ten healthy controls. For additional comparison three of the PCD subjects also inhaled the test particles with normal inhalation flow, 0.5 L/s, providing a more central deposition. The lung retention at 24 h in % of lung deposition (Ret₂₄) was higher (p < 0.001) in the PCD subjects, 79 % (95% Confidence Interval, 67.6;90.6), compared to 49 % (42.3;55.5) in the healthy controls. There was a significant clearance after 24 h both in the PCD subjects and in the healthy controls with equivalent clearance. The mean Ret₂₄ with slow inhalation flow was 73.9 ± 1.9 % compared to 68.9 ± 7.5 % with normal inhalation flow in the three PCD subjects exposed twice. During day 7–21 the three PCD subjects exposed twice cleared 9 % with normal flow, probably representing predominantly alveolar clearance, compared to 19 % with slow inhalation flow, probably representing mainly small airway clearance.

This study shows that despite ciliary dysfunction, clearance continues in the small airways beyond 24 h. There are apparently additional clearance mechanisms present in the small airways.

Stochastic model of particle clearance in human bronchial airways

A stochastic bronchial clearance model, based on a stochastic morphometric model of the human bronchial tree, has been developed, which simulates the combined action of fast and slow bronchial clearance mechanisms by Monte Carlo methods. To model fast bronchial clearance, mucus velocities in individual airways were based on a correlation between mucus velocity and airway diameter, considering conservation of mucus flow. In addition, mucus transport was assumed to be delayed at bronchial bifurcation zones. The size dependence of the slow bronchial clearance phase was considered by a linear relationship between the slow bronchial clearance fraction, f(s), and the geometric particle diameter, derived from bolus inhalation experiments. Potential variations of f(s) from proximal to distal airway generations were simulated by five different scenarios, which allocated slow bronchial clearance to successively peripheral bronchial regions. Alveolar clearance, which contributes only to longterm particle retention, was modeled by transfer rates supplied by the ICRP respiratory tract model. To test the different components of the clearance model, modeling predictions were compared with experimental retention data from bolus inhalation experiments, using various particle sizes and bolus front depths, as well as from slow inhalation experiments, with a flow rate of only 0.045 L sec(-1). The overall good agreement between modeling results and experimental data indicate that the present model correctly predicts bronchial clearance, suggesting that slow bronchial clearance mechanisms are most effective in smaller bronchial airways.

Inhalation and deposition of nebulized sodium cromoglycate in two different particle size distributions in children with asthma

The relative deposition of two inhaled droplet size distributions of sodium cromoglycate produced by a Hudson Updraft II nebulizer was evaluated, using a setup modified from the proposed Comité Européen Normalisé (CEN) standard prEN 13544-1. The modified setup comprised an Andersen 296 impactor and a Spira Electro 2 dosimeter. The setup was characterized prior to use in children with sodium cromoglycate (SCG) and sodium fluoride as tracer aerosol. The main in vivo study was designed to allow nine children with a mean age of 10 years to inhale SCG aerosol at two different relative humidities (RH), a high RH (> 90%) and a low RH (13%), which in turn resulted in two different droplet size distributions. The nebulizer/dosimeter was set to provide 1-sec nebulization during 50 inhalations. Throughout the exposures, the children were instructed to inhale in a consistent manner with target tidal volumes (0.5 L) and inhalation flows (0.4 L/sec). Blood samples were taken at predefined time intervals, and the area under the curve (AUC) was calculated. A lung deposition program, TGLD2, was used to calculate the expected deposition, using the droplet sizes and inhalation parameters obtained during in vivo exposures. The in vivo monitoring of droplet size distribution during the exposure showed that the low, intermediate (room air), and high RHs gave a mean droplet size distribution with a mass median aerosol diameter (MMAD) of 1.2, 1.7, and 2.0 microm, respectively. The average tidal volume over all exposures was 0.51 +/- 0.12 L. The total deposition fraction was 33.4% of the estimated nebulizer output. A correlation was found between tidal volume and the calculated deposited fraction. The results indicate that there is a difference in total deposition, depending on the size of the droplet size distribution, with the larger droplet size distribution (MMAD, 2.0 microm) having a higher total deposition than the smaller droplet size distribution (MMAD, 1.2 microm). The deposition results were in good agreement with the deposition fractions estimated using the TGLD2 software for the inhalation parameters found in the study. The obtained study results can arise from differences in regional deposition, but may also be explained by differences in extrathoracic deposition.