Validating deposition models in disease: what is needed?

Using Filters to Estimate Regional Lung Deposition with Dry Powder Inhalers

PURPOSE

To develop an in vitro method to rapidly evaluate regional lung doses delivered by pharmaceutical inhalers. Currently, cascade impactor measurements are used, but these are resource intensive and require significant post processing of in vitro data to arrive at regional deposition estimates.

METHODS

We present a specialized filter apparatus that mimics tracheobronchial (TB) deposition of pharmaceutical aerosols emitted by commercially available dry powder inhalers (DPIs). The filter housing includes an electrostatic neutralizer to eliminate artificial electrostatic filtration effects. Regional deposition (tracheobronchial and alveolar) for four DPIs (Onbrez Breezhaler, Flovent Diskus, Pulmicort Turbuhaler, and Asmanex Twisthaler) was estimated using cascade impactor measurements and an in silico regional deposition model. These estimates were compared to direct measurements of regional deposition as provided by the TB filter mimic and an absolute filter placed downstream of the TB filter housing, representing the alveolar dose.

RESULTS

The two methods were shown to provide similar estimates of extrathoracic, tracheobronchial, and alveolar deposition, as well as total recovery of active pharmaceutical ingredients.

CONCLUSIONS

Because of its design, the TB filter apparatus makes it possible to estimate regional deposition with inhalers directly using variable inhalation profiles without any additional equipment or changes to the experimental configuration. This method may be useful to expedite development of both innovative and generic drug products as it provides regional respiratory tract deposition estimates using fewer resources than exisiting methods.

Controlled, Parametric, Individualized, 2-D and 3-D Imaging Measurements of Aerosol Deposition in the Respiratory Tract of Asthmatic Human Subjects for Model Validation

BACKGROUND

Computer modeling is used to predict inhaled aerosol deposition in the lung based on definition of the aerosol characteristics and the breathing pattern and airway anatomy of the subject. Validation of the models is limited by the lack of detailed experimental data. Three-dimensional imaging provides an opportunity to address this unmet need.

METHODS

Radioactive aerosol was administered to six male asthmatic subjects on two occasions under carefully monitored input conditions. Input parameters varied in particle size, depth of breathing, and carrier gas. The aerosol distribution was measured by combined single photon emission computed tomography and x-ray computer tomography (SPECT/CT) and airway anatomy by high resolution CT. The deposition distribution was measured by both a 2D and 3D analysis and described in terms of the percentage of inhaled aerosol deposited in sections of the respiratory tract and in both spatial and anatomical subdivisions within each lung. The percentage deposition in the conducting airways was also assessed by 24 h clearance.

RESULTS

A set of imaging data of aerosol deposition has thus been produced in which the input parameters of inhalation are well described. The results in asthmatics were compared to previous measurements in healthy controls using an identical inhalation protocol. The percentages of deposition in extra-thoracic and thoracic compartments of the airways were not significantly affected by disease, but the regional pulmonary deposition pattern was, with asthma leading to increased deposition in the conducting airways.

CONCLUSIONS

The dataset acquired in this study will be useful in validating computer models of aerosol deposition in asthmatic subjects. Asthma did not affect the fraction of inhaled aerosol depositing in the lungs, but gave rise to a more central deposition pattern. The use of 3D SPECT imaging in combination with 24 h clearance measurements enables differentiation of deposition between bronchial and bronchiolar airways.

Reconciliation of Cascade Impaction during Wet Nebulization

Cascade impaction is an important tool for measuring aerosol distributions from wet nebulizers; however, results vary depending on laboratory and technique. The focus of this study was to reconcile the contribution of particle evaporation to these reported differences. To measure the effect of evaporation, we compared aerosol distributions from circuits ventilated with humidified air, ambient air, and a nonventilated, standing cloud circuit using low-flow cascade impaction (1.0 L/min). Aerosol distributions were similar for the humidified/ventilated and standing cloud models [mass median aerodynamic diameter (MMAD) 3.4 microm, and 3.6 microm Aero-Eclipse, 5.8 and 5.1 microm Misty-Neb, 3.8 and 3.2 microm Pari LC Plus]. In the ventilated/ambient air model, smaller particle sizes were measured (2.2 microm AeroEclipse, 2.4 microm Misty-Neb, 2.1 microm Pari LC Plus). Techniques of cascade impaction significantly affected measured aerosol distributions. MMAD were defined by nebulizer type and conditions of particle evaporation not by impactor. Aerosol mixing with ambient air caused evaporation and shrinkage of particles, and accounts for differences between laboratories. Patients breathing from nebulizers may entrain ambient air possibly affecting deposition.

Liquid Atomizing: Nebulizing and Other Methods of Producing Aerosols

Liquid atomization (or nebulization) is the most traditional method of drug delivery to the lung. Although other methods seem to often be preferred for the delivery of new drugs, nebulizers are experiencing a revival, with new devices based on different atomization techniques, and the more traditional jet nebulizers evolving to become "smart nebulizers." These smart devices synchronize delivery with the patient's breath, estimate or measure delivered dose, provide feedback and data storage, and in some cases control breathing maneuvers. Besides adding new features, new nebulizers are also addressing traditional shortcomings, namely, reducing size, bulkiness, and power consumption. But in the longer term, nebulizers are expected to offer even more important features. Following the trend toward individually optimized therapy, nebulizers will be able to estimate deposited dosage and concentrations in the lung. In addition, as progress in nanotechnology allows the development of smart drug carrying particles, advanced liquid nebulization is expected to be the delivery mode of choice for these smart particle aerosols.

Spray-freeze-dried liposomal ciprofloxacin powder for inhaled aerosol drug delivery

Spray-freeze drying was utilized to manufacture a liposomal powder formulation containing ciprofloxacin as a model active component. The powder forms liposomally encapsulated ciprofloxacin when wetted. Aerosol properties of this formulation were assessed using a new passive inhaler, in which the powder was entrained at a flow rate of 60l/min. A mass median aerodynamic diameter (MMAD) of 2.8 microm was achieved for this formulation. Using the experimental dispersion testing data, ciprofloxacin concentration in the airway surface liquid (ASL) was calculated using a Lagrangian deposition model. The reconstitution of the powder in various aqueous media gave drug encapsulation efficiencies as follows: 50% in water, 93.5% in isotonic saline, 80% in bovine mucin, 75% in porcine mucus and 73% in five-fold-diluted ex vivo human cystic fibrosis patient sputum.

In vitro and in vivo dose delivery characteristics of large porous particles for inhalation

The purpose of this study was to evaluate the in vitro and in vivo dose delivery characteristics of two large porous particle placebo formulations with different mass median aerodynamic diameters (MMAD approximately equal to 3 and 5 microm). In vitro dose delivery characteristics were measured using the multistage liquid impinger (MSLI). In vitro lung deposition was predicted by calculating the extrathoracic deposition using the ICRP model, with the remaining fraction assumed to deposit in the lungs. Healthy subjects were trained to inhale through the AIR delivery system at a target peak inspiratory flow rate (PIFR) of 60 l/min, The in vivo dose delivery of large porous particles were obtained by gamma-scintigraphy and was characterized by high ( approximately 90%), reproducible emitted doses for both the small and large MMAD powders. The mean in vivo lung deposition relative to the total metered dose were 59.0 and 37.3% for 3 and 5 microm MMAD powders, respectively. The AIR delivery system produced high in vivo lung deposition and low intersubject CVs (approximately 14%) across the range of PIFRs obtained in the study (50-80 l/min), This is relative to a variety of dry powder inhalers (DPI) that have been published in the literature, with in vivo lung deposition ranging from 13 to 35% with intersubject CVs ranging from 17 to 50%. The ICRP model provided a good estimate of the mean in vivo lung deposition for both powders. Intersubject variability was not captured by the ICRP model due to intersubject differences in the morphology and physiology of the oropharyngeal region. The ICRP model was used to predict the regional lung deposition, although these predictions were only considered speculative in the absence of experimental validation.

Bioengineering of therapeutic aerosols

The new field of therapeutic aerosol bioengineering (TAB), driven primarily by the medical need for inhaled insulin, is now expanding to address medical needs ranging from respiratory to systemic diseases, including asthma, growth deficiency, and pain. Bioengineering of therapeutic aerosols involves a level of aerosol particle design absent in traditional therapeutic aerosols, which are created by conventionally spraying a liquid solution or suspension of drug or milling and mixing a dry drug form into respirable particles. Bioengineered particles may be created in liquid form from devices specially designed to create an unusually fine size distribution, possibly with special purity properties, or solid particles that possess a mixture of drug and excipient, with designed shape, size, porosity, and drug release characteristics. Such aerosols have enabled several high-visibility clinical programs of inhaled insulin, as well as earlier-stage programs involving inhaled morphine, growth hormone, beta-interferon, alpha-1-antitrypsin, and several asthma drugs. The design of these aerosols, limited by partial knowledge of the lungs' physiological environment, and driven largely at this stage by market forces, relies on a mixture of new and old science, pharmaceutical science intuition, and a degree of biological-impact empiricism that speaks to the importance of an increased level of academic involvement.