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Prinz F, Pokorný J, Elcner J, Lízal F, Mišík O, Malý M, Bělka M, Hafen N, Kummerländer A, Krause MJ, Jedelský J, Jícha M. Comprehensive experimental and numerical validation of Lattice Boltzmann fluid flow and particle simulations in a child respiratory tract. Comput Biol Med 2024; 170:107994. [PMID: 38308867 DOI: 10.1016/j.compbiomed.2024.107994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/03/2024] [Accepted: 01/13/2024] [Indexed: 02/05/2024]
Abstract
The numerical simulation of inhaled aerosols in medical research starts to play a crucial role in understanding local deposition within the respiratory tract, a feat often unattainable experimentally. Research on children is particularly challenging due to the limited availability of in vivo data and the inherent morphological intricacies. CFD solvers based on Finite Volume Methods (FVM) have been widely employed to solve the flow field in such studies. Recently, Lattice Boltzmann Methods (LBM), a mesoscopic approach, have gained prominence, especially for their scalability on High-Performance Computers. This study endeavours to compare the effectiveness of LBM and FVM in simulating particulate flows within a child's respiratory tract, supporting research related to particle deposition and medication delivery using LBM. Considering a 5-year-old child's airway model at a steady inspiratory flow, the results are compared with in vitro experiments. Notably, both LBM and FVM exhibit favourable agreement with experimental data for the mean velocity field and the turbulence intensity. For particle deposition, both numerical methods yield comparable results, aligning well with in vitro experiments across a particle size range of 0.1-20 µm. Discrepancies are identified in the upper airways and trachea, indicating a lower deposition fraction than in the experiment. Nonetheless, both LBM and FVM offer invaluable insights into particle behaviour for different sizes, which are not easily achievable experimentally. In terms of practical implications, the findings of this study hold significance for respiratory medicine and drug delivery systems - potential health impacts, targeted drug delivery strategies or optimisation of respiratory therapies.
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Affiliation(s)
- František Prinz
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic.
| | - Jan Pokorný
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Jakub Elcner
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - František Lízal
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Ondrej Mišík
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Milan Malý
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Miloslav Bělka
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Nicolas Hafen
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Adrian Kummerländer
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Mathias J Krause
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Jan Jedelský
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Miroslav Jícha
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
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2
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Abstract
Traditionally, empirical correlations for predicting respiratory tract deposition of inhaled aerosols have been developed using limited available in vivo data. More recently, advances in medical image segmentation and additive manufacturing processes have allowed researchers to conduct extensive in vitro deposition experiments in realistic replicas of the upper and central branching airways. This work has led to a collection of empirical equations for predicting regional aerosol deposition, especially in the upper, nasal and oral airways. The present section reviews empirical correlations based on both in vivo and in vitro data, which may be used to predict total and regional deposition. Equations are presented for predicting total respiratory deposition fraction, mouth-throat fraction, nasal, and nose-throat fractions for a large variety of aerosol sizes, subject age groups, and breathing maneuvers. Use of these correlations to estimate total lung deposition is also described.
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Affiliation(s)
- Andrew R Martin
- Department of Mechanical Engineering, 10-324 Donadeo Innovation Center for Engineering, University of Alberta, Edmonton, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
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3
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Golshahi L, Finlay WH, Wachtel H. Use of Airway Replicas in Lung Delivery Applications. J Aerosol Med Pulm Drug Deliv 2022; 35:61-72. [PMID: 35262408 DOI: 10.1089/jamp.2021.29057.lg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of extrathoracic airway replicas in optimization of drug delivery to the lungs with nebulizers, dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs) is discussed. Such airway replicas have been useful in evaluating new pulmonary drug delivery platforms mainly based on the comparison of the total lung dose (TLD) and the aerodynamic particle size distribution (APSD) of the aerosol distal to the physical models. The ability of these in vitro methods to replicate in vivo results has allowed advancements in respiratory drug delivery and in the accuracy and utility of in vitro-in vivo correlations (IVIVCs).
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Affiliation(s)
- Laleh Golshahi
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Herbert Wachtel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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4
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Wu J, Weng W. COVID-19 virus released from larynx might cause a higher exposure dose in indoor environment. ENVIRONMENTAL RESEARCH 2021; 199:111361. [PMID: 34029546 PMCID: PMC8139337 DOI: 10.1016/j.envres.2021.111361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 05/10/2023]
Abstract
COVID-19 virus can replicate in the infected individual's larynx independently, which is different from other viruses that replicate in lungs only, e.g. SARS. It might contribute to the fast spread of COVID-19. However, there are few scientific reports about quantitative comparison of COVID-19 exposure dose (inhalation dose and adhesion dose) for the susceptible individual when the viruses were released from the larynx or lungs. In this paper, a typical numerical model was built based on a breathing human model with real respiratory tract. By using a computational fluid dynamics (CFD) method, two kinds of virus released sites in the infected individual's respiratory tract (larynx, lungs), seven kinds of particle sizes between 1 and 50 μm, three kinds of expiratory flow rates: calm (10 L/min), moderate (30 L/min) and intense (90 L/min) were used to compare the particle deposition proportion and escape proportion. The inhalation dose and the adhesion dose of the susceptible individual were quantified. The results showed that COVID-19 virus-containing droplets and aerosols might be released into the environment at higher proportions (39.1%-44.2%) than viruses that replicate in lungs only (15.3%-37.1%). The exposure doses (inhalation dose and adhesion dose) of the susceptible individual in different situations were discussed. The susceptible individual suffered a higher exposure dose when the viruses were released from the larynx rather than lungs (the difference for 1 μm particles was 1.2-2.2 times). This study provides a possible explanation for the higher transmission risk of COVID-19 virus compared to other viruses and some control advice of COVID-19 in typical indoor environments were also discussed.
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Affiliation(s)
- Jialin Wu
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, PR China; Beijing Key Laboratory of City Integrated Emergency Response Science, Tsinghua University, Beijing, 100084, China
| | - Wenguo Weng
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, PR China; Beijing Key Laboratory of City Integrated Emergency Response Science, Tsinghua University, Beijing, 100084, China.
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5
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Chen J, Martin AR, Finlay WH. Recent In Vitro and In Silico Advances in the Understanding of Intranasal Drug Delivery. Curr Pharm Des 2021; 27:1482-1497. [PMID: 33183191 DOI: 10.2174/1381612826666201112143230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many drugs are delivered intranasally for local or systemic effect, typically in the form of droplets or aerosols. Due to the high cost of in vivo studies, drug developers and researchers often turn to in vitro or in silico testing when first evaluating the behavior and properties of intranasal drug delivery devices and formulations. Recent advances in manufacturing and computer technologies have allowed for increasingly realistic and sophisticated in vitro and in silico reconstructions of the human nasal airways. OBJECTIVE The study aims to perform a summary of advances in the understanding of intranasal drug delivery based on recent in vitro and in silico studies. CONCLUSION The turbinates are a common target for local drug delivery applications, and while nasal sprays are able to reach this region, there is currently no broad consensus across the in vitro and in silico literature concerning optimal parameters for device design, formulation properties and patient technique which would maximize turbinate deposition. Nebulizers can more easily target the turbinates, but come with the disadvantage of significant lung deposition. Targeting of the olfactory region of the nasal cavity has been explored for the potential treatment of central nervous system conditions. Conventional intranasal devices, such as nasal sprays and nebulizers, deliver very little dose to the olfactory region. Recent progress in our understanding of intranasal delivery will be useful in the development of the next generation of intranasal drug delivery devices.
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Affiliation(s)
- John Chen
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
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Bass K, Farkas D, Hassan A, Bonasera S, Hindle M, Longest PW. High-Efficiency Dry Powder Aerosol Delivery to Children: Review and Application of New Technologies. JOURNAL OF AEROSOL SCIENCE 2021; 153:105692. [PMID: 33716317 PMCID: PMC7945982 DOI: 10.1016/j.jaerosci.2020.105692] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While dry powder aerosol formulations offer a number of advantages, their use in children is often limited due to poor lung delivery efficiency and difficulties with consistent dry powder inhaler (DPI) usage. Both of these challenges can be attributed to the typical use of adult devices in pediatric subjects and a lack of pediatric-specific DPI development. In contrast, a number of technologies have recently been developed or progressed that can substantially improve the efficiency and reproducibility of DPI use in children including: (i) nose-to-lung administration with small particles, (ii) active positive-pressure devices, (iii) structures to reduce turbulence and jet momentum, and (iv) highly dispersible excipient enhanced growth particle formulations. In this study, these technologies and their recent development are first reviewed in depth. A case study is then considered in which these technologies are simultaneously applied in order to enable the nose-to-lung administration of dry powder aerosol to children with cystic fibrosis (CF). Using a combination of computational fluid dynamics (CFD) analysis and realistic in vitro experiments, device performance, aerosol size increases and lung delivery efficiency are considered for pediatric-CF subjects in the age ranges of 2-3, 5-6 and 9-10 years old. Results indicate that a new 3D rod array structure significantly improves performance of a nasal cannula reducing interface loss by a factor of 1.5-fold and produces a device emitted mass median aerodynamic diameter (MMAD) of 1.67 μm. For all ages considered, approximately 70% of the loaded dose reaches the lower lung beyond the lobar bronchi. Moreover, significant and rapid size increase of the aerosol is observed beyond the larynx and illustrates the potential for targeting lower airway deposition. In conclusion, concurrent CFD and realistic in vitro analysis indicates that a combination of multiple new technologies can be implemented to overcome obstacles that currently limit the use of DPIs in children as young as two years of age.
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Affiliation(s)
- Karl Bass
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
| | - Dale Farkas
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
| | - Amr Hassan
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
| | - Serena Bonasera
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
| | - P. Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
- Author Contact Information: Dr. Worth Longest, PhD, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA 23284-3015, Phone: (804)-827-7023, Fax: (804)-827-7030,
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7
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Bianco F, Salomone F, Milesi I, Murgia X, Bonelli S, Pasini E, Dellacà R, Ventura ML, Pillow J. Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned. Respir Res 2021; 22:71. [PMID: 33637075 PMCID: PMC7908012 DOI: 10.1186/s12931-020-01585-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.
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Affiliation(s)
- Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy.
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Ilaria Milesi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | | | - Sauro Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Elena Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Raffaele Dellacà
- TechRes Lab, Dipartimento Di Elettronica, Informazione E Bioingegneria (DEIB), Politecnico Di Milano University, Milano, Italy
| | | | - Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, Australia
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8
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Lim SH, Park S, Lee CC, Ho PCL, Kwok PCL, Kang L. A 3D printed human upper respiratory tract model for particulate deposition profiling. Int J Pharm 2021; 597:120307. [PMID: 33540019 DOI: 10.1016/j.ijpharm.2021.120307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
Pulmonary route is the main route of drug delivery for patients with asthma and chronic obstructive pulmonary diseases, offering several advantages over the oral route. Determining the amount of drug deposited onto various parts of the respiratory tract allows for a good correlation to clinical efficacy of inhalation drug devices. However, current in vitro cascade impactors measure only the aerodynamic particle size distribution, which does not truly represent the in vivo deposition pattern in human respiratory tract. In this study, a human upper respiratory tract model was fabricated using a 3D printer and subsequently characterized for its dimensional accuracy, surface finishing and air leaking. The effects of using a spacer and/or various airflow rates were also investigated. To assess this in vitro model, the deposition pattern of a model drug, namely, salbutamol sulphate, was tested. The resultant deposition pattern of salbutamol sulphate from a metered dose inhaler at 15 L per minute with the spacer, showed no significant difference from that of a published radiological in vivo study performed in adult humans. In addition, it was also found that the deposition pattern of salbutamol at 35 L per minute was comparable to the results of another published study in human. This in vitro model, showing reasonable in vitro-in vivo correlation, may provide opportunities for personalized medicine in special populations or disease states.
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Affiliation(s)
- Seng Han Lim
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Sol Park
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia
| | - Chun Chuan Lee
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Paul Chi Lui Ho
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, Singapore 117543, Republic of Singapore
| | - Philip Chi Lip Kwok
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia
| | - Lifeng Kang
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia.
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Moore C, Rebstock D, Katz IM, Noga ML, Caillibotte G, Finlay WH, Martin AR. The influence of flowrate and gas density on positive airway pressure for high flow nasal cannula applied to infant airway replicas. J Biomech 2020; 112:110022. [PMID: 32942204 DOI: 10.1016/j.jbiomech.2020.110022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/31/2020] [Accepted: 08/26/2020] [Indexed: 01/09/2023]
Abstract
High flow nasal cannula (HFNC) therapy has been previously shown to produce positive upper airway pressures in adult and child patients. This work aimed to evaluate and quantify the effects of HFNC flowrate and gas type on airway pressures measured in vitro in infant airway replicas. Ten realistic infant airway replicas, extending from nares to trachea, were connected in turn to a lung simulator and were supplied gas flows through HFNC. Air and heliox were each provided at two weight-indexed flowrates, 1 l/min/kg and 2 l/min/kg. Pressure and lung volume were continuously measured during simulated breathing. For constant simulated patient effort, no statistically significant change in tidal volume was measured between baseline and lower or higher HFNC flowrates, nor was there any significant difference in tidal volume between air and heliox. Tracheal pressure increased with increasing HFNC flow rate, and was highly variable between airway replicas. Higher pressures were measured for air versus heliox. For air supplied at 2 l/min/kg, average airway pressures in excess of 4 cm H2O were generated, with positive end-expiratory pressure (PEEP) ranging from 2.5 to nearly 12 cm H2O across the replicas. A predictive correlation for PEEP was proposed based on supplied gas density and flow velocities exiting the cannula and nares, and was able to account for a portion of variability between airway replicas (R2 = 0.913). Additionally, PEEP was well correlated with, and predictive of, expiratory peak pressure (R2 = 0.939) and average inspiratory pressure (R2 = 0.944).
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Affiliation(s)
- Charles Moore
- Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Rebstock
- Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Ira M Katz
- Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center, Les Loges-en-Josas, France
| | - Michelle L Noga
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Georges Caillibotte
- Medical R&D, Air Liquide Santé International, Paris-Saclay Research Center, Les Loges-en-Josas, France
| | - Warren H Finlay
- Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Martin
- Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada.
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Xu C, Zheng X, Shen S. A numerical study of the effect of breathing mode and exposure conditions on the particle inhalation and deposition. Inhal Toxicol 2020; 32:456-467. [DOI: 10.1080/08958378.2020.1840679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Chang Xu
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
- Beijing Key Laboratory of City Integrated Emergency Response Science, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Xin Zheng
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Shifei Shen
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
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11
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Engineering Preclinical Tools and Therapeutics to Understand and Treat COVID-19. Dela J Public Health 2020; 6:32-35. [PMID: 34467105 PMCID: PMC8389820 DOI: 10.32481/djph.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Adkins SH, Anderson KN, Goodman AB, Twentyman E, Danielson ML, Kimball A, Click ES, Ko JY, Evans ME, Weissman DN, Melstrom P, Kiernan E, Krishnasamy V, Rose DA, Jones CM, King BA, Ellington SR, Pollack LA, Wiltz JL. Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019. JAMA Pediatr 2020; 174:e200756. [PMID: 32421164 PMCID: PMC7235914 DOI: 10.1001/jamapediatrics.2020.0756] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE To date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI). OBJECTIVE To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults. DESIGN, SETTING, AND PARTICIPANTS Surveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155). MAIN OUTCOMES AND MEASURES Demographics, substance use behaviors, and clinical characteristics. RESULTS Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI, 1.92-7.26). A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided. CONCLUSIONS AND RELEVANCE Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is recommended.
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Affiliation(s)
- Susan H. Adkins
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B. Goodman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Evelyn Twentyman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Melissa L. Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne Kimball
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor S. Click
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Mary E. Evans
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David N. Weissman
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Melstrom
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Emily Kiernan
- Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vikram Krishnasamy
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dale A. Rose
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A. King
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Sacha R. Ellington
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Lori A. Pollack
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Jennifer L. Wiltz
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
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Particle transport and deposition correlation with near-wall flow characteristic under inspiratory airflow in lung airways. Comput Biol Med 2020; 120:103703. [PMID: 32217283 DOI: 10.1016/j.compbiomed.2020.103703] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 02/04/2023]
Abstract
Exposure of lung airways to detrimental suspended aerosols in the environment increases the vulnerability of the respiratory and cardiovascular systems. In addition, recent developments in therapeutic inhalation devices magnify the importance of particle transport. In this manuscript, particle transport and deposition patterns in the upper tracheobronchial (TB) tree were studied where the inertial forces are considerable for microparticles. Wall shear stress divergence (WSSdiv) is proposed as a wall-based parameter that can predict particle deposition patterns. WSSdiv is proportional to near-wall normal velocity and can quantify the strength of flow towards and away from the wall. Computational fluid dynamics (CFD) simulations were performed to quantify airflow velocity and WSS vectors for steady inhalation in one case-control and unsteady inhalation in six subject-specific airway trees. Turbulent flow simulation was performed for the steady case using large eddy simulation to study the effect of turbulence. Magnetic resonance velocimetry (MRV) measurements were used to validate the case-control CFD simulation. Inertial particle transport was modeled by solving the Maxey-Riley equation in a Lagrangian framework. Deposition percentage (DP) was quantified for the case-control model over five particle sizes. DP was found to be proportional to particle size in agreement with previous studies in the literature. A normalized deposition concentration (DC) was defined to characterize localized deposition. A relatively strong correlation (Pearson value > 0.7) was found between DC and positive WSSdiv for physiologically relevant Stokes (St) numbers. Additionally, a regional analysis was performed after dividing the lungs into smaller areas. A spatial integral of positive WSSdiv over each division was shown to maintain a very strong correlation (Pearson value > 0.9) with cumulative spatial DC or regional dosimetry. The conclusions were generalized to a larger population in which two healthy and four asthmatic patients were investigated. This study shows that WSSdiv could be used to predict the qualitative surface deposition and relative regional dosimetry without the need to solve a particle transport problem.
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Elias-Kirma S, Artzy-Schnirman A, Das P, Heller-Algazi M, Korin N, Sznitman J. In situ-Like Aerosol Inhalation Exposure for Cytotoxicity Assessment Using Airway-on-Chips Platforms. Front Bioeng Biotechnol 2020; 8:91. [PMID: 32154228 PMCID: PMC7044134 DOI: 10.3389/fbioe.2020.00091] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 12/02/2022] Open
Abstract
Lung exposure to inhaled particulate matter (PM) is known to injure the airway epithelium via inflammation, a phenomenon linked to increased levels of global morbidity and mortality. To evaluate physiological outcomes following PM exposure and concurrently circumvent the use of animal experiments, in vitro approaches have typically relied on traditional assays with plates or well inserts. Yet, these manifest drawbacks including the inability to capture physiological inhalation conditions and aerosol deposition characteristics relative to in vivo human conditions. Here, we present a novel airway-on-chip exposure platform that emulates the epithelium of human bronchial airways with critical cellular barrier functions at an air-liquid interface (ALI). As a proof-of-concept for in vitro lung cytotoxicity testing, we recapitulate a well-characterized cell apoptosis pathway, induced through exposure to 2 μm airborne particles coated with αVR1 antibody that leads to significant loss in cell viability across the recapitulated airway epithelium. Notably, our in vitro inhalation assays enable simultaneous aerosol exposure across multiple airway chips integrated within a larger bronchial airway tree model, under physiological respiratory airflow conditions. Our findings underscore in situ-like aerosol deposition outcomes where patterns depend on respiratory flows across the airway tree geometry and gravitational orientation, as corroborated by concurrent numerical simulations. Our airway-on-chips not only highlight the prospect of realistic in vitro exposure assays in recapitulating characteristic local in vivo deposition outcomes, such platforms open opportunities toward advanced in vitro exposure assays for preclinical cytotoxicity and drug screening applications.
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Affiliation(s)
| | | | | | | | | | - Josué Sznitman
- Department of Biomedical Engineering, Technion – Israel Institute of Technology, Haifa, Israel
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Sosnowski TR, Rapiejko P, Sova J, Dobrowolska K. Impact of physicochemical properties of nasal spray products on drug deposition and transport in the pediatric nasal cavity model. Int J Pharm 2019; 574:118911. [PMID: 31809854 DOI: 10.1016/j.ijpharm.2019.118911] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022]
Abstract
The study is focused on the analysis of physicochemical properties of selected nasal sprays of mometasone furoate, and the influence of these properties on aerosol quality and penetration in the pediatric nose. After the determination of drugs surface tension and viscosity, spray geometry and size distribution of aerosol droplets, the topical delivery of each drug to different parts of the pediatric model of the nose with the flexible vestibule was evaluated by colorimetric visualization. All tested drugs are pseudo-plastic liquids, showing some differences in flow consistency constant k (range 714-1422) and flow behavior index n (range 0.16-0.31). At no-flow conditions, all sprays are deposited mainly in the anterior of the nasal cavity and the septum (2-3 cm from the nostril), as a result of inertial impaction of large droplets. The deposition range is slightly influenced by the geometry of the aerosol cloud, which, in turn, depends both on drug properties and the type of the spraying nozzle. Deposition experiments accompanied by the airflow show an enhancement of drug transport to deeper parts of the nasal cavity (up 4-6 cm from the vestibule), and this effect can be attributed to the secondary effects of spreading of the deposited liquid layer along the narrow air passages in the nose. Plume geometry, dose volume and rheological properties of the drug were shown to be important factors in the spray penetration pattern in the pediatric nose. The deepest delivery can be expected for drugs of low viscosity and short aerosol plumes.
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Affiliation(s)
- Tomasz R Sosnowski
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland.
| | - Piotr Rapiejko
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Jarosław Sova
- Department of Otolaryngology, 7th Navy Hospital in Gdansk, Poland
| | - Katarzyna Dobrowolska
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
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16
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Longest PW, Bass K, Dutta R, Rani V, Thomas ML, El-Achwah A, Hindle M. Use of computational fluid dynamics deposition modeling in respiratory drug delivery. Expert Opin Drug Deliv 2018; 16:7-26. [PMID: 30463458 DOI: 10.1080/17425247.2019.1551875] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Respiratory drug delivery is a surprisingly complex process with a number of physical and biological challenges. Computational fluid dynamics (CFD) is a scientific simulation technique that is capable of providing spatially and temporally resolved predictions of many aspects related to respiratory drug delivery from initial aerosol formation through respiratory cellular drug absorption. AREAS COVERED This review article focuses on CFD-based deposition modeling applied to pharmaceutical aerosols. Areas covered include the development of new complete-airway CFD deposition models and the application of these models to develop a next-generation of respiratory drug delivery strategies. EXPERT OPINION Complete-airway deposition modeling is a valuable research tool that can improve our understanding of pharmaceutical aerosol delivery and is already supporting medical hypotheses, such as the expected under-treatment of the small airways in asthma. These complete-airway models are also being used to advance next-generation aerosol delivery strategies, like controlled condensational growth. We envision future applications of CFD deposition modeling to reduce the need for human subject testing in developing new devices and formulations, to help establish bioequivalence for the accelerated approval of generic inhalers, and to provide valuable new insights related to drug dissolution and clearance leading to microdosimetry maps of drug absorption.
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Affiliation(s)
- P Worth Longest
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA.,b Department of Pharmaceutics , Virginia Commonwealth University , Richmond , VA , USA
| | - Karl Bass
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA
| | - Rabijit Dutta
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA
| | - Vijaya Rani
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA
| | - Morgan L Thomas
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA
| | - Ahmad El-Achwah
- a Department of Mechanical and Nuclear Engineering , Virginia Commonwealth University , Richmond , VA , USA
| | - Michael Hindle
- b Department of Pharmaceutics , Virginia Commonwealth University , Richmond , VA , USA
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Martin AR, Moore CP, Finlay WH. Models of deposition, pharmacokinetics, and intersubject variability in respiratory drug delivery. Expert Opin Drug Deliv 2018; 15:1175-1188. [PMID: 30388902 DOI: 10.1080/17425247.2018.1544616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Aerosol drug delivery to the lungs via inhalation is widely used in the treatment of respiratory diseases. The deposition pattern of inhaled particles within the airways of the respiratory tract is key in determining the initial delivered dose. Thereafter, dose-dependent processes including drug release or dissolution, clearance, and absorption influence local and systemic exposure to inhaled drugs over time. AREAS COVERED Empirical correlations, numerical simulation, and in vitro airway geometries that permit improved prediction of extrathoracic and lung deposition fractions in a variety of age groups and breathing conditions are described. Efforts to link deposition models with pharmacokinetic models predicting lung and systemic exposure to inhaled drugs over time are then reviewed. Finally, new methods to predict intersubject variability in extrathoracic deposition, capturing variability in both size and shape of the upper airways, are highlighted. EXPERT OPINION Recent work has been done to expand in vitro deposition experiments to a wide range of age groups and breathing conditions, to link regional lung deposition models with pharmacokinetic models, and to improve prediction of intersubject variability. These efforts are improving predictive understanding of respiratory drug delivery, and will aid the development of new inhaled drugs and delivery devices.
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Affiliation(s)
- Andrew R Martin
- a Department of Mechanical Engineering , University of Alberta , Edmonton , AB , Canada
| | - Charles P Moore
- a Department of Mechanical Engineering , University of Alberta , Edmonton , AB , Canada
| | - Warren H Finlay
- a Department of Mechanical Engineering , University of Alberta , Edmonton , AB , Canada
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Bass K, Longest PW. Development of an infant complete-airway in vitro model for evaluating aerosol deposition. Med Eng Phys 2018; 58:S1350-4533(18)30087-0. [PMID: 29941306 PMCID: PMC6309601 DOI: 10.1016/j.medengphy.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/19/2018] [Accepted: 05/27/2018] [Indexed: 01/07/2023]
Abstract
A complete-airway in vitro model would be very useful for toxicological dosimetry testing and for developing targeted inhaled medications in cases where conducting in vivo experiments are exceedingly difficult, as with infants. The objective of this study was to determine whether packed bed in vitro models, which contain spheres as the primary repeating unit, provide a realistic representation of aerosol deposition in the tracheobronchial region of infant lungs based on computational fluid dynamics (CFD) predictions. The packed bed (PB) CFD model contained an inlet consistent with airway bifurcation B3 (∼lobar bronchi) leading to a spherical array with voids between the spheres forming a divided flow pathway. The hydrodynamic diameter of the voids was approximately matched to the diameter of bifurcations in various lung regions. For comparison, a CFD stochastic individual pathway (SIP) geometry with realistic bifurcations extending from B4-B15 (terminal bronchioles) was selected as an anatomically accurate model. The CFD-SIP model predictions were benchmarked with existing algebraic correlations for aerosol deposition in the lungs and found to be reasonable. Unfortunately, the CFD-PB model did not provide a good representation of aerosol deposition in the tracheobronchial region of human lungs. Through careful selection of the PB sphere size and inlet conditions, total deposition in the CFD-PB model matched CFD-SIP deposition within 10% absolute error across a range of relevant aerosol sizes. However, regional deposition within the CFD-PB model was very different from the CFD-SIP case. Therefore, the PB approach cannot be recommended for determining spatial or temporal distribution of aerosol transport and impaction deposition through the lungs.
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Affiliation(s)
- Karl Bass
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - P Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, United States; Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, United States.
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19
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Oakes JM, Roth SC, Shadden SC. Airflow Simulations in Infant, Child, and Adult Pulmonary Conducting Airways. Ann Biomed Eng 2017; 46:498-512. [PMID: 29264667 DOI: 10.1007/s10439-017-1971-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
The airway structure continuously evolves from birth to adulthood, influencing airflow dynamics and respiratory mechanics. We currently know very little about how airflow patterns change throughout early life and its impact on airway resistance, namely because of experimental limitations. To uncover differences in respiratory dynamics between age groups, we performed subject-specific airflow simulations in an infant, child, and adult conducting airways. Airflow throughout the respiration cycle was calculated by coupling image-based models of the conducting airways to the global respiratory mechanics, where flow was driven by a pressure differential. Trachea diameter was 19, 9, and 4.5 mm for the adult (36 years, female), child (6 years, male), and infant (0.25 years, female), respectively. Mean Reynolds number within the trachea was nearly the same for each subject (1100) and Womersley number was above unity for all three subjects and largest for the adult, highlighting the significance of transient effects. In general, air speeds and airway resistances within the conducting airways were inversely correlated with age; the 3D pressure drop was highest in the infant model. These simulations provide new insight into age-dependent flow dynamics throughout the respiration cycle within subject-specific airways.
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Affiliation(s)
- Jessica M Oakes
- Department of Bioengineering, Northeastern University, Boston, MA, USA.
| | - Steven C Roth
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, 94720, USA
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20
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Pourchez J, Leclerc L, Sarry G, Vergnon JM, Dubus JC. [Bench-test evaluation of spacer devices for fluticasone delivery to infants]. Rev Mal Respir 2016; 34:29-35. [PMID: 27155896 DOI: 10.1016/j.rmr.2016.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Use of a spacer device to optimize the delivery of fluticasone to infants with asthma is an important issue and clinicians require guidance around the choice of device. This in vitro study characterizes the particle size and the fluticasone delivery via 9 spacers. METHODS We used an in vitro infant nasal cast with two different inspiratory flow rates (50 and 100mL/s). Fluticasone particle size in the aerosol was evaluated by laser diffractometry and tracheal deposition by spectrophotometric assay. RESULTS Significant differences in particle size were observed between the 9 spacers (similar D50 but D90 from 5.65±0.65 to 8.80±1.35μm). A 75 % or higher respirable fraction was obtained for only 5 spacers. The 50mL/s flow rate lead to the best drug delivery. At this flow, OptiChamber® (62±3 %) and Vortex® (91±8.5 %) had a tracheal deposition over 50 % of the initial dose of fluticasone, although the 7 other spacers exhibited a fluticasone deposition less than 25 %. DISCUSSION This study shows a wide variation of drug delivery between the 9 spacers studied. We demonstrate that a low inspiratory flow and a spacer showing antistatic properties facilitate drug delivery.
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Affiliation(s)
- J Pourchez
- École nationale supérieure des Mines de Saint-Étienne, CIS-EMSE, Sainbiose, 42023 Saint-Étienne, France; Inserm, U1059, Sainbiose, 42023 Saint-Étienne, France; Université de Lyon, 42023 Saint-Étienne, France.
| | - L Leclerc
- École nationale supérieure des Mines de Saint-Étienne, CIS-EMSE, Sainbiose, 42023 Saint-Étienne, France; Inserm, U1059, Sainbiose, 42023 Saint-Étienne, France; Université de Lyon, 42023 Saint-Étienne, France
| | - G Sarry
- École nationale supérieure des Mines de Saint-Étienne, CIS-EMSE, Sainbiose, 42023 Saint-Étienne, France; Inserm, U1059, Sainbiose, 42023 Saint-Étienne, France; Université de Lyon, 42023 Saint-Étienne, France
| | - J-M Vergnon
- Inserm, U1059, Sainbiose, 42023 Saint-Étienne, France; Université de Lyon, 42023 Saint-Étienne, France; Service de pneumologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - J C Dubus
- Unité de pneumopédiatrie, CHU Timone-Enfants, 13385 Marseille cedex 5, France
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Darquenne C, Fleming JS, Katz I, Martin AR, Schroeter J, Usmani OS, Venegas J, Schmid O. Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung. J Aerosol Med Pulm Drug Deliv 2016; 29:107-26. [PMID: 26829187 DOI: 10.1089/jamp.2015.1270] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Development of a new drug for the treatment of lung disease is a complex and time consuming process involving numerous disciplines of basic and applied sciences. During the 2015 Congress of the International Society for Aerosols in Medicine, a group of experts including aerosol scientists, physiologists, modelers, imagers, and clinicians participated in a workshop aiming at bridging the gap between basic research and clinical efficacy of inhaled drugs. This publication summarizes the current consensus on the topic. It begins with a short description of basic concepts of aerosol transport and a discussion on targeting strategies of inhaled aerosols to the lungs. It is followed by a description of both computational and biological lung models, and the use of imaging techniques to determine aerosol deposition distribution (ADD) in the lung. Finally, the importance of ADD to clinical efficacy is discussed. Several gaps were identified between basic science and clinical efficacy. One gap between scientific research aimed at predicting, controlling, and measuring ADD and the clinical use of inhaled aerosols is the considerable challenge of obtaining, in a single study, accurate information describing the optimal lung regions to be targeted, the effectiveness of targeting determined from ADD, and some measure of the drug's effectiveness. Other identified gaps were the language and methodology barriers that exist among disciplines, along with the significant regulatory hurdles that need to be overcome for novel drugs and/or therapies to reach the marketplace and benefit the patient. Despite these gaps, much progress has been made in recent years to improve clinical efficacy of inhaled drugs. Also, the recent efforts by many funding agencies and industry to support multidisciplinary networks including basic science researchers, R&D scientists, and clinicians will go a long way to further reduce the gap between science and clinical efficacy.
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Affiliation(s)
- Chantal Darquenne
- 1 Department of Medicine, University of California , San Diego, La Jolla, California
| | - John S Fleming
- 2 National Institute of Health Research Biomedical Research Unit in Respiratory Disease , Southampton, United Kingdom .,3 Department of Medical Physics and Bioengineering, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Ira Katz
- 4 Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay , Jouy-en-Josas, France .,5 Department of Mechanical Engineering, Lafayette College , Easton, Pennsylvania
| | - Andrew R Martin
- 6 Department of Mechanical Engineering, University of Alberta , Edmonton, Alberta, Canada
| | | | - Omar S Usmani
- 8 Airway Disease Section, National Heart and Lung Institute , Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Jose Venegas
- 9 Department of Anesthesia (Bioengineering), MGH/Harvard, Boston, Massachusetts
| | - Otmar Schmid
- 10 Comprehensive Pneumology Center (CPC), Member of the German Center for Lung Research , Munich, Germany .,11 Institute of Lung Biology and Disease, Helmholtz Zentrum München-German Research Center for Environmental Health , Neuherberg, Germany
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Tang P, Leung SSY, Hor E, Ruzycki CA, Carrigy NB, Finlay WH, Brannan JD, Devadason S, Anderson SD, Sly PD, Samnick K, Chan HK. An Apparatus to Deliver Mannitol Powder for Bronchial Provocation in Children Under Six Years Old. J Aerosol Med Pulm Drug Deliv 2015; 28:452-61. [PMID: 25844950 DOI: 10.1089/jamp.2015.1208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Currently bronchial provocation testing (BPT) using mannitol powder cannot be performed in children under 6 years. A primary reason is it is challenging for children at this age to generate a consistent inspiratory effort to inhale mannitol efficiently from a dry powder inhaler. A prototype system, which does not require any inhalation training from the pediatric subject, is reported here. It uses an external source of compressed air to disperse mannitol powder into a commercial holding chamber. Then the subject uses tidal breathing to inhale the aerosol. METHOD The setup consists of a commercially available powder disperser and Volumatic™ holding chamber. Taguchi experimental design was used to identify the effect of dispersion parameters (flow rate of compressed air, time compressed air is applied, mass of powder, and the time between dispersion and inhalation) on the fine particle dose (FPD). The prototype was tested in vitro using a USP throat connected to a next generation impactor. The aerosols from the holding chamber were drawn at 10 L/min. A scaling factor for estimating the provoking dose to induce a 15% reduction in forced expiratory volume in 1 second (FEV1) (PD15) was calculated using anatomical dimensions of the human respiratory tract at various ages combined with known dosing values from the adult BPT. RESULTS Consistent and doubling FPDs were successfully generated based on the Taguchi experimental design. The FPD was reliable over a range of 0.8 (±0.09) mg to 14 (±0.94) mg. The calculated PD15 for children aged 1-6 years ranged from 7.1-30 mg. The FPDs generated from the proposed set up are lower than the calculated PD15 and therefore are not expected to cause sudden bronchoconstriction. CONCLUSION A prototype aerosol delivery system has been developed that is consistently able to deliver doubling doses suitable for bronchial provocation testing in young children.
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Affiliation(s)
- Patricia Tang
- 1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, New South Wales, Australia
| | - Sharon S Y Leung
- 1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, New South Wales, Australia
| | - Eleanor Hor
- 1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, New South Wales, Australia
| | - Conor A Ruzycki
- 2 Department of Mechanical Engineering, University of Alberta , Edmonton, Canada
| | - Nicholas B Carrigy
- 2 Department of Mechanical Engineering, University of Alberta , Edmonton, Canada
| | - Warren H Finlay
- 2 Department of Mechanical Engineering, University of Alberta , Edmonton, Canada
| | - John D Brannan
- 3 Department of Respiratory and Sleep Medicine, John Hunter Hospital , Newcastle, New South Wales, Australia
| | - Sunalene Devadason
- 4 School of Paediatrics and Child Health, The University of Western Australia , Crawley, WA, Australia
| | - Sandra D Anderson
- 5 Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital , Camperdown, New South Wales, Australia
| | - Peter D Sly
- 6 Children's Health and Environment Program, Queensland Children's Medical Research Institute, University of Queensland , Royal Children's Hospital, Herston, QLD, Australia
| | - Kevin Samnick
- 1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, New South Wales, Australia
| | - Hak-Kim Chan
- 1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, New South Wales, Australia
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Walenga RL, Tian G, Hindle M, Yelverton J, Dodson K, Longest PW. Variability in Nose-to-Lung Aerosol Delivery. JOURNAL OF AEROSOL SCIENCE 2014; 78:11-29. [PMID: 25308992 PMCID: PMC4187112 DOI: 10.1016/j.jaerosci.2014.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nasal delivery of lung targeted pharmaceutical aerosols is ideal for drugs that need to be administered during high flow nasal cannula (HFNC) gas delivery, but based on previous studies losses and variability through both the delivery system and nasal cavity are expected to be high. The objective of this study was to assess the variability in aerosol delivery through the nose to the lungs with a nasal cannula interface for conventional and excipient enhanced growth (EEG) delivery techniques. A database of nasal cavity computed tomography (CT) scans was collected and analyzed, from which four models were selected to represent a wide range of adult anatomies, quantified based on the nasal surface area-to-volume ratio (SA/V). Computational fluid dynamics (CFD) methods were validated with existing in vitro data and used to predict aerosol delivery through a streamlined nasal cannula and the four nasal models at a steady state flow rate of 30 L/min. Aerosols considered were solid particles for EEG delivery (initial 0.9 μm and 1.5 μm aerodynamic diameters) and conventional droplets (5 μm) for a control case. Use of the EEG approach was found to reduce depositional losses in the nasal cavity by an order of magnitude and substantially reduce variability. Specifically, for aerosol deposition efficiency in the four geometries, the 95% confidence intervals (CI) for 0.9 and 5 μm aerosols were 2.3-3.1 and 15.5-66.3%, respectively. Simulations showed that the use of EEG as opposed to conventional methods improved delivered dose of aerosols through the nasopharynx, expressed as penetration fraction (PF), by approximately a factor of four. Variability of PF, expressed by the coefficient of variation (CV), was reduced by a factor of four with EEG delivery compared with the control case. Penetration fraction correlated well with SA/V for larger aerosols, but smaller aerosols showed some dependence on nasopharyngeal exit hydraulic diameter. In conclusion, results indicated that the EEG technique not only improved lung aerosol delivery, but largely eliminated variability in both nasal depositional loss and lung PF in a newly developed set of nasal airway models.
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Affiliation(s)
- Ross L Walenga
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
| | - Geng Tian
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
| | - Joshua Yelverton
- Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA
| | - Kelley Dodson
- Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA
| | - P. Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA
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