Compatible Stability and Aerosol Characteristics of Atrovent® (Ipratropium Bromide) Mixed with Salbutamol Sulfate, Terbutaline Sulfate, Budesonide, and Acetylcysteine

Comprehensive Aerodynamic and Physicochemical Stability Evaluations of Nanocrystal-Based Dry Powder Inhalers: The Role of Mannitol and Leucine in Enhancing Performance

Background: Nanocrystals, a carrier-free nanotechnology, offer significant advantages for pulmonary drug delivery by enhancing the dissolution and solubility of poorly soluble drugs while maintaining favorable biological properties and low toxicity. This study aims to investigate the aerodynamic performance and stability of nanocrystal-based dry powders (NC-DPs). Methods: Nanocrystalline suspensions were produced via wet media milling and subjected to stability studies before undergoing nano spray drying. A factorial design was employed to optimize the process parameters. The influence of mannitol and leucine, individually and in combination, was evaluated in terms of aerodynamic properties (Aerodynamic Particle Sizer (APS), in silico modeling) and the physicochemical stability at room temperature (in a desiccator) and accelerated conditions (40 ± 2 °C, 75 ± 5% relative humidity). Results: APS analysis revealed that leucine-containing powders (K-NC-Ls) exhibited the smallest median (1.357 µm) and geometric mean (1.335 µm) particle sizes, enhancing dispersibility. However, in silico results indicated the highest exhaled fraction for K-NC-L, highlighting the need for optimized excipient selection. Although mannitol showed the lowest exhaled fraction, it was mainly deposited in the extra-thoracic region in silico. The mannitol/leucine combination (K-NC-ML) revealed a low exhaled fraction and high lung deposition in silico. Also, K-NC-ML demonstrated superior stability, with a 6% reduction in D[0.5] and a 5% decrease in span overtime. Furthermore, no significant changes in crystallinity, thermal behavior, drug release, or mass median aerodynamic diameter were observed under stress conditions. Conclusions: These findings confirm that combined incorporation of mannitol and leucine in NC-DP formulations enhances stability and aerodynamic performance, making it a promising approach for pulmonary drug delivery.

Complexities related to the amorphous content of lactose carriers

Although the amount of amorphous content in lactose is low, its impact on the performance of a dry powder inhalation formulation might be high. Many formulators and regulatory agencies believe that the levels of amorphous content should be controlled once there is a relationship with the final product performance. This is however not an easy task. The current paper elaborates on multiple challenges and complexities that are related to the control of the amorphous content in lactose. The definition and quantification methods of amorphous lactose are reviewed, as well as challenges related to thermodynamic instability. Additionally, current monographs and recent position papers considering this parameter are discussed to provide an overview of the regulatory landscape. Development of a control strategy is recommended, provided that the amorphous content at a specific moment in the process has shown to have an impact on the performance of the dry powder inhaler.

Drug combinations for inhalation: Current products and future development addressing disease control and patient compliance

Pulmonary delivery is an alternative route of administration with numerous advantages over conventional routes of administration. It provides low enzymatic exposure, fewer systemic side effects, no first-pass metabolism, and concentrated drug amounts at the site of the disease, making it an ideal route for the treatment of pulmonary diseases. Owing to the thin alveolar-capillary barrier, and large surface area that facilitates rapid absorption to the bloodstream in the lung, systemic delivery can be achieved as well. Administration of multiple drugs at one time became urgent to control chronic pulmonary diseases such as asthma and COPD, thus, development of drug combinations was proposed. Administration of medications with variable dosages from different inhalers leads to overburdening the patient and may cause low therapeutic intervention. Therefore, products that contain combined drugs to be delivered via a single inhaler have been developed to improve patient compliance, reduce different dose regimens, achieve higher disease control, and boost therapeutic effectiveness in some cases. This comprehensive review aimed to highlight the growth of drug combinations by inhalation over time, obstacles and challenges, and the possible progress to broaden the current options or to cover new indications in the future. Moreover, various pharmaceutical technologies in terms of formulation and device in correlation with inhaled combinations were discussed in this review. Hence, inhaled combination therapy is driven by the need to maintain and improve the quality of life for patients with chronic respiratory diseases; promoting drug combinations by inhalation to a higher level is a necessity.

Medicines management for nurses: explaining legal governance

There are multiple acts of law and case law that govern UK prescribing practice. This article examines three important topics for nurses: the classification and prescribing of controlled drugs, including the meaning of medicine classes and schedules; the prescribing of unlicensed medicines, including the difference between unlicensed and off-license medicines; and negligence in prescribing practice. The article outlines the acts of law that are relevant to each topic and provides examples of significant case law or other legal rulings to demonstrate how the law is relevant to nurses' clinical practice.

Nebulizer systems: a new frontier for therapeutics and targeted delivery

Drug delivery via the pulmonary route is a cornerstone in the pharmaceutical sector as an alternative to oral and parenteral administration. Nebulizer inhalation treatment offers multiple drug administration, easily employed with tidal breathing, suitable for children and elderly, can be adapted for severe patients and visible spray ensures patient satisfaction. This review discusses the operational and mechanical characteristics of nebulizer delivery devices in terms of aerosol production processes, their usage, benefits and drawbacks that are currently shaping the contemporary landscape of inhaled drug delivery. With the advent of particle engineering, novel inhaled nanosystems can be successfully developed to increase lung deposition and decrease pulmonary clearance. The above-mentioned advances might pave the path for treating a life-threatening disorder like severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is also discussed in the current state of the art.

Nanoparticle-Based Drug Delivery System: The Magic Bullet for the Treatment of Chronic Pulmonary Diseases

Chronic pulmonary diseases encompass different persistent and lethal diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), asthma, and lung cancers that affect millions of people globally. Traditional pharmacotherapeutic treatment approaches (i.e., bronchodilators, corticosteroids, chemotherapeutics, peptide-based agents, etc.) are not satisfactory to cure or impede diseases. With the advent of nanotechnology, drug delivery to an intended site is still difficult, but the nanoparticle's physicochemical properties can accomplish targeted therapeutic delivery. Based on their surface, size, density, and physical-chemical properties, nanoparticles have demonstrated enhanced pharmacokinetics of actives, achieving the spotlight in the drug delivery research field. In this review, the authors have highlighted different nanoparticle-based therapeutic delivery approaches to treat chronic pulmonary diseases along with the preparation techniques. The authors have remarked the nanosuspension delivery via nebulization and dry powder carrier is further effective in the lung delivery system since the particles released from these systems are innumerable to composite nanoparticles. The authors have also outlined the inhaled particle's toxicity, patented nanoparticle-based pulmonary formulations, and commercial pulmonary drug delivery devices (PDD) in other sections. Recently advanced formulations employing nanoparticles as therapeutic carriers for the efficient treatment of chronic pulmonary diseases are also canvassed.