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Farkas Á, Tomisa G, Kugler S, Nagy A, Vaskó A, Kis E, Szénási G, Gálffy G, Horváth A. The effect of exhalation before the inhalation of dry powder aerosol drugs on the breathing parameters, emitted doses and aerosol size distributions. Int J Pharm X 2023; 5:100167. [PMID: 36824288 PMCID: PMC9941374 DOI: 10.1016/j.ijpx.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
Airway deposition of aerosol drugs is highly dependent on the breathing manoeuvre of the patients. Though incorrect exhalation before the inhalation of the drug is one of the most common mistakes, its effect on the rest of the manoeuvre and on the airway deposition distribution of aerosol drugs is not explored in the open literature. The aim of the present work was to conduct inhalation experiments using six dry powder inhalers in order to quantify the effect of the degree of lung emptying on the inhalation time, inhaled volume and peak inhalation flow. Another goal of the research was to determine the effect of the exhalation on the aerodynamic properties of the drugs emitted by the same inhalers. According to the measurements, deep exhalation before drug inhalation increased the volume of the inhaled air and the average and maximum values of the inhalation flow rate, but the extent of the increase was patient and inhaler specific. For different inhalers, the mean value of the relative increase in peak inhalation flow due to forceful exhalation was between 15.3 and 38.4% (min: Easyhaler®, max: Breezhaler®), compared to the case of normal (tidal) exhalation before the drug inhalation. The relative increase in the inhaled volume was between 36.4 and 57.1% (min: NEXThaler®, max: Turbuhaler®). By the same token, forceful exhalation resulted in higher emitted doses and smaller emitted particles, depending on the individual breathing ability of the patient, the inhalation device and the drug metered in it. The relative increase in the emitted dose varied between 0.2 and 8.0% (min: Foster® NEXThaler®, max: Bufomix® Easyhaler®), while the relative enhancement of fine particle dose ranged between 1.9 and 30.8% (min: Foster® NEXThaler®, max: Symbicort® Turbuhaler®), depending on the inhaler. All these effects and parameter values point toward higher airway doses due to forceful exhalation before the inhalation of the drug. At the same time, the present findings highlight the necessity of proper patient education on the importance of lung emptying, but also the importance of patient-specific inhaler-drug pair choice in the future.
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Key Words
- AF, aerosolized fraction
- Aerosol drug delivery
- BMI, body mass index
- Breathing parameters
- CAD, computer aided design
- COPD, chronic obstructive pulmonary disease
- CT, computed tomography
- DPI, dry powder inhaler
- Dry powder inhalers
- ED, emitted dose
- FEV1, expiratory volume at the end of the first second of forced exhalation
- FPF, fine particle fraction
- FVC, forced vital capacity
- GSD, geometric standard deviation
- ICS, inhalation cortico-steroid
- IV, inhaled volume
- IVC, inspiratory vital capacity
- IVdev, inhaled volume through an inhalation device
- Inhalation therapy
- LABA, long-acting beta-agonist
- Lung emptying
- MMAD, mass median aerodynamic diameter
- PEF, peak expiratory flow
- PIF, peak inhalation flow
- PIFdev, peak inhalation flow through an inhalation device
- PIL, patient information leaflet
- Q, mean inhalation flow rate
- Qdev, mean inhalation flow rate through an inhalation device
- SPC, summary of product characteristics
- tin, inhalation time
- tin-dev, inhalation time through an inhalation device
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Affiliation(s)
- Árpád Farkas
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary,Corresponding author at: Centre for Energy Research, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary.
| | - Gábor Tomisa
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
| | - Szilvia Kugler
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Nagy
- Wigner Research Centre for Physics, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Vaskó
- Pulmonology Clinic, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
| | - Erika Kis
- Babes-Bolyai University, Hungarian Department of Biology and Ecology, Cluj-Napoca, Romania
| | | | - Gabriella Gálffy
- County Institute of Pulmonology, Department of Pulmonology, Munkácsy M. u. 70, 2045 Törökbálint, Hungary
| | - Alpár Horváth
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
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Easwaran M, Martinez JD, Ramirez DJ, Gall PA, Erickson-DiRenzo E. Short-term whole body cigarette smoke exposure induces regional differences in cellular response in the mouse larynx. Toxicol Rep 2021; 8:920-937. [PMID: 33996505 PMCID: PMC8099918 DOI: 10.1016/j.toxrep.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Short-term CSE induced regional differences in murine laryngeal cellular responses. Basal cell hyperplasia accompanies adaptive cell proliferation in the vocal folds. Increased subglottic cell proliferation persists even after CS cessation. SEM revealed vocal fold microprojection damage with possible necrotic features. Subglandular acidic mucins decreased and neutral mucins increased post-CSE.
The larynx is an essential organ in the respiratory tract and necessary for airway protection, respiration, and phonation. Cigarette smoking is a significant risk factor associated with benign and malignant laryngeal diseases. Despite this association, the underlying mechanisms by which cigarette smoke (CS) drives disease development are not well elucidated. In the current study, we developed a short-term murine whole body inhalation model to evaluate the first CS-induced cellular responses in the glottic [i.e. vocal fold (VF)] and subglottic regions of the larynx. Specifically, we investigated epithelial cell proliferation, cell death, surface topography, and mucus production, at various time points (1 day, 5 days, 10 days) after ∼ 2 h exposure to 3R4F cigarettes (Delivered dose: 5.6968 mg/kg per cigarette) and following cessation for 5 days after a 5 day CS exposure (CSE). CSE elevated levels of BrdU labeled proliferative cells and p63 labeled epithelial basal cells on day 1 in the VF. CSE increased proliferative cells in the subglottis at days 5, 10 and following cessation in the subglottis. Cleaved caspase-3 apoptotic activity was absent in VF at all time points and increased at day 1 in the subglottis. Evaluation of the VF surface by scanning electron microscopy (SEM) revealed significant epithelial microprojection damage at day 10 and early signs of necrosis at days 5 and 10 post-CSE. SEM visualizations additionally indicated the presence of deformed cilia at days 5 and 10 after CSE and post-cessation in the respiratory epithelium lined subglottis. In terms of mucin content, the impact of short-term CSE was observed only at day 10, with decreasing acidic mucin levels and increasing neutral mucin levels. Overall, these findings reveal regional differences in murine laryngeal cellular responses following short-term CSE and provide insight into potential mechanisms underlying CS-induced laryngeal disease development.
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Key Words
- AB/PAS, Alcian blue/Periodic acid Schiff
- BLOQ, below limits of quantitation
- BSA, bovine serum albumin
- BrdU, 5-bromo-2′-deoxyuridine
- CBF, ciliary beat frequency
- CC3, cleaved caspase-3
- CO, Carbon monoxide
- CS, cigarette smoke
- CSE, cigarette smoke exposure
- Cell death
- Cell proliferation
- Cigarette smoke
- DAB, 3,3′-diaminobenzidine
- FTC/ISO, Federal Trade Commission/International Standard Organization
- GSD, geometric standard deviation
- H&E, Hematoxylin and Eosin
- HIER, heat-induced antigen retrieval
- HPF, high power field
- MCC, mucociliary clearance
- MMAD, Mass median aerodynamic diameter
- Mucus production
- Murine larynx
- NMR, nicotine metabolite ratio
- OECD, organization for economic co-operation and development
- PAHs, polycyclic aromatic hydrocarbons
- RE, respiratory epithelium
- REV, reversibility
- ROS, reactive oxygen species
- SCIREQ, Scientific Respiratory Equipment Inc
- SEM, scanning electron microscopy
- SSE, stratified squamous epithelium
- SWGTOX, Scientific Working Group for Forensic Toxicology
- Surface topography
- TBST, tris-buffered saline-tween 20
- TPM, total particulate matter
- TSNA, tobacco-specific nitrosamines
- UPLC-MS/MS, ultra-performance liquid chromatography-tandem mass spectrometer
- VF, vocal fold
- VSC, veterinary service center
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Affiliation(s)
- Meena Easwaran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua D Martinez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel J Ramirez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Phillip A Gall
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Zhou Y, Niu B, Wu B, Luo S, Fu J, Zhao Y, Quan G, Pan X, Wu C. A homogenous nanoporous pulmonary drug delivery system based on metal-organic frameworks with fine aerosolization performance and good compatibility. Acta Pharm Sin B 2020; 10:2404-2416. [PMID: 33354510 PMCID: PMC7745127 DOI: 10.1016/j.apsb.2020.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/24/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
Pulmonary drug delivery has attracted increasing attention in biomedicine, and porous particles can effectively enhance the aerosolization performance and bioavailability of drugs. However, the existing methods for preparing porous particles using porogens have several drawbacks, such as the inhomogeneous and uncontrollable pores, drug leakage, and high risk of fragmentation. In this study, a series of cyclodextrin-based metal-organic framework (CD-MOF) particles containing homogenous nanopores were delicately engineered without porogens. Compared with commercial inhalation carrier, CD-MOF showed excellent aerosolization performance because of the homogenous nanoporous structure. The great biocompatibility of CD-MOF in pulmonary delivery was also confirmed by a series of experiments, including cytotoxicity assay, hemolysis ratio test, lung function evaluation, in vivo lung injury markers measurement, and histological analysis. The results of ex vivo fluorescence imaging showed the high deposition rate of CD-MOF in lungs. Therefore, all results demonstrated that CD-MOF was a promising carrier for pulmonary drug delivery. This study may throw light on the nanoporous particles for effective pulmonary administration.
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Key Words
- ANOVA, analysis of variance
- BALF, bronchoalveolar lavage fluid
- BET, Brunauer–Emmett–Teller
- CCK-8, cell counting kit-8
- CD-MOF, cyclodextrin-based metal-organic framework
- CD-MOF-K, ketoprofen-loaded cyclodextrin-based metal-organic framework
- CD-MOF-R, rhodamine B-loaded cyclodextrin-based metal-organic framework
- CF, commercial formulation
- CTAB, cetyl trimethyl ammonium bromide
- Cdyn, dynamic lung compliance
- DPPC, 1,2-dipalmitoyl-sn-glycero-3-phosphocholine
- FBS, fetal bovine serum
- FDA, U.S. Food and Drug Administration
- FPF, fine particle fraction
- GSD, geometric standard deviation
- HE, Hematoxylin-Eosin
- HPLC, high performance liquid chromatography
- Inhalable dry powder
- LDH, lactate dehydrogenase
- LPS, lipopolysaccharide
- MFI, mean fluorescence intensity
- MMAD, mean mass aerodynamic diameter
- MOF, metal-organic framework
- Metal-organic framework
- NGI, next generation pharmaceutical impactor
- Nanoporous particle
- PBS, phosphate buffered solution
- PVP, poly(vinyl pyrrolidone)
- PXRD, powder X-ray diffraction
- Pulmonary drug delivery
- Rl, lung resistance
- SD rat, Sprague–Dawley rat
- SEM, scanning electron microscopy
- SLF, simulated lung fluid
- γ-CD, γ-cyclodextrin
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Yao W, Gallagher DL, Dietrich AM. An overlooked route of inhalation exposure to tap water constituents for children and adults: Aerosolized aqueous minerals from ultrasonic humidifiers. Water Res X 2020; 9:100060. [PMID: 32793876 PMCID: PMC7408721 DOI: 10.1016/j.wroa.2020.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 05/06/2023]
Abstract
Fine particulates and aerosols emitted by commonly used, room-sized ultrasonic humidifiers may pose adverse health effects to children and adults. The literature documents adverse effects for children exposed to minerals emitted from humidifiers. This study performs novel and comprehensive characterization of bivariate particle size and element concentrations of emitted airborne aerosols and particles from ultrasonic humidifiers filled with tap water, including size distribution from 0.014 to 10 μm by scanning mobility particle sizer and AeroTrak; corresponding metal and elemental concentrations as a function of particle size by inductively coupled plasma mass spectrometer; and calculations of deposition fraction in human lungs for age-specific groups using the multi-path particle dosimetry model (MPPD). Deposition fraction is the ratio of mass deposited to total mass inhaled. When filled with tap water, water evaporated from emitted aerosols to form submicron particles that became essentially "dried tap water" with median size 146 nm and mean concentration of 211 μg-total elements/m3-air including 35 μg-calcium/m3-air in a room of 33.5 m3 and air exchange rate at ∼0.8 hr-1. Approximately 90% of emitted particles deposited in human lungs were <1 μm as shown by MPPD model. The smaller particles contained little water and higher concentration of minerals, while larger particles of >1 μm consisted of lower elemental concentrations and more water due to low evaporation. Deposition fraction in pulmonary region was ∼2-fold higher, and deposited particulate mass was 3.5-fold higher for children than adults, indicating greater inhalation exposure to children compared to adults. Modeled data of total particles mass per body weight (BW) that will deposit in adult and child lungs after 8-h humidifier exposure were respectively 2.8 μg/kg-BW and 9.8 μg/kg-BW, where calcium contributes 0.4 μg/kg-BW and 1.6 μg/kg-BW. This comprehensive study of bivariate inorganic chemical composition as a function of particle size expanded, quantified, and modeled exposure for children and adults to aerosolized calcium and other inorganic constituents in water.
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Affiliation(s)
- Wenchuo Yao
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Daniel L. Gallagher
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Andrea M. Dietrich
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
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