Systemic involvement and comorbidities are common in chronic obstructive pulmonary disease (COPD). They add to the burden of disease and are associated with significant disability and mortality. These include cardiovascular disease, mood disorders, anemia, cachexia, skeletal muscle dysfunction and bone pathology. In this article, we review the pathophysiology, diagnosis and treatment of two such comorbidities, osteoporosis and sarcopenia, as they relate to patients with COPD.
Delivery of medication to sites of action through airways has been used for centuries but has gained momentum in recent decades. Currently available modes of aerosol delivery offer advantages but still there are shortcomings. Delivery of active agents to sites of action is affected by many factors beyond the characteristics of the delivery devices, including the coordination between inhalation and actuation and dependence on the patient's inspiratory flow and breathing pattern. Recent advances in drug delivery focus around changes in the generation of particle size with better penetration to the targeted sites, easier activation of the device with inspiratory flow, ease of use including fewer steps in using the device, and better portability. Availability of computer chips allows for smart delivery devices to tailor delivery to the patient's breathing pattern and lung function. Further, smart devices can provide feedback to patients. Novel inhaler technologies, separately or in combination with new therapeutic agents, are in development not only for respiratory diseases but also for diseases of other systems. This article reviews some of the recent clinically relevant advances in aerosol delivery devices.
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