Clinical aerosols II. Therapeutic aerosols

Abstract

The current uses of clinical aerosols such as water, saline, mucolytics, bronchodilators, cromolyn sodium, corticosteroids, and antimicrobials have been reviewed. The benefits of water, saline, and detergent aerosols continue to be surrounded by uncertainty and controversy. Aerosolized mucolytic and proteolytic agents have not been conclusively shown to be of substantial value in the improvement of respiratory disorders. Favorable bronchodilator therapy is achieved with aerosols of certain sympathomimetic and anticholinergic agents. However, successful therapy depends on the dose administered and the site of aerosol deposition in the lung. The prophylactic use of cromolyn sodium in patients with asthma is another useful application of aerosols. Topically active corticosteroid aerosols are increasingly being used since they may reduce risks of systemic effects from corticosteroids. Research on uncommonly aerosolized agents has widened the spectrum of therapeutic applications of aerosols.

Recurrent Acute Rhinosinusitis: A Single Blind Clinical Study of N-Acetylcysteine vs Ambroxol Associated to Corticosteroid Therapy

“…In the past, the first therapeutic choice was to prescribe nasal washes to help mucus removal, associated to several drugs that were tested for their mucolytic properties. Many studies were performed giving disconcordant results; the only substance that showed significant effect on mucus reduction was N-Acetilcysteine (NAC) (8)(9)(10).…”

Pressurized metered-dose inhaler (pMDI) aerosol deposition : measurements in add-on spacers

“…The lungs with a combined surface area of more than 100 m together with a low metabolic activity (Lourenco andCotroman, 1982, Clarke andNewman, 1984) makes them an ideal site for drug absorption and a potential route for the systemic administration of certain drugs that cannot be delivered by other means. Many studies have shown that greater bioavailability has been achieved for macromolecular drugs than any other route of administration to the systemic circulation Platz, 1992, Byron andPatton, 1994).…”

Antibiotic Use in Cystic Fibrosis

“…Aerosolized Antibiotic Therapy Barach 128 Well-controlled placebo trials or comparisons with systemic therapy have not been done due to ethical considerations of withholding therapy in patients. However, trials of aerosolized polymyxin for prophylaxis against gram-negative pneumonia in seriously ill patients have failed.…”

“…However, trials of aerosolized polymyxin for prophylaxis against gram-negative pneumonia in seriously ill patients have failed. 128 When used continuously, the aerosol appears to increase the development of polymyxin-resistant organisms. 128 Aerosolized gentamicin and carbenicillin have been used in PA pneumonia without clear evidence of improved therapeutic effect.…”

“…128 When used continuously, the aerosol appears to increase the development of polymyxin-resistant organisms. 128 Aerosolized gentamicin and carbenicillin have been used in PA pneumonia without clear evidence of improved therapeutic effect. 129 Klastersky et al reported a significant benefit for sisomicin aerosol 25 mg tid over placebo aerosol administered endotracheally in patients with gram-negative pneumonia.55 All patients also received systemic carbenicillin and sisomicin; however, the peak serum sisomicin concentrations of 1.1 t'g/ml were well below the therapeutic concentration for gram-negative pneumonias."…”