Efficient Delivery to the Lungs of Flunisolide Aerosol From a New Portable Hand-Held Multidose Nebulizer

Abstract

In order to provide asthmatic patients with an inhaler that does not use chlorofluorocarbon propellants, a novel multidose hand-held nebulizer (RESPIMAT, Boehringer Ingelheim Ltd.) has been developed. This device delivers 200 x 15 microL metered doses of drug solution, but does not use propellants of any kind. In this study of 10 healthy volunteers, the deposition pattern in the lungs and oropharynx of an ethanolic solution of flunisolide delivered via a prototype III multidose nebulizer has been determined by gamma scintigraphy. A comparison was made with the same dose (250 micrograms) of flunisolide delivered by a pressurized metered dose inhaler (MDI) and MDI plus Inhacort spacer. Mean (SD) whole lung deposition from the multidose nebulizer (39.7 (9.9) % of the metered dose) was significantly higher than that from either MDI (15.3 (5.1) %, P < 0.01) or MDI plus spacer (28.0 (7.0) %, P = 0.01). A mean 10.4% of the dose was recovered from an exhaled air filter for the multidose nebulizer, but less than 2% of the dose for MDI or MDI plus spacer. Oropharyngeal deposition was significantly reduced for the multidose nebulizer (39.9 (9.4) %) compared to MDI (66.9 (7.1) %), but was reduced further for the MDI plus spacer (27.3 (11.3) %). The multidose nebulizer delivers an unusually high percentage of an aerosol dose to the lungs, and it "targets" flunisolide to the lungs more effectively than the MDI. The multidose nebulizer could constitute a viable alternative to MDIs in asthma maintenance therapy.

What the pulmonary specialist should know about the new inhalation therapies

“…This produces a fine mist that is slow moving, leading to lower deposition in the mouth and throat and relatively high lung deposition (i.e. ,39%) [95][96][97].…”

New abilities of administration of tiotropium bromide using the aerosol delivery device Respimat®

“…В сцинтиграфических исследованиях продемон стрирована более высокая легочная и меньшая ро тоглоточная депозиция препаратов при использова нии ингалятора ТР по сравнению с ДПИ и ДАИ со спейсером и без такового [28][29][30][31][32]. В исследовании с участием здоровых добровольцев S.P.Newman et al показано, что легочная депозиция флунизолида или фенотерола при использовании ингалятора ТР со ставляет 39,2-44,6 %, в то время как ротоглоточная депозиция -только 26,2-39,9 % (рис.…”

“…В исследовании с участием здоровых добровольцев S.P.Newman et al показано, что легочная депозиция флунизолида или фенотерола при использовании ингалятора ТР со ставляет 39,2-44,6 %, в то время как ротоглоточная депозиция -только 26,2-39,9 % (рис. 4) [29,30]. В этих же исследованиях легочная депозиция лекар ственных препаратов при их ингаляции с помощью ДАИ без спейсера составила 11,0-15,3 %, а при использовании ДАИ со спейсером -9,9-28,0 % (см.…”

“…рис. 4) [29,30]. В другом исследовании проведе но сравнение депозиции будесонида, ингалируемого с помощью ингаляторов Респимат ® и Турбухалер ® , ле гочная депозиция препарата составляла 51,6 и 28,5 % соответственно, а ротоглоточная депозиция -19,3 и 49,3 % соответственно [31].…”

Respimat^® (a New Soft Mist Inhaler) Delivering Fenoterol plus Ipratropium Bromide Provides Equivalent Bronchodilation at Half the Cumulative Dose Compared with a Conventional Metered Dose Inhaler in Asthmatic Patients

“…Respimat is a reusable, mechanically driven, propellant-free, multidose inhaler which emits the dose slowly (over a period of 1.2 s) as a soft mist, with a high proportion of the dose in the fine particle fraction [12]. Scintigraphic studies in volunteers have shown that this fine particle fraction results in improved lung deposition (39–45% of dose vs. 11–15% for MDI) and reduced oropharyngeal impaction (26–40% of dose vs. 67–71% for MDI), and together with the slow speed of aerosol delivery facilitates the co-ordination of inspiration and actuation during drug administration [13, 14, 15, 16, 17, 18]. …”