Future Trends in Nebulized Therapies for Pulmonary Disease

Abstract

Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.

Challenges and opportunities for antiviral monoclonal antibodies as COVID-19 therapy

“…Readers are referred to an excellent review on the mechanism of protein aggregation during nebulization [ 212 ]. Finally, jet nebulizers typically have considerable “dead volume”; residual mass can be up to 50% of the loaded drug mass [ 213 , 214 ]. This wasted volume would be a significant concern with an expensive, complex, biological molecule like mAb.…”

Defining a Regulatory Strategy for ATMP/Aerosol Delivery Device Combinations in the Treatment of Respiratory Disease

“…Interestingly, beyond hepatic first losses being a major blockade, for ATMPs it has been proposed that aerosol-mediated delivery helps overcome the risks associated with aggregation in the microvasculature. Considering these factors in combination, aerosol-mediated delivery has the potential to profoundly impact the future of cellular therapies in a clinical setting [ 23 , 125 , 126 ].…”

Рossibilities of clinical application of modern nebulizers

“…Так, был показан более интенсивный иммунный ответ на ингаляционную форму вакцины против кори, по сравнению с инъекционной, даже при использовании меньших доз первой [35]. Оцениваются также возмож-ности эндобронхиальной доставки гепарина, инсулина, моноклональных антител [36][37][38][39]. Все это лишь подтверждает, что небулайзеры занимают прочное место, и не только в респираторной медицине.…”