Surfactant-Assisted Distal Pulmonary Distribution of Budesonide Revealed by Mass Spectrometry Imaging

Zecchi, Riccardo; Franceschi, Pietro; Tigli, Laura; Pioselli, Barbara; Mileo, Valentina; Murgia, Xabier; Salomone, Fabrizio; Pieraccini, Giuseppe; Usada, Haruo; Schmidt, Augusto F.; Hillman, Noah H.; Kemp, Matthew W.; Jobe, Alan H.

doi:10.3390/pharmaceutics13060868

Cited by 2 publications

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References 49 publications

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“…This is consistent with the findings of Riccardo Zecchi et al In the study, they used mass spectrometry imaging to analyze the distribution of PS/budesonide in lamb lungs, and they demonstrated that compared with the PS/saline group, the PS/budesonide group had a more uniform distribution of budesonide in the lung and more distribution in the peripheral lung. 94…”

Section: The Way Of Administration Of Budesonidementioning

confidence: 99%

Recent advances in understanding NARDS, and the effect of the budesonide on the prevention of NARDS

Liu

Lei

et al. 2022

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Acute respiratory distress syndrome (ARDS) is an acute respiratory failure syndrome caused by non-cardiogenic pulmonary edema of various etiologies.[1](#ref-0001) When the fetus encounters asphyxia, acidosis, infection, meconium inhalation, et al. during childbirth, the inflammatory pathway will be activated. The systemic inflammatory response can remove pathogens, but the excessive inflammatory response will prompt pulmonary surfactant (PS) inactivation and increase the permeabilities of alveolar epithelial and endothelial cells, resulting in the accumulation of edema fluid in the alveoli and eventually leading to severe hypoxemia, respiratory distress and decreased lung compliance.[1,2](#ref-0001) Population-based studies in the United States, Australia, Europe, and New Zealand reported that the incidence of ARDS in children is 2.0-12.8 per 100000 person-years,[3](#ref-0003) and according to the interim report of the International Neonatal ARDS Multicenter Study, the mortality of neonatal ARDS (NARDS) is approximately 20%.[4](#ref-0004) Due to the high mortality of NARDS, the researchers try to explore potential new treatments to limit the incidence and mortality of NARDS. Systemic inflammatory response plays a significant role in the occurrence and development of NARDS, budesonide, a non-halogenated corticosteroid, has a potent local pulmonary anti-inflammatory effect, therefore, it may be an effective treatment option for NARDS. This article reviews the evolution of ARDS definition and diagnosis, pathophysiological mechanisms of NARDS, and gives an outlook on the application of budesonide in NARDS.

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Section: The Way Of Administration Of Budesonidementioning

confidence: 99%

Recent advances in understanding NARDS, and the effect of the budesonide on the prevention of NARDS

Liu

Lei

et al. 2022

Preprint

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“…Budesonide is a potent corticosteroid used in asthma to treat lung inflammation [6]. In its aerosolized form, budesonide remains in the airways; however, when combined with surfactant, it is transported into the more distal lung where BPD occurs [7,8]. Unfortunately in premature infants, budesonide can be detected systemically shortly after intratracheal administration, though it is rapidly metabolized by the liver [1,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Early Physiological and Adrenal Effects of Budesonide Mixed with Surfactant in Large Observational Preterm Cohort Study

et al. 2022

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Background: The combination of surfactant and budesonide has been shown to decrease BPD rates and severity. Budesonide may be released systemically from lungs, and the effects on the immature adrenal glands are not known. Objective: The aim of this study was to determine if adrenal suppression rates are higher in preterm infants receiving budesonide with surfactant compared to surfactant alone. Methods: A retrospective chart review of 608 infants ≤1,250 g received intubation for surfactant therapy from 2013 through 2020. In August 2016, budesonide was added to surfactant for these infants. Indicators of adrenal suppression, including mean blood pressures, plasma electrolyte levels, hydrocortisone use, and the use of vasoactive medications, were analyzed for the first 14 days after birth. Respiratory variables, biochemical signs of adrenal insufficiency, and neonatal morbidities were analyzed. Results: There was no difference in hydrocortisone administration in the first 14 days between infants receiving budesonide with surfactant (n = 314) or surfactant alone (n = 294) (23% vs. 19%, p = 0.38). Budesonide exposed infants received hydrocortisone 3 days later than surfactant only infants (median DOL 5 vs. 2, p < 0.001). Infants receiving budesonide had higher blood pressures, required less dopamine (19% vs. 39%, p < 0.001) and dobutamine (2% vs. 6%, p = 0.02). Budesonide exposed infants were discharged home after a shorter NICU stay (85 days vs. 94 days, p = 0.02) and at a younger gestational age (39 vs. 40 weeks, p = 0.001). Conclusions: The use of surfactant and budesonide does not alter the rate of hydrocortisone use, but does delay the timing of treatment initiation and decreases the use of vasoactive medications.

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Surfactant-Assisted Distal Pulmonary Distribution of Budesonide Revealed by Mass Spectrometry Imaging

Cited by 2 publications

References 49 publications

Recent advances in understanding NARDS, and the effect of the budesonide on the prevention of NARDS

Recent advances in understanding NARDS, and the effect of the budesonide on the prevention of NARDS

Early Physiological and Adrenal Effects of Budesonide Mixed with Surfactant in Large Observational Preterm Cohort Study

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