Treating the Small Airways

Usmani, Omar

doi:10.1159/000343629

Cited by 70 publications

(60 citation statements)

References 180 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(144,145) In order to achieve this very coarse differentiation in regional inhaled aerosol deposition within the lungs, many factors can be influential of which particle size and aerosol velocity are key aerosol attributes (2) (see section on Basics of Aerosol Transport and Deposition in Lung).…”

Section: Importance Of Aerosol Deposition Distribution To Clinical Efmentioning

confidence: 99%

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Darquenne

Fleming

Katz

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

Self Cite

View full text Add to dashboard Cite

Development of a new drug for the treatment of lung disease is a complex and time consuming process involving numerous disciplines of basic and applied sciences. During the 2015 Congress of the International Society for Aerosols in Medicine, a group of experts including aerosol scientists, physiologists, modelers, imagers, and clinicians participated in a workshop aiming at bridging the gap between basic research and clinical efficacy of inhaled drugs. This publication summarizes the current consensus on the topic. It begins with a short description of basic concepts of aerosol transport and a discussion on targeting strategies of inhaled aerosols to the lungs. It is followed by a description of both computational and biological lung models, and the use of imaging techniques to determine aerosol deposition distribution (ADD) in the lung. Finally, the importance of ADD to clinical efficacy is discussed. Several gaps were identified between basic science and clinical efficacy. One gap between scientific research aimed at predicting, controlling, and measuring ADD and the clinical use of inhaled aerosols is the considerable challenge of obtaining, in a single study, accurate information describing the optimal lung regions to be targeted, the effectiveness of targeting determined from ADD, and some measure of the drug's effectiveness. Other identified gaps were the language and methodology barriers that exist among disciplines, along with the significant regulatory hurdles that need to be overcome for novel drugs and/or therapies to reach the marketplace and benefit the patient. Despite these gaps, much progress has been made in recent years to improve clinical efficacy of inhaled drugs. Also, the recent efforts by many funding agencies and industry to support multidisciplinary networks including basic science researchers, R&D scientists, and clinicians will go a long way to further reduce the gap between science and clinical efficacy.

show abstract

Section: Importance Of Aerosol Deposition Distribution To Clinical Efmentioning

confidence: 99%

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Darquenne

Fleming

Katz

et al. 2016

Journal of Aerosol Medicine and Pulmonary Drug Delivery

Self Cite

View full text Add to dashboard Cite

show abstract

“…With diameters <2 mm, the small airways have been recognised as important sites of chronic inflammation and disease with associated abnormalities [23, 24]. Therefore, for effective treatment of the disease it is important to deliver therapy to both small and large airways [25]. …”

Section: What Are the Current Incentives Driving Inhaler Development mentioning

confidence: 99%

Is there room for further innovation in inhaled therapy for airways disease?

Biddiscombe

Usmani

2018

Breathe

Self Cite

View full text Add to dashboard Cite

Inhaled medication is the cornerstone in the treatment of patients across a spectrum of respiratory diseases including asthma and chronic obstructive pulmonary disease. The benefits of inhaled therapy have long been recognised but the most important innovations have occurred over the past 60 years, beginning with the invention of the pressurised metered dose inhaler. However, despite over 230 different device and drug combinations currently being available, disease control is far from perfect.Here we look at how innovation in inhaler design may improve treatments for respiratory diseases and how new formulations may lead to treatments for diseases beyond the lungs. We look at the three main areas where innovation in inhaled therapy is most likely to occur: 1) device engineering and design; 2) chemistry and formulations; and 3) digital technology associated with inhalers. Inhaler design has improved significantly but considerable challenges still remain in order to continually innovate and improve targeted drug delivery to the lungs. Healthcare professionals want see innovations that motivate their patients to achieve their goal of improving their health, through better adherence to treatment. Patients want devices that are easy to use and to see that their efforts are rewarded by improvements in their condition.Key pointsThe dictionary definition of innovation is the introduction of new things, ideas or ways of doing something. We show how this definition can be applied to inhaled therapy.We take a look at the past to see what drove innovation in inhaler design and how this has led to the current devices.We look at the current drivers of innovation in engineering, chemistry and digital technology and predict how this may translate to new devices.Can innovation help the healthcare professional manage their patients better?What does the patient expect from innovation in their device?Educational aimsTo understand the importance of inhaled medication in the treatment of lung diseases.To understand how innovation has helped advance some of the devices patients use today from basic and inefficient designs.To understand the obstacles that prevent patients from receiving optimal treatment from their inhalers.To understand how innovation in inhaler design can lead to improved treatment for patients and widen the range of diseases that can be treated via the inhaled route.

show abstract

“…With this regards, the small airways have been extensively reported to be significantly involved in the onset and progression of COPD and a target site of action for inhaled therapy. However, due to their localization deep in the lungs and their anatomical structure, they may not be easily reached by all drug/device products [27,28], Drug deposition in the bronchial tree is achieved through different modalities [29]. Turbulence and inertial impaction occur when larger particles deposit in proximal airways, where the velocity of airflow is maximal.…”

Section: Particle Size and Fine Particle Fractionmentioning

confidence: 99%

The importance of inhaler devices in the treatment of COPD

Bonini

Usmani

2015

COPD Res Pract

Self Cite

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) represents a socio-economic burden and requires regular and ongoing treatment. Inhalation therapy is recommended at all stages of the disease and allows the delivery of active molecules directly to the target site of action, whilst minimising adverse side-effects. Inhalers therefore play a crucial role in the effective management of patients with COPD and their choice is as important as that of the drug. The three most important factors that influence inhaled drug deposition within the airways are the patient's inhalation flow, the aerosol velocity, and the inhaled drug particle size. These ultimately impact on the amount of drug reaching the target site and therefore the functional and clinical responses of the patient. Furthermore, patients' training and education in the use of inhalers have been shown to be directly related to the efficacy of the therapy. However, in daily clinical practice, too little consideration is given to the features of the different inhalers and to the ability of patients to properly handle the device, and precise recommendations are greatly needed to help healthcare professionals to advise and prescribe the most 'appropriate' inhaled drug/device product. The present review aims to provide the latest evidence on the importance of the inhaler device in the management of patients with COPD.

show abstract

Treating the Small Airways

Abstract: The final article in this series evaluates the approaches undertaken to treating the small-airway region of the lungs and the clinical implications of inhaled therapy targeting the periphery in patients with asthma and chronic obstructive pulmonary disease.

Cited by 70 publications

References 180 publications

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung

Is there room for further innovation in inhaled therapy for airways disease?

The importance of inhaler devices in the treatment of COPD

Contact Info

Product

Resources

About