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Pharmacological Consequences of Inhaled Drug Delivery to Small Airways in the Treatment of Asthma

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Abstract

Small peripheral airways are an important target for the anti-inflammatory treatment of asthma. To make anti-inflammatory drugs (inhaled corticosteroids [ICS]) effectively reach small airways, they should be delivered using inhalation techniques containing high proportions of fine or super-fine particles. Higher proportions of fine particles are associated with higher systemic absorption of ICS leading to an increased risk of endogenous cortisol suppression. Ciclesonide, despite the highest proportion of fine and super-fine particle fractions, is the only ICS not associated with an increased risk of systemic adverse effects, including cortisol suppression. In contrary to ICS, bronchodilators should not be administered to peripheral airways. This does not improve their efficacy and may increase their risk of cardiotoxicity. Thus, from a pharmacological point of view and the theory of aerosols’ deposition, fixed combinations of ICS and long-acting beta agonists are always suboptimal. In many cases, the best solution may be to use fine-particle ciclesonide and a non-fine particle beta agonist administered from separate inhalers.

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Acknowledgments

We thank Proper Medical Writing Sp. z o.o. which provided medical writing services and was funded by Takeda Poland. No other funding or sponsorship was received for this study or publication of this article. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Conflict of interest

Anna Bodzenta-Łukaszyk gave the lectures upon request of Takeda, Novartis, and Hal Allergy companies. Marek Kokot is a current Takeda Polska employee.

Compliance with ethics guidelines

This article is based on previously conducted studies, and does not involve any new studies of human or animal subjects performed by any of the authors.

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Correspondence to Anna Bodzenta-Łukaszyk.

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Bodzenta-Łukaszyk, A., Kokot, M. Pharmacological Consequences of Inhaled Drug Delivery to Small Airways in the Treatment of Asthma. Adv Ther 31, 803–816 (2014). https://doi.org/10.1007/s12325-014-0143-7

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