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Currently Available Inhaled Therapies in Asthma and Advances in Drug Delivery and Devices

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Abstract

Medications delivered in the inhaled form remains the cornerstone of medical management of asthma. There have been considerable advances in the development of inhaled medications and devices over the past several decades. Clinicians also have access to regularly updated international guidelines for management of asthma. Despite this, a substantial proportion of children with asthma continue to have persistent poor asthma control and considerable morbidity even in well-resourced settings. The wide selection of medications and devices may complicate clinical decision making. The ideal inhaler would be one that the patient can and will use as advised. One cannot overemphasize the importance of medication adherence and a correct inhaler technique in achieving optimal asthma control. Clinicians who manage children with asthma should have a good understanding of inhaled medications and devices commercially available for the management of asthma and this would help them select the right medication and device for the right patient. This review aims to provide an overview of physiologic basis of inhaler therapy, commonly used inhaled therapies, and the advances in the field of inhaler devices including emerging technologies.

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References

  1. Anderson PJ. History of aerosol therapy: liquid nebulization to MDIs to DPIs. Respir Care. 2005;50:1139–50.

    PubMed  Google Scholar 

  2. Dessanges JF. A history of nebulization. J Aerosol Med. 2001;14:65–71.

    Article  CAS  Google Scholar 

  3. Usmani OS. Treating the small airways. Respiration. 2012;84:441–53.

    Article  Google Scholar 

  4. Schittny JC. Development of the lung. Cell Tissue Res. 2017;367:427–44.

    Article  Google Scholar 

  5. Rottier BL, Rubin BK. Asthma medication delivery: mists and myths. Paediatr Respir Rev. 2013;14:112–8.

    Article  Google Scholar 

  6. Yu J, Chien YW. Pulmonary drug delivery: physiologic and mechanistic aspects. Crit Rev Ther Drug Carrier Syst. 1997;14:395–453.

    Article  CAS  Google Scholar 

  7. Fernández Tena A, Casan CP. Deposition of inhaled particles in the lungs. Arch Bronconeumol. 2012;48:240–6.

    Article  Google Scholar 

  8. Usmani OS. Improved lung deposition: new inhaler devices. In: Ian M, Adcock and Kian Fan Chung, editors. Overcoming Steroid Insensitivity in Respiratory Disease. 1st ed. John Wiley & Sons, Ltd. 2008. p. 263–81.

  9. Buels KS, Fryer AD. Muscarinic receptor antagonists: effects on pulmonary function. Handb Exp Pharmacol. 2012:317–41. https://doi.org/10.1007/978-3-642-23274-9_14.

  10. Sunther M, Marchon K, Gupta A. Tiotropium in the management of paediatric and adolescent asthma: Systematic review. Paediatr Respir Rev. 2021;38:58–62.

    PubMed  Google Scholar 

  11. Barnes PJ. Distribution of receptor targets in the lung. Proc Am Thorac Soc. 2004;1:345–51.

    Article  CAS  Google Scholar 

  12. Barnes NC. The properties of inhaled corticosteroids: similarities and differences. Prim Care Respir J. 2007;16:149–54.

    Article  Google Scholar 

  13. Salvi S, Shevade M, Aggarwal A, et al. A practical guide on the use of inhaler devices for asthma and COPD. J Assoc Physicians India. 2021;69:8–26.

    Google Scholar 

  14. O’Callaghan C, Lynch J, Cant M, Robertson C. Improvement in sodium cromoglycate delivery from a spacer device by use of an antistatic lining, immediate inhalation, and avoiding multiple actuations of drug. Thorax. 1993;48:603–6.

    Article  CAS  Google Scholar 

  15. James RW, Masters IB. Single breath versus panting technique in salbutamol delivery through a 750 mL spacing device. Pediatr Pulmonol. 1990;8:263–7.

    Article  CAS  Google Scholar 

  16. Laube BL, Janssens HM, de Jongh FH, et al. International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37:1308–31.

  17. GINA: Interim Guidance about COVID-19 & Asthma. The Global Initiative for Asthma (GINA). 2021. Available at : https://ginasthma.org/. Accessed on 21st July 2021.

  18. Rubin BK, Fink JB. Optimizing aerosol delivery by pressurized metered-dose inhalers. Respir Care. 2005;50:1191–200.

    PubMed  Google Scholar 

  19. Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax. 1991;46:712–6.

    Article  CAS  Google Scholar 

  20. Stein SW, Sheth P, Hodson PD, Myrdal PB. Advances in metered dose inhaler technology: hardware development. AAPS PharmSciTech. 2014;15:326–38.

    Article  CAS  Google Scholar 

  21. Morais-Almeida M, Pité H, Cardoso J, et al. Asthma management with breath–triggered inhalers: innovation through design. Asthma Res Pract. 2020;6:4.

    Article  Google Scholar 

  22. Adachi Y, Adachi YS, Itazawa T, Yamamoto J, Murakami G, Miyawaki T. Measurement of peak inspiratory flow rates with an in–check meter to identify preschool children’s ability to use dry powder inhalers; Diskus and Turbuhaler. J Allergy Clin Immunol. 2004;113:S114.

    Article  Google Scholar 

  23. Stein SW, Thiel CG. The history of therapeutic aerosols: a chronological review. J Aerosol Med Pulm Drug Deliv. 2017;30:20–41.

    Article  Google Scholar 

  24. Ibrahim M, Verma R, Garcia-Contreras L. Inhalation drug delivery devices: technology update. Med Devices (Auckl). 2015;8:131–9.

    Google Scholar 

  25. Dalby R, Spallek M, Voshaar T. A review of the development of respimat soft mist inhaler. Int J Pharm. 2004;283:1–9.

    Article  CAS  Google Scholar 

  26. Szefler SJ, Murphy K, Harper T 3rd, et al. A phase III randomized controlled trial of tiotropium add-on therapy in children with severe symptomatic asthma. J Allergy Clin Immunol. 2017;140:1277–87.

    Article  CAS  Google Scholar 

  27. Ari A. Jet, ultrasonic, and mesh nebulizers: an evaluation of nebulizers for better clinical practice. Eurasian J Pulmonol. 2014;16:1–7.

    Article  Google Scholar 

  28. Taylor KMG, McCallion ONM. Ultrasonic nebulisers for pulmonary drug delivery. Int J Pharm. 1997;153:93–104.

    Article  CAS  Google Scholar 

  29. Ari A, Fink JB. Guidelines for aerosol devices in infants, children and adults: which to choose, why and how to achieve effective aerosol therapy. Expert Rev Respir Med. 2011;5:561–72.

    Article  Google Scholar 

  30. Vecellio L. The mesh nebuliser: a recent technical innovation. for aerosol therapy. Breathe. 2006;2:253–60.

  31. Denyer J, Dyche T. The adaptive aerosol delivery (AAD) technology: past, present, and future. J Aerosol Med Pulm Drug Deliv. 2010;23:S1-10.

    Article  CAS  Google Scholar 

  32. Fischer A, Stegemann J, Scheuch G, Siekmeier R. Novel devices for individualized controlled inhalation can optimize aerosol therapy in efficacy, patient care and power of clinical trials. Eur J Med Res. 2009;14:71–7.

    Article  Google Scholar 

  33. Nikander K, Arheden L, Denyer J, Cobos N. Parents’ adherence with nebulizer treatment of their children when using an adaptive aerosol delivery (AAD) system. J Aerosol Med. 2003;16:273–81.

    Article  Google Scholar 

  34. Fleming L, Murray C, Bansal AT, et al. U-BIOPRED Study Group. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts. Eur Respir J. 2015;46:1322–33.

  35. Sullivan PW, Ghushchyan V, Navaratnam P, et al. National prevalence of poor asthma control and associated outcomes among school-aged children in the United States. J Allergy Clin Immunol Pract. 2018;6:536–44.

    Article  Google Scholar 

  36. Klok T, Kaptein AA, Duiverman EJ, Brand PL. It’s the adherence, stupid (that determines asthma control in preschool children)! Eur Respir J. 2014;43:783–91.

    Article  Google Scholar 

  37. Simmons MS, Nides MA, Kleerup EC, et al. Validation of the doser, a new device for monitoring metered-dose inhaler use. J Allergy Clin Immunol. 1998;102:409–13.

    Article  CAS  Google Scholar 

  38. Aldridge D. Project red and asthmapolis. Comput Inform Nurs. 2011;29:542–3.

    Article  Google Scholar 

  39. PuffMinder Inhaler Medications Asthma COPD MDI Medication Reminders. Epill Medication reminders. Available at: https://www.epill.com/puffminder.html. Accessed on 21st July 2021.

  40. Foster JM, Smith L, Usherwood T, Sawyer SM, Rand CS, Reddel HK. The reliability and patient acceptability of the SmartTrack device: a new electronic monitor and reminder device for metered dose inhalers. J Asthma. 2012;49:657–62.

    Article  CAS  Google Scholar 

  41. Charles T, Quinn D, Weatherall M, Aldington S, Beasley R, Holt S. An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma. J Allergy Clin Immunol. 2007;119:811–6.

    Article  Google Scholar 

  42. Adherium. 2001. Available at: https://www.adherium.com/. Accessed on 21st July 2021.

  43. Chan AH, Stewart AW, Harrison J, Camargo CA Jr, Black PN, Mitchell EA. The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial. Lancet Respir Med. 2015;3:210–9.

    Article  Google Scholar 

  44. The doctor-recommended way to manage your asthma or COPD. Propeller. 2021. Available at: https://www.propellerhealth.com/. Accessed on 21st July 2021.

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Authors and Affiliations

  1. Department of Pediatric Respiratory Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, Singapore

    Biju Thomas & Arun Pugalenthi

  2. Duke-NUS Medical School, Koo Teck Puat Building, 8 College Road, Singapore

    Biju Thomas & Arun Pugalenthi

  3. Lee Kong Chian School of Medicine, 1 Mandalay Rd, Singapore

    Biju Thomas & Arun Pugalenthi

Authors
  1. Biju Thomas
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  2. Arun Pugalenthi
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Both authors have made equal contribution for this article. BT is the guarantor for this paper.

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Correspondence to Biju Thomas.

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Thomas, B., Pugalenthi, A. Currently Available Inhaled Therapies in Asthma and Advances in Drug Delivery and Devices. Indian J Pediatr 89, 387–394 (2022). https://doi.org/10.1007/s12098-021-03976-2

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