Airway deposition and airway effects of antiasthma drugs delivered from metered-dose inhalers

Many different metered-dose inhalation devices are becoming available for the treatment of airway diseases. Each of these inhalers differs in its delivery characteristics. An assessment of the efficacy of drug delivery by these inhalers is essential, in view of their therapeutic use. A review of the literature on the relationship between airway deposition and airway effects of drugs delivered from metered-dose inhalers is presented. Nebulizers or spacers are not discussed. The effect of an inhaler depends on the characteristics of the inhaler and the inhalation manoeuvre performed by the patient. This review focuses on the influence of inhaler characteristics on the airway deposition and airway effects. Data from several studies show that there is a significant relationship between the amount of drug deposited in the airways and the airway effects of the drug. Studies on the relationship between airway deposition and airway effect have been troubled by methodological problems, such as the absence of multiple dose comparisons and the difficulty in obtaining steep dose-response curves. The techniques for measuring airway deposition of inhaled drugs, namely the scintigraphic and the pharmacokinetic method, are discussed and compared. The appropriate use of these techniques can help to define and compare the drug delivery characteristics of different devices, thus enabling inhaled therapy to be optimized.

This article has been cited by other articles:

				R. A.M. Al-Showair, S. B. Pearson, and H. Chrystyn The Potential of a 2Tone Trainer To Help Patients Use Their Metered-Dose Inhalers Chest, June 1, 2007; 131(6): 1776 - 1782. [Abstract] [Full Text] [PDF]

				R. S. Irwin and N. D. Richardson Side Effects With Inhaled Corticosteroids: The Physician's Perception Chest, July 1, 2006; 130(1_suppl): 41S - 53S. [Abstract] [Full Text] [PDF]

				O. S. Usmani, M. F. Biddiscombe, and P. J. Barnes Regional Lung Deposition and Bronchodilator Response as a Function of {beta}2-Agonist Particle Size Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1497 - 1504. [Abstract] [Full Text] [PDF]

				J. Winkler, G. Hochhaus, and H. Derendorf How the Lung Handles Drugs: Pharmacokinetics and Pharmacodynamics of Inhaled Corticosteroids Proceedings of the ATS, December 1, 2004; 1(4): 356 - 363. [Abstract] [Full Text] [PDF]

				R. Condos, F. P. Hull, N. W. Schluger, W. N. Rom, and G. C. Smaldone Regional Deposition of Aerosolized Interferon-{gamma} in Pulmonary Tuberculosis Chest, June 1, 2004; 125(6): 2146 - 2155. [Abstract] [Full Text] [PDF]

				M.T. Newhouse, P. Patel, and M. Parry-Billings Protection against methacholine-induced bronchospasm: salbutamol pMDI versus Clickhaler(R) DPI Eur. Respir. J., May 1, 2003; 21(5): 816 - 820. [Abstract] [Full Text] [PDF]

				M.E.A.C. Broeders, J. Molema, N.A. Vermue, and H.Th.M. Folgering Peak inspiratory flow rate and slope of the inhalation profiles in dry powder inhalers Eur. Respir. J., November 1, 2001; 18(5): 780 - 783. [Abstract] [Full Text] [PDF]

				E. DEROM, L. BORGSTROM, J. VAN SCHOOR, A.-B. LOFROOS, and R. PAUWELS Lung Deposition and Protective Effect of Terbutaline Delivered from Pressurized Metered-Dose Inhalers and the Turbuhaler in Asthmatic Individuals Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1398 - 1402. [Abstract] [Full Text] [PDF]

				M. S. Berridge and Z. Lee Scintigraphic Assessment of the Regional Distribution and Kinetics of Pharmaceuticals Journal of Pharmacy Practice, October 1, 2001; 14(5): 416 - 426. [Abstract] [PDF]

				M. B. Affrime, T. Kosoglou, C. M. Thonoor, B. E. Flannery, and J. M. Herron Mometasone Furoate Has Minimal Effects on the Hypothalamic-Pituitary-Adrenal Axis When Delivered at High Doses Chest, December 1, 2000; 118(6): 1538 - 1546. [Abstract] [Full Text] [PDF]

				D. Giannini, A. Di Franco, E. Bacci, F. L. Dente, M. Taccola, B. Vagaggini, and P. Paggiaro The Protective Effect of Salbutamol Inhaled Using Different Devices on Methacholine Bronchoconstriction Chest, May 1, 2000; 117(5): 1319 - 1323. [Abstract] [Full Text] [PDF]

				J. Rosenborg, P. Larsson, K. Tegnér, and G. Hallström Mass Balance and Metabolism of [3H]Formoterol in Healthy Men after Combined i.v. and Oral Administration-Mimicking Inhalation Drug Metab. Dispos., October 1, 1999; 27(10): 1104 - 1116. [Abstract] [Full Text]

				T W Harrison, J Oborne, P J Wilding, and A E Tattersfield Randomised placebo controlled trial of beta  agonist dose reduction in asthma Thorax, February 1, 1999; 54(2): 98 - 102. [Abstract] [Full Text]