Maniscalco M, Sofia M, Weitzberg E, Lundberg J O
Department of Pharmacology and Physiology, Karolinska Institute, Stockholm, Sweden.
Eur J Clin Invest. 2006 Jul;36(7):509-13. doi: 10.1111/j.1365-2362.2006.01654.x.
The use of aerosol therapy is commonly suggested in the treatment of paranasal disorders but it is difficult to achieve an effective penetration of drugs into the sinuses. The authors have recently shown that an oscillating airflow produced by phonation (nasal humming) causes a large increase in the gas exchange between the nose and the paranasal sinuses. This is reflected by a high peak in nasally exhaled nitric oxide (NO) levels because NO accumulated in the sinuses is rapidly washed-out via the sinus ostia.
This study was designed to test whether the increase in sinus gas exchange caused by an oscillating airflow could be used to enhance penetration of a drug into the sinuses.
In six healthy subjects a nitric oxide-synthase inhibitor L-NAME was administrated into the nostrils by a jet nebulizer connected to a duck call, which could be modified to generate either a sounding airflow or a non-sounding airflow. The degree of L-NAME penetration into the sinuses was judged from the reduction in nasal NO during humming exhalations. Sinus drug deposition was also studied in a model of the nose and sinus.
In humans the delivery of L-NAME with the non-sounding airflow had no effect on the NO levels achieved during humming, whereas L-NAME administration with sound caused a significant 22-35% reduction in nasal NO. In the model the aerosol delivery with the sounding airflow caused a fourfold increase in sinus drug deposition as compared with an aerosol without sound.
A sounding airflow increases the delivery of an aerosolized drug into the paranasal sinuses.
雾化疗法常用于治疗鼻窦疾病，但药物难以有效渗透到鼻窦中。作者最近发现，发声（鼻腔哼唱）产生的振荡气流会使鼻腔与鼻窦之间的气体交换大幅增加。这表现为经鼻呼出的一氧化氮（NO）水平出现高峰，因为积聚在鼻窦中的NO会通过鼻窦开口迅速排出。
本研究旨在测试振荡气流引起的鼻窦气体交换增加是否可用于增强药物向鼻窦的渗透。
在6名健康受试者中，通过连接鸭笛的喷射雾化器将一氧化氮合酶抑制剂L-NAME喷入鼻孔，鸭笛可进行改装以产生发声气流或不发声气流。根据哼唱呼气时鼻腔NO的降低情况判断L-NAME渗透到鼻窦中的程度。还在鼻腔和鼻窦模型中研究了鼻窦药物沉积情况。
在人体中，不发声气流输送L-NAME对哼唱时的NO水平没有影响，而发声时给予L-NAME会使鼻腔NO显著降低22%-35%。在模型中，与不发声的气雾剂相比，发声气流输送气雾剂使鼻窦药物沉积增加了四倍。
发声气流可增加雾化药物向鼻窦的输送。
