Allen Stephen
Department of Medicine and Geriatrics, The Royal Bournemouth Hospital and University of Bournemouth, Bournemouth, UK.
Drugs Aging. 2008;25(2):89-94. doi: 10.2165/00002512-200825020-00001.
Although inhalation has been used as a route for the delivery of systemic drugs for millennia, the recent emergence of fine milling and nano-technology methods has extended the range of potential therapies that can be absorbed from the alveolar surface. Administration of insulin by inhalation has attracted particular attention. However, there has been very little research into the pharmacokinetic and pharmacodynamic characteristics of such new inhaled substances in elderly patients and the effects of lung aging and co-pathologies are not known, particularly in the very old. Furthermore, it has been shown that the decrements in cognition, praxis and executive function that are highly prevalent in frail elderly people have a profoundly detrimental effect on inhaler technique. Consequently, it is likely that a large proportion of elderly patients would not be able to use drugs targeted for alveolar absorption because accurate and reliable inhalation performance would not be achieved. On the other hand, it is expected that cognitively intact older people with good neurological, pulmonary and musculoskeletal performance would be able to use inhaled treatments in the same manner as younger individuals. In frail old age, and in patients with unreliable deep inhalation techniques, there might be more scope for the use of inhaled preparations for mucosal absorption from the nasal passages and upper airways. Indeed, the number of drugs under consideration for that mode of application is growing. This article focuses on the potential use of inhaled systemic treatments in old age and the physical and cognitive problems that might limit their use in that group of patients.
尽管吸入作为全身用药途径已使用了数千年，但精细研磨和纳米技术方法的出现，扩大了可从肺泡表面吸收的潜在治疗方法的范围。吸入胰岛素尤其受到关注。然而，对于这类新型吸入物质在老年患者中的药代动力学和药效学特性，以及肺老化和合并症的影响，目前研究甚少，尤其是在高龄老人中。此外，研究表明，认知、实践和执行功能下降在体弱老年人中非常普遍，对吸入器技术有严重的不利影响。因此，很可能有很大一部分老年患者无法使用针对肺泡吸收的药物，因为无法实现准确可靠的吸入操作。另一方面，预计认知功能正常、神经、肺部和肌肉骨骼功能良好的老年人能够像年轻人一样使用吸入治疗。在高龄体弱以及深吸气技术不可靠的患者中，鼻腔和上呼吸道黏膜吸收的吸入制剂可能有更大的应用空间。事实上，考虑采用这种给药方式的药物数量正在增加。本文重点探讨老年患者吸入全身治疗的潜在用途，以及可能限制其在该组患者中使用的身体和认知问题。
