Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany.
J Physiol Pharmacol. 2009 Nov;60 Suppl 5:15-26.
Clinical experience since many years has shown that aerosol inhalation is an established route for the treatment of pulmonary diseases. In contrast, treatment of systemic diseases by means of aerosol inhalation is a novel therapeutic approach. This was caused for a long time by a lack of accuracy, efficiency, and reproducibility of the administered drug doses due to a poor knowledge of the physiological background of aerosol inhalation, an insufficient inhaler technology as well as a suboptimal breathing procedure. However, these problems have been solved in the last years and nowadays modern aerosol delivery systems allow the production of an aerosol with a defined and optimised particle size combined with an optimized breathing maneuver and optimization of the efficacy of the technology. Clinical studies demonstrated that only a small number of morphological factors (e.g., exogen allergic alveolitis, active sarcoidosis, active smoking) influence alveolar drug deposition and the inhaled systematically active compounds caused no relevant allergic reactions even after inhalation for longer time periods. Up to now, most data are available for the inhalation of insulin which has been introduced in clinical treatment for a short time. However, a lot of other molecules have been tested in aerosol inhalation studies. This review describes some examples other than insulin in the field of inhalant treatment of systemic diseases.
多年的临床经验表明，气溶胶吸入是治疗肺部疾病的一种既定途径。相比之下，通过气溶胶吸入治疗系统性疾病是一种新的治疗方法。这主要是由于对气溶胶吸入的生理背景了解不足、吸入器技术不够完善以及呼吸过程不理想，导致所给予的药物剂量准确性、效率和重现性较差。然而，这些问题在过去几年中已经得到解决，如今的现代气溶胶输送系统能够产生具有定义和优化的颗粒大小的气溶胶，同时结合优化的呼吸动作和技术功效的优化。临床研究表明，只有少数形态因素（例如外源性过敏性肺泡炎、活动性结节病、主动吸烟）会影响肺泡药物沉积，而吸入的具有系统活性的化合物即使在长时间吸入后也不会引起相关的过敏反应。到目前为止，大多数数据都可用于吸入胰岛素，它在临床治疗中已经应用了很短的时间。然而，在气溶胶吸入研究中已经测试了许多其他分子。这篇综述描述了胰岛素以外的一些在治疗系统性疾病的吸入治疗领域的例子。
