Chow Michael Y T, Pan Harry W, Lam Jenny K W
Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Adv Pharmacol. 2023;98:273-311. doi: 10.1016/bs.apha.2023.03.001. Epub 2023 Mar 28.
Inhaled therapy is the cornerstone of the management of asthma and chronic obstructive pulmonary disease (COPD). Drugs such as bronchodilators and corticosteroids are administered directly to the airways for local effect and rapid onset of action while systemic exposure and side effects are minimized. There are four major types of inhaler devices used clinically to generate aerosols for inhalation, namely, pressurized metered-dose inhalers (pMDIs), nebulizers, Soft Mist™ inhalers (SMIs) and dry powder inhalers (DPIs). Each of them has its own unique characteristics that can target different patient groups. For instance, patients' inhaler technique is critical for pMDIs and SMIs to achieve proper drug deposition in the lung, which could be challenging for some patients. Nebulizers are designed to deliver aerosols to patients during tidal breathing, but they require electricity to operate and are less portable than other devices. DPIs are the only device that delivers aerosols in dry powder form with better stability, but they rely on patients' inspiration effort for powder dispersion, rendering them unsuitable for patients with compromised lung function. Choosing a device that can cater for the need of individual patient is paramount for effective inhaled therapy. This chapter provides an overview of inhaled therapy for the management of asthma and COPD. The operation principles, merits and limitations of different delivery technologies are examined. Looking ahead, the challenges of delivering novel therapeutics such as biologics through the pulmonary route are also discussed.
吸入疗法是哮喘和慢性阻塞性肺疾病（COPD）管理的基石。支气管扩张剂和皮质类固醇等药物直接作用于气道，以产生局部效应并迅速起效，同时将全身暴露和副作用降至最低。临床上用于产生吸入气雾剂的吸入装置主要有四种，即压力定量吸入器（pMDIs）、雾化器、软雾吸入器（SMIs）和干粉吸入器（DPIs）。它们各自具有独特的特性，可以针对不同的患者群体。例如，患者的吸入技术对于pMDIs和SMIs在肺部实现适当的药物沉积至关重要，而这对一些患者来说可能具有挑战性。雾化器设计用于在潮式呼吸期间向患者输送气雾剂，但它们需要电力操作，并且比其他装置的便携性差。DPIs是唯一以干粉形式输送气雾剂且稳定性更好的装置，但它们依赖患者的吸气力量来分散粉末，因此不适合肺功能受损的患者。选择一种能够满足个体患者需求的装置对于有效的吸入疗法至关重要。本章概述了用于哮喘和COPD管理的吸入疗法。研究了不同给药技术的操作原理、优点和局限性。展望未来，还讨论了通过肺部途径递送生物制剂等新型治疗药物所面临的挑战。
