Pauwels R, Newman S, Borgström L
Dept of Respiratory Diseases, University Hospital, Ghent, Belgium.
Eur Respir J. 1997 Sep;10(9):2127-38. doi: 10.1183/09031936.97.10092127.
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.
许多不同的定量吸入装置可用于治疗气道疾病。这些吸入器中的每一种在其递送特性上都有所不同。鉴于其治疗用途，评估这些吸入器的药物递送效果至关重要。本文对定量吸入器药物气道沉积与气道效应之间关系的文献进行了综述。雾化器或储雾罐不在讨论范围内。吸入器的效果取决于吸入器的特性以及患者执行的吸入动作。本综述重点关注吸入器特性对气道沉积和气道效应的影响。多项研究数据表明，气道中沉积的药物量与药物的气道效应之间存在显著关系。气道沉积与气道效应之间关系的研究一直受到方法学问题的困扰，例如缺乏多剂量比较以及难以获得陡峭的剂量反应曲线。本文讨论并比较了测量吸入药物气道沉积的技术，即闪烁扫描法和药代动力学方法。合理使用这些技术有助于定义和比较不同装置的药物递送特性，从而优化吸入治疗。
