Wildhaber J H
Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia.
Schweiz Med Wochenschr. 1998 Aug 15;128(33):1223-8.
Aerosol therapy plays a major role in the diagnosis and treatment of various lung diseases. The aim of inhalation therapy is to deposit a reproducible and adequate dose of a specific drug to the airways, in order to achieve a high, local, clinical effect while avoiding serious systemic side effects. To achieve this goal, it is therefore important to have an efficient inhalation device to deliver different medications. However, the currently available therapeutic inhalation devices (nebuliser, pressurised metered-dose inhaler and dry powder inhaler) are not very efficient in aerosol delivery and have several disadvantages. Inhalation devices can be assessed by in vitro studies, filter studies and radiolabelled deposition studies. Several radiolabelled deposition studies have shown that nebulisers and pressurised metered-dose inhalers are not very efficient in aerosol delivery. In children, before 1997, only 0.5% to 15% of the total nebulised or actuated dose from a nebuliser or pressurised metered-dose inhaler actually reached the lungs. These numbers were somewhat improved in adults, 30% of the total nebulised or actuated dose reaching the airways. Aerosol therapy with dry powder inhalers was the most efficient before 1997, 30% of the total dose being deposited in the lungs of adults and children. In 1997, new developments in pressurised metered-dose inhalers much improved their efficiency in aerosol delivery. Lung deposition can be increased by up to 60% with use of a non-electrostatic holding chamber and/or a pressurised metered-dose inhaler with a hydrofluoroalkane propellant possessing superior aerosol characteristics. Several studies comparing the clinical efficiency of different inhalation devices have shown that the choice of an optimal inhalation device is crucial. In addition to the aerosol characteristics, ventilation parameters and airway morphology have an important bearing on deposition patterns. These parameters may be greatly influenced by the patient's acceptance of a specific inhalation device and therefore determine the choice of the device used. It is important for the clinical impact to develop more efficient inhalation devices, which need to be assessed for use in different age groups. These devices should be cheap, easy to use, portable, usable with all medications and environmentally safe.
雾化疗法在各种肺部疾病的诊断和治疗中发挥着重要作用。吸入疗法的目的是将可重复且足够剂量的特定药物输送到气道，以获得高效的局部临床效果，同时避免严重的全身副作用。因此，为实现这一目标，拥有一种能输送不同药物的高效吸入装置至关重要。然而，目前可用的治疗性吸入装置（雾化器、压力定量吸入器和干粉吸入器）在气溶胶输送方面效率不高，且存在若干缺点。吸入装置可通过体外研究、过滤研究和放射性标记沉积研究进行评估。多项放射性标记沉积研究表明，雾化器和压力定量吸入器在气溶胶输送方面效率不高。在1997年之前的儿童中，雾化器或压力定量吸入器雾化或启动的总剂量中，实际仅有0.5%至15%到达肺部。在成人中，这些数字有所改善，雾化或启动的总剂量中有30%到达气道。1997年之前，干粉吸入器的雾化疗法效率最高，总剂量的30%沉积在成人和儿童的肺部。1997年，压力定量吸入器的新进展大大提高了其在气溶胶输送方面的效率。使用非静电储雾罐和/或配备具有优异气溶胶特性的氢氟烷烃推进剂的压力定量吸入器，肺部沉积可提高多达60%。多项比较不同吸入装置临床效率的研究表明，选择最佳吸入装置至关重要。除了气溶胶特性外，通气参数和气道形态对沉积模式也有重要影响。这些参数可能会受到患者对特定吸入装置接受程度的极大影响，从而决定所使用装置的选择。开发更高效的吸入装置对临床影响至关重要，这些装置需要针对不同年龄组进行使用评估。这些装置应价格便宜、易于使用、便于携带、可与所有药物配合使用且对环境安全。
