Advances in aerosols: adult respiratory disease.

Gerald C Smaldone
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引用次数: 44

Abstract

Recognition of the importance of breathing pattern in aerosol delivery and deposition has led to the design of devices that allow targeting of deposition to airways and alveoli. Systems incorporating patient feedback provide control of factors affecting deposition, and the control of dose to the lung can now be expected. New devices combined with a medical realization of therapeutic need are beginning to affect the range of drugs now available to the caregiver or in development for the immediate future. The interface between the patient and the device represents a new area of practical research. Facemasks have been shown to be important in terms of drug delivery with different behavior in metered dose inhaler (MDI)/valved holding chambers compared to nebulizers. Recently completed clinical trials have demonstrated the usefulness of therapy targeted to the lungs in reducing systemic toxicity with enhanced efficacy. A prime example is aerosolized cyclosporine, used to prevent rejection in lung transplantation. This agent has recently been shown to reduce mortality in transplant recipients and will lead to a new drug application in the United States. For larger patient populations, the pursuit of therapies to reduce the incidence of ventilator-associated pneumonia (VAP) can affect the outcome of illness in the intubated patient in the Intensive Care Unit (ICU). Patients with idiopathic pulmonary fibrosis (IPF) may benefit from high doses of aerosolized interferon gamma. Patient and caregiver safety are additional factors that will affect future approaches to therapy.

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气溶胶的进展:成人呼吸道疾病。
认识到呼吸模式在气溶胶输送和沉积中的重要性,导致设计了能够靶向沉积到气道和肺泡的设备。纳入患者反馈的系统可以控制影响沉积的因素,并且现在可以预期对肺剂量的控制。与医疗治疗需求相结合的新设备开始影响护理人员现有药物的范围,或在不久的将来开发药物。病人和设备之间的接口代表了一个新的实用研究领域。与雾化器相比,口罩在计量吸入器(MDI)/阀式保持室中具有不同的行为,在药物输送方面具有重要作用。最近完成的临床试验已经证明了针对肺部的治疗在减少全身毒性和增强疗效方面的有效性。一个典型的例子是用于防止肺移植排斥反应的雾化环孢素。这种药物最近被证明可以降低移植受者的死亡率,并将导致一种新药在美国的应用。对于更大的患者群体,寻求降低呼吸机相关性肺炎(VAP)发生率的治疗方法可能会影响重症监护病房(ICU)插管患者的疾病结局。特发性肺纤维化(IPF)患者可能受益于高剂量雾化干扰素γ。患者和护理人员的安全是影响未来治疗方法的其他因素。
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