Lung Deposition of Fenoterol and Flunisolide Delivered Using a Novel Device for Inhaled Medicines: Materials and Methods
Posted by James WhiteThe aims of the two randomized three-way crossover studies in healthy volunteers reported in this article were to examine, using gamma scintigraphy, the in vivo lung deposition of (1) the bronchodilator fenoterol and (2) the corticosteroid flunisolide following single-dose inhalation. Comparisons were made of the total and regional deposition of these drugs delivered by the new device, conventional MDIs, and MDIs with spacer devices. Furthermore, in the flunisolide study, the effect on lung deposition of a modification of the RESPIMAT by the addition of a baffle in the mouthpiece, designed to eliminate large, “nonrespirable” droplets from the spray, was investigated. Read the rest of this entry »
Categories: Lung Deposition
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Currently, most drugs used in the treatment of asthma and airflow obstruction are given by the inhaled route. This includes bronchodilators such as β2-agonists and anti-cholinergics, and anti-inflammatory medications such as corticosteroids, cromolyn sodium, and nedocromil sodium. Inhaled medication is preferable to oral medication because the drug is delivered directly to the airways, allowing lower doses to be used, usually a more rapid onset of action, and a reduced incidence of side effects. The pressurized metered-dose inhaler (MDI) is the most widely used inhaler device. It has the advantages of being compact, portable, relatively cheap, and easy to use. However, many patients, especially children and the elderly, do not obtain optimal benefit because they fail to use their MDIs effectively. 
We found that HIV-related variables significantly influenced the in-hospital outcome and to a lesser extent, the in-ICU outcome. These variables were also closely associated with the long-term outcome. The number of previous opportunistic infections, as well as the stage and duration of AIDS, were significantly associated with the short- and long-term outcomes. The CD4 count is the prognostic marker most widely used in HIV-infected patients. However, as shown in Table 3 and Figure 2, differences in median and mean survival times across CD4+ lymphocyte count groups were modest. We believe that variations in CD4+ counts probably have little prognostic value in patients with CD4 counts <0.100X109/L. It has been reported that only logarithmic values are of interest in this population. HIV disease is a chronic disease that remains ultimately fatal, with a life expectancy that varies according to a number of clinical and laboratory marker 25,26 Clearly, the long-term outcome is closely dependent on this specific life expectancy. 
Cumulative survival rates in the 281 patients who were discharged from the ICU were 51 ±38% at 6 months, 28±38% at 12 months, and 18±30% at 24 months. Table 3 shows long-term outcome univariate and multivariate analysis results, as well as crude mean and median survival times. Figure 1 shows survival curves according to the admission cause group and functional status, and Figure 2 shows survival curves according to HIV disease stage and CD4+ count.