A review of nebulized drug delivery in COPD

Abstract

Current guidelines recommend inhaled pharmacologic therapy as the preferred route of administration for treating COPD. Bronchodilators (β₂-agonists and antimuscarinics) are the mainstay of pharmacologic therapy in patients with COPD, with long-acting agents recommended for patients with moderate to severe symptoms or those who are at a higher risk for COPD exacerbations. Dry powder inhalers and pressurized metered dose inhalers are the most commonly used drug delivery devices, but they may be inadequate in various clinical scenarios (eg, the elderly, the cognitively impaired, and hospitalized patients). As more drugs become available in solution formulations, patients with COPD and their caregivers are becoming increasingly satisfied with nebulized drug delivery, which provides benefits similar to drugs delivered by handheld inhalers in both symptom relief and improved quality of life. This article reviews recent innovations in nebulized drug delivery and the important role of nebulized therapy in the treatment of COPD.

Keywords: COPD; nebulized drug delivery; pharmacologic therapy.

Figure 1

Examples of commercially available nebulizers that incorporate newer aerosol generating technologies. Notes: Akita^® Jet (Courtesy of Ventura, UK) and the I-neb^® (Courtesy of Philips Healthcare, USA) employ AAD technology to deliver and monitor nebulizer treatments. Trek^® S (Courtesy of PARI, USA; Trek^® S is a trademark of PARI Gmbh and its affiliates) is a portable jet nebulizer. MicroAir^® NE-U22 (Courtesy of Omron, USA) and the eFlow^® (Courtesy of PARI, USA; eFlow^® is a trademark of PARI Gmbh and its affiliates) are vibrating mesh aerosol nebulizers. Respimat^® is a high-efficiency soft mist inhaler (Reproduced with permission from Boehringer Ingelheim Pharmaceuticals, Inc. Respimat^® is a trademark of and/or used under license from Boehringer Ingelheim International GmbH or its affiliated companies. Materials may also be subject to copyright protection). Aeroneb^® Go (Courtesy of Philips Healthcare) is an ultrasonic nebulizer. All of these devices are approved for use in the US. Abbreviation: AAD, adaptive aerosol delivery.

Figure 2

AAD technology used in the Akita^® and I-neb^® nebulizers. Notes: During the first three breaths, AAD calculates when to pulse the aerosol. In subsequent breaths, AAD pulses aerosol during the first 50%–80% of inspiration (blue shade). Republished with permission of Respiratory Care: the official science journal of the American Association for Respiratory Care, from New Aerosol Delivery Devices for Cystic Fibrosis, KC Kesser and DE Geller, volume 54, edition 6, 2009; permission conveyed through Copyright Clearance Center, Inc. Abbreviation: AAD, adaptive aerosol delivery.