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INHALATIONDRUG DELIVERY SYSTEM
Why pulmonary drug administration?and where?
1. Local therapy (in the airways) :– Asthma, COPD, Cystic Fibrosis, HIV, influenza– Advantages:
• High dose at the site of action• Increased efficacy• Rapid onset of action• Reduced side-effects
2. Systemic therapy (airways but often alveoli) :• The lung as a “port of entry” for the systemic
administration of drug• Peptides and proteins (insulin, interferon-)• Morfine, Ergotamine, 9-tetrahydrocannabinol
Advantages of the Inhalation Route of Administration With Aerosolized Drugs in Treating Pulmonary Diseases:1. Aerosol doses are generally smaller than systemic doses. For example, the oral dose of albuterol is 2 - 4 mg, whereas the inhaled dose is 0.2 mg (via MDI) to 2.5 mg (via SVN).2. Onset of effect is faster with inhalation than with oral administration. For example, the onset of effect with oral albuterol is about 30 min, whereas inhaled albuterol takes effect within about 5.3. The drug is delivered directly to the target organ (lung), withminimized systemic exposure.4. Systemic adverse effects are less severe and less frequent withinhalation than with systemic drug delivery (injection or oral) (eg, less muscle tremor and tachycardia with β-2 agonists; lesshypothalamic pituitary adrenal suppression with corticosteroids). 5. Inhaled drug therapy is painless and relatively comfortable.MDI metered dose inhaleiSVN small volume nebulizerCOPD chionic obstiuctive pulmonaiy Gisease
Structure of the lung• The airways:
– 23 bifurcations through which the air flows
– Covered with mucus– Mucus is moved to the pharynx by cilia– Air flow rate is decreasing
turbulent laminar• Alveoli:
– No mucus, no movement– Alveolar lining fluid (dipalmitoyl
phosphatidylcholine)– Thin membrane
The lung model of Weibelgeneration diameter
(cm)length(cm) number
total crosssectional
area (cm2)trachea 0 1.80 12.0 1 2.54
1 1.22 4.8 2 2.332 0.83 1.9 4 2.13
bronchi
3 0.56 0.8 8 2.004 0.45 1.3 16 2.48co
nduc
ting
zone
bronchioles
terminal bronchioles
5
16
0.35
0.06
1.07
0.17
32
6·104
3.11
180.01718respiratory
bronchioles19 0.05 0.10 5·105 103
2021alveolar ducts22
tran
sitio
nal a
ndre
spira
tory
zon
es
alveolar sacs 23 0.04 0.05 8·106 104
Cross sectional area of the airways available for air flow
Conducting zonegeneration 1-11
Transitional zonegeneration 12-16
Respiratory zonegeneration 17-23
Structure of the alveoli– Large surface area: 43-102 m2
– high degree of vascularization– Thin membrane– Covered with a thin layer of
fluid (ALF: alveolar lining fluid, dipalmitoyl-phosphatidylcholine)
– Limited amount of proteolitic enzymes
– No mucus, nocilia, nomovement
– Clearance of insoluble particles: macrophages (weeks-years)
– Clearance of low molecular weight soluble substances: transepithelial transport
Another Physiological Adventage of Alveoli
• No 1st Pass Metabolism• Small efflux transporter activity• Rich in protease inhibitor• Small volume of fluid (10 – 20 ml)• Prolonged residence time
No non invasive route of delivery provide the speed of action that an inhaled drug can provide
structure of the alveolar membrane• Thin type I alveolar cells (0.05-0.1 µm) with a
relatively large surface (6000 µm2) cover 93 % of alveolar surface
• Tight junctions space ±5 nm– accessible for proteins up to 40 kD
• Capilary endothelial pores: 10-15 nm
Caveolae
• Transport through the epithelial cells• Non coated vesicles• Up to 1.7 x 106 caveolae per type I cell• 40- 100 nm (up to 400 kDa)
Absorption over the alveolar endothelium
• What is rate limiting? – Dissolution– transport over the alveolar-capillary
membrane– Others ?
• Possible routes:» Passive transport through
hydrophilic pores (tight junctions» Passive transport through lipophilic
pathways (cell membranes?)» facilitated passive transport» active transport (caveolae)
Route of Absorbstion
• Macromoleculules, throught tight junction and endocytic veicles
• Endogenous molecules (albumin, immunoglobulin, transferrin) have spesific receptor-mediated transport
• Disodium cromoglikat and cycloleucyn transported by carier mediated transport
Inhaled Peptides and Protein
• Biasanya diberikan secara suntikan• Tidak nyaman, kepatahan kurang terutama
jika harus obat jalan• Route non invasive memberikan
bioavailabilitas jelek• Dikembangkan inhalasi• Contoh: insulin, LHRH• Peptida mudah terhidrolisis, protein sulit
karena ujungnya menekuk (globuler)
Factors affecting protein pulmonary absorption
• Size and volume:– proteins < 20 kDa are absorbed with near IV like
kinetics– Proteins > 20 kDa slow release pattern:
• lung acts as a depot• Risk of depot formation or sequestering:
– stimulation of defence mechanisms (housekeeper cells, metabolising enzymes)
– Immune respons or inflamatory reactions– Morphological changes in tissue
(irreversible!)– changes in gas permeability– reduced resistance against (pathogenic)
micro-organisms
Why inhalation delivery of peptides and proteins ?
• Poor oral bioavailability:– G-I tract environment:
• pH (secondary and tertiary structure)• enzymatic activity in the G-I lumen
– membrane transport (tight junctions size limitation)
– first pass metabolism• Mucosal (e.g. nasal, sublingual, buccal or rectal)
transport only feasible for smaller peptides (up to 10-18 amino acids)
• Parenteral administration is uncomfortable for the patient
Molecular weight : effect on bioavailability
Peptide Mw (Da) Tmax (hr) r.B.A.(%)LHRH analog 1,067 1.0 4.6 - 95 DDAVP 1,209 0.5 84Insulin 5,700 0.25 15-25 PTH 9,418 0.5 >20GCSF 18,600 1.5 45Glycos. Interferon 19,000 6.0 <5Human growth horm. 22,000 0.75 9 - 36DNase 32,000 <2Albumin 68,000 20.0 4-5IgG 150,000 16.0 1.5-1.8
Enam peptida pertama memberikan bioavailabilitas yang bagus karena tahan terhadap peptidase
• Terjadi modifikasi pada ujung C atau N, atau• Terikat dengan cincin seperti siklosporin
Natural peptida (somastatin, VIP, Glucagon)Terdegradasi di paru
Peptide and protein absorbtion
• Siklosporin, kelarutan dalam air rendahdissolution rate limiting step?
T maks Insulin reguler (60 – 180 menit)>insulin inhalasi (5 – 60 menit)
GCSF = granulocyte colony-stimulating factor; hGH = human growth hormone.
Inhalation Technology
The behaviour of an aerosol particle in the airways
• Determined by the physical interaction between the particle and the airflow– The inhalation airflow generated by patients
shows large variations– Particles: manipulation of behaviour through
change of physical properties• Mass (size)• Density• Shape• Velocity
Forces acting on aerosol particles in a bent airway duct
FC is the centrifugal force
FC = m.UT2/R
FD is the drag force
FD = 3...UPA.D/CC
FG is the force of gravity
FG = m.g
M= /6 . D3 . P
Deposition mechanisms in the respiratory tract
Inertial impaction
Sedimentation
Diffusion
Particle size, penetration and deposition in the lung
>5 minertial impactionin oropharnyx
1- 5 m sedimentation indeeper airways
< 1 m diffusion andexhalation
0
20
40
60
80
100(%)
Deposition
Penetrationin target area
Particle diameter (m)
Per
cent
age
pene
tratio
n /de
posi
tion
Preferredparticle size
0.1 0.5 1 2 4 6 8 10
How can we combine high penetration changes with high deposition changes??
Different groups (principles)
of aerosolisation devices for pulmonary drug delivery
Group 1: dry powder inhalers (dpi’s)
Group 2: metered dose inhalers (mdi’s)
Group 3: classic jet and ultrasonic nebulisers
Group 4: soft mist inhalers
Criteria for selection
of aerosolisation devices for pulmonary drug delivery
The target area for the drug (local or systemic delivery)
Patient factors
The therapeutic dose (range) for the drug
Stability of the drug (in aqueous solution or suspension)
The quantity of drug being available
particle size distribution in relation to the inhalation manoeuvre
inhaler handling and lung physiological parameters
microgram or milligram range
dry powder formulations may guarantee a greater stability
e.g. testing of small unformulated samples: preformulation phase
The most fundamental differencesbetween the four groups of inhalation devices
are: the mode and rate with which the entire dose is aerosolised the inhalation manoeuvre with which the aerosol is inhaled
This may have consequences for the deposition efficiency and patient compliance
Example dry powder inhalers: aerosolisation of the entire dose is in (split) seconds using the energy within the generated air flow for dispersion* the fine particle fraction may vary with the inspiratory flow rate administration is in one single inhalation instructions are to inhale deeply and forcefully (high flow rate?)
* With a few exeptions, e.g. Exubera
The most fundamental differencesbetween the four groups of inhalation devices
Metered dose inhalers: instantaneous firing of the entire dose propellant delivers the energy for aerosolisation high plume velocity (CFC >> HFA) co-ordination between firing of a dose and inhalation is required
Classic (jet) nebulisers: the aerosolisation process requires several minutes preparation and cleaning (disinfection) increase total nebulisation time aerosolisation is continuous; inhalation is intermittent patient can exercise a normal breathing pattern
Soft mist inhalers: aerosolisation of the entire dose varies from seconds to minutes production of a dense aerosol with low velocity claims include monodisperse droplets
NEBULIZERAerosolization of solution or suspension done by:1. Jet Nebulizer (umum)
Aliran gas dihasilkan oleh kompresor atau gas yang dimampatkan
2. Ultrasonic nebulizerTenaga listrik menggetarkan lempengan sehingga permukaan cairan bergetar dan jadilah kabut.
The volume at the surface of a liquid is dispersed in
the airflow
1. Through momentum transfer from air to fluid:
Jet nebulizer
2. High frequency sound waves: Ultrasonic
nebulizer
Disadventage:
Long administration times (30 minutes)
Only about 10% lung deposition (highly variable)
The working principleof jet and ultrasonic nebulisers
Jet nebulisers (basically two fluid atomisers): droplet
formation is by a combination of ligament stripping and turbulent
rupture, resulting in a wide droplet size distribution
Ultrasonic nebulisers: droplet formation occurs on the tops of standing waves created by high
frequency vibration imposed (directly or indirectly)upon the liquid surface
JET NEBULIZER DIAGRAM
Jet nebulisers: two examples
Exhaled airAir valve (inlet)
Pressurized air
Baffle
Maximum level for drug solution
Medic-Aide Sidestream (open vent)
Pari LC Plus (breath assisted open vent)
Classical nebulizers
Modern nebulizers:Adaptive aerosol delivery
• Registration of the inhalation flow profile of the three preceding breath cycles
• Aerosol (ultrasonic) released only during inspiration
600
300
0
300
600
Flow
ml/s
inspiration
expiration
time
aerosol release
mouthpiece
bafflemedication
chamber
selectionbuttons
electronics
How to use Jet Nebulizer
Nebulizers are used to treat asthma, Chronic Obstructive Pulmonary Disease (COPD), and other conditions where inhaled medicines are indicated. Nebulizers deliver a stream of medicated air to the lungs over a period of time.
Assemble the nebulizer according to its instructions. Connect the hose to an air compressor.
Fill the medicine cup with your prescription, according to the instructions.
Attach the hose and mouthpiece to the medicine cup.
Place the mouthpiece in your mouth. Breathe through your mouth until all the medicine is used, about 10-15 minutes. Some people use a nose clip to help them breathe only through the mouth.Some people prefer to use a mask.Wash the medicine cup and mouthpiece with water, and air-dry until your next treatment.
Wash the medicine cup and mouthpiece with water, and air-dry until your next treatment.
Presurized Metered Dose Inhaler
The aerosol generation• Liquefied propellant
How the spray from a pressurized metered-dose inhaler is formed.
The pressurized metered dose inhaler (pMDI)• Drugs in propellant:
– Dissolved– Suspension (stability)
• CFC’s (Freon) banned and replaced by HFA’s: Tetrafluoro ethane (HFA134a) or Hepta Fluoro propana (HFA 227)
• Good hand-lung co-ordination required– Spacers– Autohaler
• High speed of the droplets– Lung-deposition: 10-20%– Throat deposition: 70-90%
Lung deposition and actuator retention with a hydrofluoroalkane (HFA) solution formulation of fenoterol and ipratropium bromide delivered through actuator nozzles with diameters of 0.2 mm, 0.25 mm, and 0.3 mm. The data are compared with values from a chlorofluorocarbon (CFC) formulation containing the same drugs. * indicates a statistically significant difference compared with HFA 0.3 mm.
Adventage of pMDI• Practical benefit: Small size, portability,
convenience, relatively unexpensive• The Multi Dose capability• Deliver of drug in few second, unlike nebulizer
Limitation of pMDI Misuse, failure to coordinate actuation and
inhalation Some patien suffer from cold propellant
(esspecially freon), cause stop inhaling
result in supoptimal dosing
Solution of disadventage- Breath-Actuated pMDIs:
sense the patient’s inhalation through the actuator and fire the inhaler automatically in synchrony.ex: Autohaler (3M Pharmaceutical USA), Easibreate (Norton Healtcare UK), K-Haler (Aldsworth UK), MD Turbo (Respiric, USA), Xcelovent (Meridika, UK)
- Breath-coordinated Devicesex: Easidose (Bespak, UK), BCI (Aeropharm, USA)
- Novel Devices: placing baffles near the actuator nozzleSpacehaler (Celtech Medeva, USA), Tempo (Map Pharm, USA), Bronchoair (Ger)
- Spacer Design
SPACER DEVICE
• The larger the spacer better the dose available• However, increasing the spacer volume to 1 L
would probably be counterproductive, because the spacer would no longer be easilyportable, and because it would be more difficult for the patient to inhale the complete contents.
LINK Video
• How to use jet/classic nebulizer:• http://www.youtube.com/watch?
v=A7DhGX0p1KY• How to use metered dose inhalers:• http://www.youtube.com/watch?
v=A7DhGX0p1KY&feature=channel
Dry powder inhaler (DPI)• “Breath-controlled, “breath-actuated”• 40 to 60 % lung deposition possible• No propellant• Stable formulations possible• For processing agglomerated particles required• In the aerosol de-agglomerated particles
required• Formulation
difficult
Functional parts of a DPI
Mouthpiece
Powder disperser (disintegration principle)
Powder formulation
Dose measuring system
Or preloaded cartidges
The design of DPI’s
DPI performancedose entrainmentpowder disintegrationlung deposition
DPI designpowder formulationdose systemdisintegration principle
Patientinstructionclinical pictureage and gendertrainingsmoker/non smoker
Patient’s effort
DPI air flow resistance Flow parameterspeak flow rate (PIFR)flow increase rate (FIR)inhalation time
Variables and interactionsin the use of dry powder inhalers
From design
Powder formulations for particles of 2 - 5 m
• Soft spherical pellets– Micronized drug– cohesive forces– instable– good de-agglomeration
• adhesive mixtures– Micronized drug with
(larger) carrier crystals– adhesive and cohesive
forces– stable systems– Difficult de-agglomeration
Fine particle fractionsfrom different DPI’s
TH: Turbuhaler
AH: Diskus
FDH: Flixotide Diskhaler
BDH: Beclometasone Diskhaler
SH: Spinhaler
CH: Cyclohaler
The relative lungdose decreases when the inhalation flow rate increases
In order to compensate for the relatively decreased lung penetration the absolute fine particle dose must increase to keep the lung dose at the same level.
Oropharyngeal deposition increases, when the inhalation flow rate increases
(FC = m.UT2/R)
Carrier related variables
Size and size distributionImpurities
storage and conditioning
Inhaler and inhalation
Bulk propertiesSurface properties
Example 1: Interpretations and understanding• Budesonide versus salbutamol fine particle fractions
from mixtures with different Respitose carriers% fpf (stage 4+3+filter)
0
10
20
30
40
50
60
70
SV007 SV003 ML001
1% 2% 2% 0.5%
C N D H C N D H C N D H
C: Cyclohaler
N: Novolizer
D: Diskus
H: HandiHaler
budesonide
salbutamol
Dat
a sh
own
by c
ourt
esy
of D
MV-
Font
erra
, The
Net
herla
nds
Obvious conclusion: budesonide particles attach to the carrier surface
with higher force than salbutamol particles
–4 kPa or 100 l/min
The effect of the carrier surface properties is determined by:
• The particle size of the carrier
• The payload of the drug on the carrier
• The bulk properties and mixing of the powder mixture
Additives• Additives (force control agents) mentioned in
literature:– Lactose fines– Magnesium stearate– L-leucine
• Effects of additives:– “Competition” for active sites– Change the payload of a mixture– Reduce press-on forces during mixing– Agglomeration of additives and drug
Powder formulation
Desintegration principe
poor
moderate good
Generation of the aerosol in a DPI: a balance between binding forces and de-agglomereation forces
Binding forces:v.d. Waals forcessurface irregularitiesimpuritiescapillaire forceselectrostatic forces
De-agglomeration forces:shear and friction forcesDrag and lift forcesImpaction forces
The powder formulation
Nucleus agglommerateAdhesive mixture Spherical pellets
Drug concentration up to 10%Mechanically stableDifficult to break upLow risk of inhaler pollution
Drug concentration up to 50% (or more)InstableEasy to break upLow risk of inhaler pollution
Drug concentration up to 100%Highly instableEasy to break upHigh risk of inhaler pollutionBatch variability
Effective dry powder inhalation
requires good control of a series of processes that are dominated by various forces, e.g.:
inertial and frictional forces during mixing
interparticulate forces in the powder blend
drag forces during dose entrainment
dispersion forces during inhalation
deposition forces in the respiratory tract
AHB01
formulation
DPI design
and
patient factors