Adaptive aerosol delivery

Many reviews on the relevant technical aspects for drug nebulization are available (e.g. [43 5]. The greatest disadvantages of nebulizers are their poor deposition efficiency (see Section 3.11) and low output rate (e.g. [46]). Several developments have been reported to improve their efficacy, like the use of open vents or breath-assisted open vents [47] and adapted aerosol delivery [48]. A renewed interest in nebulizer therapy may also come from the generation of special aerosols, such as hposomes [49]. 

Denyer, J., Nikander, K., and Smith N. J. (2004), Adaptive aerosol delivery (AAD) technology, Expert Opin. Drug Deliv., 1,165-176. 

Nikander, K., Arheden, L., Denyer, J., and Cobos, N. (2003), Parents adherence with nebulizer treatment of their children when using an adaptive aerosol delivery (AAD) system, J. Aerosol Med., 16, 273-281. 

Chan, H.K. Daciskas, E. Eberl, S. Robinson, M. Bautovich, G. Young, I. Deposition of aqueous aerosol of technetium-99m diethylene triamine penta-acetic acid generated and delivered by a novel system (AERx ) in healthy subjects. Eur. J. Nuclear Med. 1999, 26, 320-327. Denyer, J. Adaptive aerosol delivery in practice. Eur. Respir. Rev. 1997, 7, 388-389. 

Marsden R, Dood ME, Conway S, Weller PH. Comparison of compliance in cystic fibrosis patients using Halolite Adaptive Aerosol Delivery (AAD) system with conventional high-output nebuhzer system. In Respiratory Dmg Delivery V Dalby RN, Byron PR, Farr SJ, eds. Interpharm Press Phoenix, AZ, 2002 557-560. 

Nikander K. Adaptive aerosol delivery the principles. Eur Resp Rev 1997 7 385-387. 

Figure 2 Schematic illustrating adaptive aerosol delivery from Halolite. Solid boxes represent periods of aerosol delivery for four different breathing patterns. Aerosol is only delivered during the first half of each inspiration. The HaloLite system indicates when the preprogrammed dose has been delivered. In each of the four examples, the dose delivered is the same but the treatment time wiU be different. The treatment time is dependent on the ratio of inspiratory to expiratory time and the number of breaths per minute. (From Ref. 11.)...

Denyer, J. Dyche, T. The Adaptive Aerosol Delivery (AAD) technology Past, present, and future. /. Aerosol. Med. Pulm. Drug Deliv. 2010, 23 (Suppl. 1), Sl-SlO. 

An 11-year-old boy was given iloprost by inhalation via an adaptive aerosol delivery system for severe pulmonary hypertension [32 ]. After inadvertent removal of the mouthpiece, iloprost was directly applied to the skin. He rapidly developed paiiiless erythematous lesions, probably because of iloprost-induced vasodilatation, over the face and neck, which resolved spontaneously after 3 days. 

Denyer J, Dyche T (2010) The adaptive aerosol delivery (AAD) technology past, present and future. J Aerosol Med Pulm Drug Deliv (Suppl 1) S1-10. doi 10.1089/jamp.2009.0791... 

Derksen F, Olszewski M, Robinson N 1996 Use of a handheld, metered-dose aerosol delivery device to administer pirbuterol acetate to horses with heaves. Equine Veterinary Journal 28 306-310 Derksen F, Olszewski M, Robinson N 1999 Aerosolized albuterol sulfate used as a bronchodilator in horses with recurrent ainway obstruction. American Journal of Veterinary Research 60 689-693 Duvivier D, Votion D, Vandenput S et al 1997 Technical validation of a facemask adapted for dry powder inhalation in the equine species. Equine Veterinary Journal 29 471-476... 

Meter-dose inhalers which can either be dry power inhaler or metered-dose inhalers require a greater amovmt of testing because the metered valve, oral adapter, and the formulation are collectively responsible for the delivery the API to the appropriate site in the respiratory passages. Similar to aerosols and nasal sprays, very specialized tests which include leakage rate, number of dose per container (i.e., emitted dose test), particle distribution, and value delivery tests have been devised to test the suitability of the metered-dose inhalers. 

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