Inhaleables systemic diseases, treatment

The answer is c. (Hardman, pp 156-158.) A wide variety of clinical conditions are treated with antimuscarinic drugs. Dicyclomine hydrochloride and methscopolamine bromide are used to reduce Gl motility, although side effects—dryness of the mouth, loss of visual accommodation, and difficulty in urination—may limit their acceptance by patients. Cyclopentolate hydrochloride is used in ophthalmology for its mydriatic and cycloplegic properties during refraction of the eye. Trihexyphenidyl hydrochloride is one of the important antimuscarinic compounds used in the treatment of parkinsonism. For bronchodilation in patients with bronchial asthma and other bronchospastic diseases, ipratropium bromide is used by inhalation. Systemic adverse reactions are low because the actions are largely confined to the mouth and airways. 

The inhalation route for administering drugs into the pulmonary system for treatment of respiratory diseases eliminates many bioavailability problems such as plasma binding and first-pass metabolism, which are encountered in parenteral or oral administration. Consequently, a small inhalation dose is adequate for achieving... 

Sinee this monograph first took shape, the field of particle-lung interactions has expanded considerably. The bad particles are currently ultrafine particles released into the environment from eombustion processes. The good particles are those carrying insulin into the lungs. The treatment of diabetes via the inhalation route will most likely beeome the first approved aerosol treatment for a systemic disease. Nevertheless, we both hope that established knowledge and controversial issues are sufficiently reflected in this volume on particle-lung interactions. 

The first commercially available DPI system appeared on the market in 1949, developed and marketed by Abbott under the name Aerohaler. Like all early pulmonary drug-delivery devices, it delivered small-molecule compoimds (bronchodilators or inhaled corticosteroids) to the airways (not necessarily the deep limg) for the treatment of asthma or chronic obstructive pulmonary disease. Table 6 lists some of the early DPI systems used for asthma and COPD the energy somces in these devices were mechanical and patient inspiration. 

The corticosteroids are effective in most children and adults with asthma. They are beneficial for the treatment of both acute and chronic aspects of the disease. Inhaled corticosteroids, including triamcinolone ace-tonide (Azmflcort),beclomethasone dipropionate (Beclo-vent, Vancerit), flunisolide AeroBid), and fluticasone (Flovent), are indicated for maintenance treatment of asthma as prophylactic therapy. Inhaled corticosteroids are not effective for relief of acute episodes of severe bronchospasm. Systemic corticosteroids, including prednisone and prednisolone, are used for the short-term treatment of asthma exacerbations that do not respond to (32-adrenoceptor agonists and aerosol corticosteroids. Systemic corticosteroids, along with other treatments, are also used to control status asthmaticus. Because of the side effects produced by systemically administered corticosteroids, they should not be used for maintenance therapy unless all other treatment options have been exhausted. 

Because marijuana is a natural product it can also harbor bacteria and fungi, some of which can be harmful if inhaled. Scientists have found bacteria such as Aspergillus, Salmonella, Klebsiella, Enterobacter, and Streptococcus on marijuana samples. This is especially significant for people with compromised immune systems, such as cancer or AIDS patients, many of whom may consider marijuana to counter some of the effects of their disease or treatments. 

Table 2 lists the most-prescribed anti-inflammatory steroids on the U.S. market today. Table 2 shows that some of the first compounds to be marketed still have a place in the treatment of inflammatory disease 50 years and more after their discovery. Table 2 also illustrates that continued effort to improve potency, to increase safety and to find better drug delivery systems (e.g., inhalers) succeeded in creating marketable products into the 1990s. Today very little, if any, research is going on to find improved steroid anti-inflammatory drugs. Some work continues in the pharmaceutical development area mostly to improve the formulation of existing molecules and to find better delivery systems. 

Bronchodilation. p2-Adrenoceptor-medi-ated bronchodilation plays an essential part in the treatment of bronchial asthma and chronic obstructive lung disease (p.340). For this purpose, p2-agonists are usually given by inhalation preferred agents being those with low oral bioavailability and low risk of systemic unwanted effects (e. g., feno-terol, salbutamol, terbutaline). 

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