Efficacy of inhaled medications in asthma and COPD related to disease severity

ABSTRACT

Introduction: The administration of medication by inhalation has become the most important route in treating airway diseases. The efficacy of this route depends on several factors like correct inhalation techniques, compliance and the size of the particles. The flow properties and internal flow distribution contribute to the deposition pattern.

Areas covered: What has been less well studied is the effect of the internal flow distribution. We know from recent studies that using systemic anti-inflammatory compounds that open up the distal airways redistributes flow internally and enhances the deposition of inhaled particles to the active site of bronchoconstriction or airway inflammation. We discuss this in more detail in this paper, and also make reference to the use of functional respiratory imaging (FRI) that allows for the description of this flow pattern starting from chest CT followed by post processing with segmentation software and the application of fluid dynamics.

Expert opinion: The method that was previously validated does show the importance of redistribution of flow in the final clinical results that could be obtained with inhaled medication, especially in more severe obstructive airway diseases. Based on these insights and novel diagnostic tools, patients in end stage respiratory failure would benefit from a personalized approach with inhaled medication.

KEYWORDS:

• Inhalation medication
• lung deposition
• functional respiratory imaging
• internal flow distribution

Article highlights

• For personalized treatment, there is a great need for better understanding of disease pathophysiology and recognition of disease heterogeneity and complexity.

• Classical lung function tests are not sensitive enough to detect diseased areas in their early development.

• FRI allows for the detection of diseased airways and lung structures very early in its development and for the description of the proportion of diseased versus healthy lung

• FRI can describe internal flow distribution and associated particle tracking. With this regional information, clinicians can choose the most adequate treatment approach.

• For personalized treatment, there is a great need for a better understanding of disease pathophysiology and recognition of disease heterogeneity and complexity. Functional respiratory imaging is very useful to meet this challenge.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.