Development challenges and opportunities in aerosol drug delivery systems in non-invasive ventilation in adults

ABSTRACT

Introduction: With the gain in popularity of non-invasive ventilation (NIV), particularly in patients requiring drug delivery by aerosol therapy, the feasibility of the combination between NIV and aerosol therapy has regularly been questioned.

Areas covered: This review covers the in vitro and in vivo studies which explored the effects of this combination on pulmonary drug delivery (imaging and pharmacological studies) and on physiological measurements.

Expert opinion: Even if the feasibility of the combination is evident, the type of nebulizer influences the lung deposition with a greater delivery with vibrating mesh nebulizers. The influence of the interfaces of NIV devices should be further investigated even if vented masks may seem less efficient for nebulization. There is also a need to develop new devices and modalities, or specific components better designed for a more efficient delivery, to offer more optimal particles size to lung delivery. The use of spacer also seems promising to improve the lung delivery even if strong evidences are still missing. Finally, it would be interesting to explore the influence of all spontaneous modes which use different flow-time curves. Further investigations should focus on the synchronization of the delivery with the inspiratory part of the respiratory cycle in patients during NIV, particularly when delivering toxic or expensive drugs.

KEYWORDS:

• Non-invasive ventilation
• nebulizer
• aerosol
• drug delivery

Article highlights

• The feasibility of the combination between aerosol and NIV is evident

• The vibrating-mesh nebulizers offer the greater lung delivery of drug

• The vented masks seem less efficient for nebulization when combined with NIV.

• The use of spacer seems promising to improve lung delivery

• The influence of other modes of NIV which use different flow-time curves and synchronization should be further investigated.

This box summarizes key points contained in the article.

Acknowledgments

G Reychler has received a grant from the Institut de Recherche Expérimentale et Clinique (Université catholique de Louvain – Brussels – Belgium).

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.