Quantitative efficacy assessment of aerosol therapy
Although inhalation treatment has a long history dating back more than 4000 years ago calling for quantitative scientific measurement of aerosol therapy started only in the 1970s. Further evidence on inhalation therapy began to accumulate when a study of Newman et al. was published on the deposition of pressurised aerosol in the human respiratory tract.
Comparing oral, parenteral and inhaled therapy in obstructive lung diseases clearly demonstrates the advantages of aerosol treatment. Since drug is placed directly into the target organ generally allows for a lower dose resulting in fewer and less severe adverse effects. Additionally it could be shown that quickest and largest response (FEV1) after application of a β2-agonist was achieved by inhalation followed by subcutaneous administration. Slowest onset and smallest effect was seen with oral application.
In general any kind of inhalation device nebulizer, pressurized metered-dose inhaler (pMDI) or dry powder inhaler (DPI) appear to be equally effective. However patients selected for participation in controlled clinical trials do not represent the overall population of asthmatic patients. They are carefully instructed and controlled concerning the correct use of the studied device in contrast to the “real-life” patient. Therefore results of these studies cannot be easily extrapolated for the normal asthmatic patient.
Dolovich MB, Ahrens RC, Hess RD, Anderson P, Dhand R, Rau JL, Smaldone GC, Guyatt G. Device selection and outcomes of aerosol therapy: evidence-based guidelines. 2005. Chest; 127 (1): 335-371
Herland K, Akselen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger “real life” population of patients with obstructive lung disease? 2005. Respiratory Medicine; 99: 11-19
Newman SP, Pavia D, Moren F, Sheahan NF, Clarke SW. Deposition of pressurized suspension aerosols in the human respiratory tract. 1981; 36 (1): 52-55
Rau JL. The inhalation of drugs: advantages and problems. 2005. Respiratory Care; 50 (3): 367-382
EFFICACY DATA OF DIFFERENT KIND OF DEVICES FROM RANDOMIZED DOUBLE-BLIND CONTROLLED CLINICAL TRIALS
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