Pratiksha S MapariPROJECT Final

Pulmonary Drug Delivery System For Asthma Management
INDEX
Sr. No. Chapter Page No.
1. Abstract 2
2. Introduction 3-6
3. Review Of Literature 7-8
9
4. Aim And Objective
5. Pulmonary drug delivery system 10-18
6. Asthma 19-27
7. Treatment & Pulmonary 28-33

Delivery Devices
8. Result & Discussion 34
9. Reference 35-39
GAWANDE COLLEGE OF PHARMACY, SAKHARKHERDA Page 1

ABSTRACT
Pulmonary drug delivery has attracted tremendous scientific and biomedical interest in recent
years and has progressed considerably within the context of local treatment for lung diseases, by
virtue of enhanced local targeting and reduced systemic side effects with the administration of
minute drug dosages. Furthermore, with the high surface area and permeability of the lung, the
21st century has seen a paradigm shift to inhaled therapy for systemic use. But the pulmonary
tract tends to be considered as very promising and attractive route for the administration of active
substances intended to treat local pulmonary e.g., asthma, chronic obstructive pulmonary disease
(COPD), microbial infections) as well as systemic diseases. (e.g., diabetes) Recent progress
within biotechnology has generated a group of novel protein and peptide drugs to which
administration to the respiratory tract, to obtain systemic delivery seems advantageous compared
to e.g. parenteral or gastrointestinal administration (tablets, capsules etc.). The low metabolic
activity in the lungs allows systemic delivery without liver passage Hence lung is an attractive
environment for biomolecules, which are highly susceptible to enzymatic degradation in the
gastrointestinal tract (ventricle and guts) as well as hepatic degradation (first pass metabolism)

Introduction
Drug:
A drug is a chemical substance with known biological effects on humans or other animals. In the
pharmacology field, a drug is defined as a chemical substance used in the treatment, cure,
prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being.
Drugs usually affect either normal or abnormal physiological processes. Drugs may be used for a
limited duration, or on a regular basis for chronic disorders.[1]
Drug delivery systems:
Drug delivery systems are technological systems that formulate and store drug molecules into
suitable forms like tablets or solutions for administration. They hasten the reach of drugs to the
specific targeted site in the body, thereby maximizing therapeutic efficacy and minimizing
offtarget accumulation in the body Drugs have various routes through which they can be
introduced into the body, they include but are not limited to the oral route of administration
buccal and sublingual routes of administration nasal and ophthalmic, transdermal and
subcutaneous, anal and transvaginal and intravesical. The components of the drug account for its
physiochemical properties and are responsible for the changes it influences in the body system
when taken. Over the past few decades, DDS have been applied effectively in the treatment of
diseases and improvement of health due to increased systemic circulation and control of the
pharmacological effect of the drug. The advancement of pharmacology and pharmacokinetics
showed the importance of drug release in determining therapeutic effectiveness, giving rise to the
concept of controlled release. The controlled-release formulation of a drug was first approved in
the 1950s, and it has since attracted considerable attention due to its significant advantages over
conventional drugs. It releases drugs at a predetermined rate and for a specific period of time. In
addition, controlled drug delivery systems are not affected by physiological conditions and can
thus last for days to years. It also provides spatial control over drug release, with constant or
variable release rates. Furthermore, it improves drug solubility, target site accumulation, efficacy,
pharmacological activity, pharmacokinetic properties, patient acceptance, and compliance, and
reduces drug tox. Recently, several drug delivery systems (NDDS) have been developed using
advanced systems for more convenient, controlled, and targeted delivery. Each drug delivery

system has its own peculiarities that determine its release rate and mechanism. This is largely due
to the differences in the physical, chemical, and morphological characteristics which will
ultimately affect their affinities for various drug substances. Studies on these have identified
diffusion, chemical reaction, solvent reaction, and stimuli control as major release mechanism.
For instance, since most cancer cells can proliferate the porous blood vessels and lymphatic
system, the drug can easily permeate through this opening to reach the target tissues. This is
referred to as Enhanced Permeability and Retention (EPR). EPR is a passive diffusion
mechanism well researched and applied in the delivery of many chemotherapeutic agents.
Although EPR is a controversial concept, this effect has been observed by many researchers in
various types of human tumors and is the basis for the use of nanomedicine in cancer treatment.
Though it has a drawback of lack of selectivity and increased toxicity. Active targeting
overcomes the lack of specificity and selectivity found in passive targeting. It involves attaching
to the carriers, certain ligands, and molecules that can actively bind to the surface of target
tissues. This prevents uptake by non-target cells thereby reducing side effects and toxicity.
Selectivity of ligands to target cells, immunogenicity, and chances of lysosomal degradation after
macrophage endocytosis still pose solid challenges to the full development of actively targeting
Drugs. These delivery systems can also reach the target cells through the control of one or more
physical or chemical properties in the process of responsive stimuli targeting. These physical
properties include pH, temperature, ultrasound, magnetic and electric field [2-3].
Lung disease or lung disease is an illness or disease that affects the lungs and respiratory system.
It may be caused by bacteria, viruses or fungi, or it may be caused by the environment.
According to the World Health Organization's 2017 report, lung diseases account for
approximately 10.9% in India and are the fourth leading cause of respiratory diseases. Major
diseases include obstructive pulmonary disease, asthma, bronchitis, emphysema, pneumonia,
chronic obstructive pulmonary disease, interstitial lung disease, and lung cancer. Pulmonary drug
delivery involves devices, machines, or structures that deliver drugs to the lungs for the treatment
of respiratory diseases or delivery of other diseases. Today, the delivery of lung drugs is done by
oral or nasal inhalation of drugs that can be used both locally and in the body. They provide
greater bioavailability, providing the important benefit that the drug can reach the system
directly. It provides a non-invasive method that also bypasses first-pass metabolism. However,
the effectiveness and safety of the inhaler is still an important issue. 1 Due to the unique nature
of the lung, pulmonary drug delivery may be an alternative to drug delivery. Special features of
the body include.[4]
●Various Type Drug Delivery System
Fig.1 Various Type Of Drug Delivery System
Researchers have recognized the potential benefits of nanotechnology in vastly improving

medicine delivery methods throughout time. Red blood cell membrane-camouflaged nanoparticle
are a new class of drug delivery systems. The nature and biological significance of red blood
cells (RBCs) allow for their use as an efficient system as a nanoparticle camouflaging material.
Because red blood cells (RBCs) are the most abundant circulating cells in the body, their
biocompatibility (non-immunogenic), biodegradability, and extended circulating half-life,
making them an ideal vehicle for drug delivery. As technology continues to advance and science

evolves, more and more materials are being researched and studied to help improve drug
delivery. Among these materials is Boron nitride (BN) which is a crystalline material with a
balanced stoichiometry of nitrogen (N) and boron (B) atoms. This material occurs in various
forms such as cubic BN (c-BN), hexagonal BN (h-BN), wurtzite BN (wBN), and rhombohedra
BN (r-BN). Hexagonal Boron Nitride is a twodimensional (2D) layered-dense structure with sp2
hybridized B–N bonds. It can also be called white graphene sometimes regarded as an analogue
of graphite. The B–N atoms substitute the carbon atoms and are held together by a strong
covalent bond forming interlocking rings. The layers of the compound are held together by van
dyer Waals forces with a bond length of 1.466 Å and an interlayer space of 3.331 Å. This
compound is partially ionic and as a result of this unique characteristic has its B–N bonds to be
polar. H-BN is an insulator that has gained wide applications in various fields of life such as
cosmetics, dental, cement, ceramics, and most especially in medicine as a drug carrier similar to
graphene or graphene.[4]
Asthma is defined as an inflammatory disease of the respiratory tract. Hypersensitivity is

associated with airway hyper responsiveness (greater narrowing of the airways Greater response
to triggers such as allergies and exercise), causing symptoms such as wheezing, difficulty
breathing (dyspnea), chest tightness and cough. Symptoms are usually associated with large but
variable airflow through the lungs, often with regular reversal or asthma treatment.[5]
Worldwide, more than 300 million people suffer from asthma or Chronic obstructive pulmonary
disorder (COPD). Asthma is one of the most common chronic diseases worldwide and affects 22
million persons in the United States. Asthma is the most common chronic disease in childhood,
affecting an estimated 6 million children, and it is a common cause of hospitalization for children
in the United States. [6]

Review of literature:
Hatem Amin Hejaz1 and RafikKaraman et al. (2015) A drug is a chemical substance with
known biological effects on humans or other animals. In the pharmacology field, a drug is
defined as a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or
used to otherwise enhance physical or mental well-being. Drugs usually affect either normal or
abnormal physiological processes
Tobechukwu Christian Ezike et al. (2023) Advances in drug delivery systems, challenges and
future directions drug delivery systems (DDS) are formulated using advanced technology to
accelerate systemic drug delivery to the specific target site, maximizing therapeutic efficacy and
minimizing off-target accumulation in the body. As a result, they play an important role in
disease management and treatment and various drug delivery.
Harish Kumar, K. Rathod, VinayakA.Katekar, Yashkumar, R. Dhole .and Prashant S.

Nalinde et al.(2021-2023)Pulmonary drug delivery system: A review An important
route for the management of various drugs is the lung drug delivery system (PDDS). In recent
years, the lungs have become increasingly concerned about the scientific and environmental
value of treating lung diseases. Lung delivery of drugs has evolved into one of the most widely
used routes of the planned or local drug rescuer Due to its potential localized lung function; drug
delivery systems for the treatment of lung diseases are being developed.
Harold Kim, Jorge Mazza et al.(2014) Asthma is the most common respiratory disorder in
Canada. Despite significant improvement in the diagnosis and management of this disorder, the
majority of Canadians with asthma remain poorly controlled. In most patients,however, control
can be achieved through the use of avoidance measures and appropriate pharmacological
interventions. Inhaled corticosteroids (ICSs) represent the standard of care for the majority of
patients
Sara M Tony1, Mohamed EA Abdelrahim et al.(2022) Inhalation Devices and Pulmonary
DrugDelivery Inhaled drug delivery is mainly used to treat pulmonary airway disorders by
transporting the drug directly to its targeted location for action. This decreases the dose required
to exert a therapeutic effect and minimizes any potential adverse effects. Direct drug delivery to
air passages facilitates a faster onset of action
ND Shah, VV Shah and ND Chivate et al. (2012) Pulmonary Drug Delivery: A Promising
Approach Mechanism of drug deposition: The mechanisms by which particles deposit in the
respiratory tract includes impaction(inertial deposition),sedimentation(gravitational deposition),
Brownian diffusion, interception, and electrostatic precipitation.Respiratory patterns
The pattern of respiration during aerosol exposure influences regional deposition, since breathing
volume and frequency determine the mean flow rates in each region of the respiratory tract,
which, in turn, influence the effectiveness of each deposition mechanism

Aim And Objective

Aim : A brief review on Pulmonary Drug Delivery System For Asthma Management.
This review aims to comprehensively explore the current landscape of pulmonary drug delivery
systems for the management of asthma. Specifically, it seeks to evaluate the efficacy, safety, and
practicality of various delivery methods, including metered-dose inhalers, dry powder inhalers,
and nebulizers.
Objective:
1) The objective of this brief review is to provide a comprehensive overview of pulmonary drug
delivery systems used in the management of asthma.
2) The review aims to evaluate the effectiveness, safety, and patient adherence associated with
various delivery devices such as metered-dose inhalers, dry powder inhalers, and nebulizers.
Additionally, it seeks to summarize recent advancements and innovations in pulmonary drug
delivery technology.
3) By synthesizing existing literature, the review aims to offer insights into the current
landscape of asthma management and identify opportunities for improving treatment
outcomes through optimized pulmonary drug delivery systems.
4) The objective of this brief review is to critically examine the role and efficacy of pulmonary
drug delivery systems in the management of asthma.
5) Specifically, the review aims to evaluate the various delivery devices and formulations
available for administering asthma medications directly to the lungs.
6) By assessing the advantages, limitations, and comparative effectiveness of metered-dose
inhalers, dry powder inhalers, and nebulizers, the review seeks to provide healthcare
professionals and researchers with valuable insights into the optimal selection and utilization
of pulmonary drug delivery systems for asthma management.
7) Additionally, the review aims to highlight emerging trends and areas for future research to
enhance the effectiveness and patient outcomes associated with pulmonary drug delivery in
asthma therapy.
8) The objective of this brief review is to provide a concise assessment of pulmonary drug
delivery systems for asthma management.

Pulmonary Drug Delivery System:
Pulmonary drug delivery has received scientific and biomedical attention in recent years, and
significant advances have been made in the local treatment of lung diseases by improving the
local target and reducing side effects through the application of micro drug dosing. There is a
change in the use of inhaled drugs due to the large area and permeability of the lungs. Although
it is not understood that the drug is administered by inhalation, it has been known for many
years. However, lungs are often considered an attractive and risky way to deliver products for the
treatment of local lung diseases (such as obstructive pulmonary disease (COPD), asthma,
microbial) and systemic diseases (such as diabetes). The drug is mainly administered to the lungs
by oral inhalation and is used in the treatment of many diseases. Inhalation therapy is often
needed to prevent lung infections using medications such as long- and short-acting beta
sympathomimetic, corticosteroids, and anticholinergics. Therefore, the respiratory route is
receiving more attention in the delivery of parenteral drugs, mainly for the delivery of inhaled
insulin and peptide and protein therapy.[7]
Advantages
o It is needle-free pulmonary delivery.
o It requires a low fraction of oral dose.
o Pulmonary drug delivery has negligible side effects since the rest of the body is not
exposed to the drug.
o The onset of action is very quick with pulmonary drug delivery.
o Degradation of the drug by the liver is avoided in pulmonary drug delivery.
Disadvantages
o Oropharyngeal deposition gives local side effects.
o Patients may have difficulty using the pulmonary drug devices correctly. oDrug
absorption may be limited by the physical barrier of the mucus layer.
o Various factors affect the reproducibility of drug delivery in the lungs, including
Physiological and pharmaceutical barriers.
o The lungs are not only accessible surfaces for drug delivery complexes but also delivery
devices are required to target drug delivery.
o Stability of drug in vivo.
o Targeting specificity.
o Drug irritation and toxicity.
o Immunogenicity of proteins.
o Drug absorption may be limited by the physical barrier of the mucus layer.
o Patients may have some problems using the pulmonary drug delivery devices correctly.
o Oropharyngeal deposition gives local side effects. [8-9]
Anatomy and Physiology of Human Respiratory Tract:
The respiratory system works with body organs to transport oxygen from the lungs to the cells,
remove carbon dioxide, and return it to the lungs to be excreted. The exchange of oxygen and
carbon dioxide between air, blood and tissues is called respiration. Healthy lungs breathe
approximately 1 pint of air 12-15 times per minute. All the blood in the body passes through the
lungs every minute. The respiratory system is divided into two main parts: the upper respiratory
system, consisting of the nose, nostrils and pharynx; Internal organs include the lungs, trachea,
bronchi, and lungs . The trachea begins at the edge of the larynx, divides into two bronchi and
continues towards the lungs. The trachea allows air to pass from the larynx to the bronchi and
from there to the lungs. The bronchi divide into smaller bronchioles, which branch into the lungs
to produce air. The end of the bronchi are the alveoli. Alveoli are the functional organs of the
lungs and create space for gas exchange. The trachea, or air duct, is a continuation of the larynx
that extends to the right of the fifth thoracic vertebra. Here, it is divided (bifurcated) at the carina
into the left and right bronchi, which form the entire lungs. It is approximately 10-11 cm long
and is in the middle plain in front of the esophagus. Bronchi are made of the same tissue as the
trachea. They are covered with ciliated columnar epithelium. The bronchi gradually divide into
bronchioles, terminal bronchioles, alveolar ducts and finally alveoli. The cartilage shape in the
distal bronchi is not good and it is not at the bronchiolar level. Alveoli are small; There are
approximately 300 million in each lung. Although alveoli are small structures, their total surface
area is quite large (approximately 100 m2), which allows efficient gas exchange. The blood
barrier between the alveolar space and the pulmonary capillaries is thin and allows

Figure 2: Human Respiratory System
Fig3: Schematic illustration of the human respiratory system shows the upper respiratory and
lower respiratory tracts [10]

Mechanisms of Particle Deposition in the Respiratory Tract:
Effective resistance mechanisms may reduces the burden of outer particles enter the airways, and
clearing them it may achieve something in being stored. Therapeutic aerosols are two-phase
colloidal systems in which the drug is contained in a dispersed phase they may have a liquid,
solid or combination of the two, depend on the method and formulation of aerosol generation.
Evidently for effective therapy, the drug must have provided to the lung in aerosol droplets or
particles that deposit in the specific lung region and in sufficient quantity to be essential. The
respiratory mechanisms of resistance of mucociliary clearance and phagocytosis by macrophages
can act upon insoluble particles. Aerosol particle dissolution they may slow and the drug may
then subsequently to be subject to enzymatic reaction before it reaches to its specific site of
pharmacological action. Aerosols for pulmonary drug delivery are transported from the mouth .
The mechanism of particle deposition in the respiratory tract .
Inertial impaction:
This is the major deposition mechanism for particles >1 μm in the upper tracheo-bronchial
regions. A particle with a large momentum may not able to follow the altering direction of the
inspired air as it transferred the bifurcations and it will result in colliding with the airway walls as
it continues on its original course.[11]
Sedimentation:
The particles may deposited by settling under gravity. It becomes highly important for
particles that reach airways where velocity of the airstream is relatively low, e.g. the
bronchioles and alveolar region. The fraction of particles deposited by this mechanism
may be dependent upon the time the particles use in these regions.
Brownian diffusion:
This is of minor significance for particles >1 μm. Particles smaller than this size are
moved by a sequentially bombardment of gas molecules, which may results in particle
collision with the airway walls. The oppertunity of particle deposition by diffusion
increases with the particle size decreases. Brownian diffusion is often more common in

regions where airflow is very low or absent, e.g. in the alveoli. Another method of
deposition, is of important for fibers but it may not for drug delivery.
Generally:
Particles larger than 10 μm will have impact in the upper airways and are rapidly removed by
swallowing, coughing and mucociliary processes The particles in the size range 0.5–5 μm may
break away from impaction in the upper airways and may accumulated by sedimentation and
impaction in the lower TB and A regions. If the particle size of aerosol is between the 3 and 5 μm
then deposition mainly present in the TB region. If the particles are smaller than the 3 μm then
sufficient deposition in the A region is likely to occur.
Interception:
Interception occurs when a particle contacts an airway surface due to its physical shape or size.
Unlike impaction, particles that are deposited by interception do not deviate from their air
streamlines. Interception is likely to occur in small airways or when the air streamline is close to
an airway wall. Interception is generally significant for fibers, which easily contact airway
surfaces do to their length. There fore, fibers have very small aerodynamic diameters relative to
their size, so they can often reach the smallest airway. [12]
Absorption:
The pulmonary membrane is naturally permeable to many therapeutic peptides and proteins and
to small molecule drugs. The epithelium of the lung, the barrier which is significant to absorption
of inhaled drugs, is found to be thick (50–60 μm) in the trachea, but minimize in thickness to an
extremely thin up to 0.2 μm in the alveoli. The change occur in cell types and morphology
moving from trachea, bronchi, and bronchioles to alveoli is much dramatic. The lungs are more
permeable to macromolecules than other portal for entry into the body. Therefore most promising
therapeutic agents are peptides and proteins, which can be inhaled instead of injected, due to this
improve compliance. Particularly, peptides that have been chemically changed to inhibit
peptidase enzymes exhibit much high bio-availabilities through the pulmonary route. Small
molecules can show prolonged absorption if they are highly soluble or highly cationic. Although
the rapid absorption of molecules has much conceivable medical uses, there are instances when
one want to slow the absorption of an inhaled small molecule, either to make it acting longer

locally in lung, or to regulate its absorption into the body. Much insoluble molecules that slowly
dissolve from the inhaled particle will stick in the lung for hours or even days. Amphothericin B,
fluticasone propionate, and retinoic acid which is all-trans, absorbed from the lungs for period of
hours, due in part to their slow dissolution rate from relatively insoluble lipophilic particles.
Encapsulation in slow release particles such as liposomes and nanoparticles can also be used to
control absorption. [13]
Electrostatic Precipitation:
Electrification normally occurs in aerosol generating processes. The unipolar charge present on
the particle may have a significant effect on the deposition efficiency of particles in the lungs
during breathing. The deposition of the particles in the lungs shows a relatively small fractional
deposition in the lungs under same conditions when condensation aerosols are used. Since, the
condensation, aerosols are free of electric charges, the difference in fractional deposition can be
caused due to the additional deposition from electrostatic forces. This type of effect is quite
significant for submicron and micron particles carrying unipolar charge of magnitude of hundred
electrons. The observed changes are caused primarily by electrostatic precipitation resulting from
the image force between the particle and the wall.
Respiratory Patterns
The pattern of respiration during aerosol exposure promotes regional deposition, since breathing
volume and frequency determine the mean flow rates in each region of the respiratory tract,
which, in turn, promotes the effectiveness of each deposition mechanism. Turbulence tends to
enhance particle deposition, the degree of potentiating depending on the particle size. Rapid
breathing is often combined with increased deposition of larger particles in the upper respiratory
tract, while slow, steady inhalation increases the number of particles that penetrate to the
peripheral parts of the lungs slow breathing, with or without breath-holding, showed a broad
maximum deposition in the ciliated airways (tracheobronchial region). The pulmonary maximum
occurred between 1.5 μm and 2.5 μm with breath holding and between 2.5 μm and 4μm without
breath-holding. Rapid inhalation showed similar trends: the tracheo-bronchial region maximum
falls and shifts to between 3 μm and 6 μm. Pulmonary deposition sharpens and occurs between
1.5 μm and 2 μm with breath-holding, and between 2 μm and 3 μm without breath-holding.
When the above considerations are taken into account, the ideal scenario for aerosol would be:

● Aerosol AD smaller than 5 μm, to minimize oropharyngeal

deposition.
● Steady, Slow inhalation and
● A breath-holding period on completion of inhalation. [14]
Pulmonary Clearance:
The primary function of the pulmonary defensive response to inhaled particles is to keep the
respiratory surfaces of the alveoli clean and ready for respiration. The elimination of particles
deposited in the lower respiratory tract serves an essential defense mechanism to prevent
potentially adverse interactions of aerosols with lung cells. Insoluble particulates are cleaned by
several pathways, which are only partially understood. These pathways are known to be impaired
in some diseases and are thought to based on the nature of the administered material.
Swallowing, expectoration, and coughing contain the first sequence related to clearance
mechanisms operating in the naso/oropharynx and tracheobronchial tree. A major mechanism of
clearance for inhaled particulate matter deposited in the conducting airways is the mucociliary
escalator, whereas uptake by alveolar macrophage predominates in the alveolar region. In
addition to these pathways, soluble particles can be cleared due to dissolution with subsequent
absorption from the lower airways. The rate of particle clearance from those regions differs
appropriately and its prolongation can have serious consequences, causing lung diseases
originating from the toxic effects of inhaled compounds. It is now well recognized that the lungs
are a site for the uptake, accumulation, and/or metabolism of numerous exogenous or
endogenous compounds. All metabolizing enzymes found in the liver are also present in the lung,
although in smaller amounts. The rate at which a drug is cleared and absorbed from the
respiratory tract depends on the dynamic interaction of several factors, predominantly.
 Themucociliary clearance rate
 Site of deposition along the airways
 Biopharmaceutical factors (particulates vs. drug in solution)
 Release rate of drug
 The physicochemical properties of the drug, such as molecular weight, partition
coefficient, and charge.[15]

Pulmonary Absorption:
The pulmonary membrane is naturally permeable to small molecule drugs and to many
therapeutic proteins and peptides. The epithelium of the lung, the significant barrier to absorption
of inhaled drugs, is thick (50–60 μm) in the trachea, but decreases in thickness to an extremely
thin 0.2 μm in the alveoli. The change in cell types and morphology going from bronchi, trachea,
and bronchioles to alveoli is very dramatic. The lungs are for more permeable to macromolecules
than other portal of entry into the body. The desirable aerodynamic particle size range of 0.5-
5μm (500-5000nm) is considered optimum for uptake of macrophages in the alveolar region.
Phagocytosis is done in carrier particles and loss of drug molecule. The rapid phagocytosis
targeting is the useful tool for sustained drug release in lung. Lung barriers in drug absorption
through pulmonary route are epithelial lining fluid thickness of 10μm in central airways, and 0.05
μm in alveoli, heterogeneous composition of cell types in epithelium and endothelium, basement
and interstitial membrane drained by lymphatic vessels and lymphatic system, alveolar
macrophages of defence phagocytic cells, surfactant secreted generally by type II cells,
mucocilliary clearance from trachea to bronchioles, mucus production and pathophysiological
changes such as inflammation, hypersecretion and epithelial disruption. Transcellular
diffusion,Passive diffusion, (lipophilic compounds), paracellular diffusion take place with
hydrophilic compounds. Transport mechanisms such as vesicle mediated transcytosis, carrier
mediated transport, and efflux transports are occurred in pulmonary absorption. Lung has very
thin barrier with large surface area, higher systemic bioavailability, drugs are better absorbed.
Therefore rapid absorption occurred in lung after inhalation, challenge is the formulation should
stay in local site of the lung and drug release for the prolonged period of time. Polar drugs are
better absorbed, and faster absorption with lesser metabolisms are advantages in comparison of
lung versus gastrointestinal tract absorption properties. Naturally lung metabolism rates are less,
expression of esterase is similar in lung and liver, Phase I activities generally 10% in lung
compared to liver. Small proteins and peptides are absorbed very rapidly after inhalation than
after subcutaneous injection. For other small molecules, inhalation is a rapid way to get into the
body because drug efflux transporters and metabolizing enzymes are available in the lung at very
lower levels than the gastrointestinal tract. Lipophilic small molecules are absorbed very rapid,
t1/2 absorption being approximately 1–2 minutes. Water soluble small molecules are absorbed

fast, t1/2 absorption being appropriately 65 minutes. Small molecules can exhibit prolonged
absorption if they are highly soluble or highly cationic.
Although the rapid absorption of molecules has many conceivable medical applications, there are
instances when one might want to slow the absorption of an inhaled small molecule, either to
allow it acting longer locally in lung, or to regulate its absorption into the body. Very insoluble
molecules that slowly dissolve from the inhaled particle can stick in the lung for many hours or
even days.
Amphothericin B, Fluticasone propionate, and all-trans retinoic acid are absorbed from the lungs
over a period of hours, due in part to their slow dissolution rate from comparatively insoluble
lipophilic particles. Encapsulation in slow release particles such as liposomes and nanoparticles
can also be used to control absorption.[16]
Mechanism of drug accumulation (deposition) in pulmonary airways:
Three main mechanisms for drug deposition occur in the lungs. The initial mechanism is termed
inertial impaction. It is the most common mechanism by which particles deposit in the upper
airways. When air passes through the upper respiratory tract, the particle that gains elevated
momentum (velocity x mass) seems incapable of coping with the altered track of inspired air.
This high velocity causes impaction on the airway walls inside the lungs. Since the probability of
impaction is proportional to the particle’s momentum, particles that are larger and moving at a
greater speed or have a higher density will exhibit more impaction.
Sedimentation is another mechanism for drug accumulation. Once the airflow velocity decreases,
particles are deposited downwards due to gravity. This happens when airflow is restricted in the
bronchioles and alveoli. The duration the particles spend in these locations determines the
percentage of particles deposited by this mechanism. Holding one’s breath after inspiration
increases the time the particles remain in these locations, resulting in higher drug deposition in
the lungs. [17]

ASTHMA
Fig.4 Asthma
Asthma is defined as an inflammatory disease of the respiratory tract. Hypersensitivity is

associated with airway hyper responsiveness (greater narrowing of the airways Greater response
to triggers such as allergies and exercise), causing symptoms such as wheezing, difficulty
breathing (dyspnea), chest tightness and cough. Symptoms are usually associated with large but
variable airflow through the lungs, often with regular reversal or asthma treatment.[18].
Around the globe, it is estimated that as many as 300 million people of all ages, races, and
ethnicities suffer from asthma and that asthma is becoming more common in children and adults;
rising prevalence is often linked with increasing urbanization [19]. It is estimated that asthma
accounts for 250,000 deaths each year worldwide, most of which are preventable [20]. In the
United States, asthma prevalence rates have been estimated to be 8.2% (24.6 million persons)

with slightly higher prevalence rates among children compared to adults and females compared
to males. The prevalence of asthma is increasing in the United States; the symptoms of asthma
lead to 10.6 million doctor visits and 444,000 hospitalizations annually. According to the Centers
for Disease Control and Prevention, 16.4 million adults (7.3%) and seven million children (9.4%)
in the United States suffer from asthma, and asthma accounts for nearly 4000 deaths annually
[21]. International consensus recommendations and guidelines for the treatment of asthma have
identified that the primary goal of asthma management is to optimize asthma control [22]. In an
effort to improve asthma management, the Global Initiative for Asthma (GINA) guidelines
recommend evaluating control through the assessment of daytime symptoms, activity limitation,
night-time awakenings and symptoms, the need for rescue treatment, lung function, and
exacerbations. Similarly, the joint American Thoracic Society/ European Respiratory Society
(ATS/ERS) task force report determines level of control based on existing symptoms and the
extent to which the patient can carry out activities of daily living and achieve optimal quality of
life, while taking into account risk of future adverse events including loss of control,
exacerbations, accelerated decline in lung function, and side-effects of treatment. Despite slight
differences in definitions within asthma control guidelines, the main goals of asthma treatment
are the achievement of good asthma control and the reduction of future risk of exacerbations to
the patient, with low cost and minimum adverse events [23]. While a number of factors likely
contribute to asthma control or lack of asthma control, the focus of this article is on the role of
asthma triggers, which may be defined as a substance or event that leads to an acute onset or
worsening of asthma symptoms lasting several hours or days [24, 25]. Some triggers have been
found to contribute to severe asthma exacerbations and the need for intensive care unit (ICU)
admissions [26]. Typically, clinicians, authoritative bodies, and patient education programs assist
patients with identifying triggers of asthma and provide suggestions for ways of reducing
exposure to triggers as part of asthma control management [27, 28]. In a large retrospective
cohort study, results showed that triggers were discussed in 85% of patient clinic visits, and
advice regarding trigger management was given in 30% of visits [29]. A recent focus group study
in the United States explored patients perceptions of triggers and behaviors undertaken to
manage triggers in the real world. Results demonstrated that patients with asthma identify a wide
array of frequent asthma triggers in their environments, including indoor/ outdoor allergens,

environmental pollutants/irritants, strong odors, foods, weather, exercise, sinusitis/respiratory

infections, stress, medications, and strong emotions that are perceived to contribute to the
frequency and severity of asthma symptoms [30]. This study also found that patients make
temporary or permanent lifestyle changes to maintain control in the presence of triggers. Given
the focus on trigger education and avoidance as a way of optimizing asthma control for asthma
patients, and patients’ perceptions of high trigger burden and lifestyle modifications made to
avoid such triggers in their daily lives, the objective of this literature review was to gather
empirical evidence regarding trigger management in order to inform evidence-based practice and
scientific inquiry into optimal ways for managing triggers using information, educational
programs, drug therapy, or a combination of the above. Based on preliminary searches of the
asthma trigger literature, it was found that the adult and pediatric literature are separate, and
more definitive empirical studies have been published regarding trigger management for
pediatric patients. This review focuses on evidence concerning trigger avoidance for adult
asthma patients. The specific objectives of literature review were to [19] review guidelines and
educational materials in order to present current thinking on definitions of triggers and best
practices on current methods for clinical management of triggers; [20] gather information on
international types of asthma triggers and raise awareness of common triggers patients are
encountering in their lives; and [21] gather empirical evidence for guidelines on recommended
trigger management practices from the medical and scientific literature. These study objectives
were undertaken for the purpose of gaining a better understanding of the role of triggers in
asthma control in order to improve trigger management in clinical practice and to identify areas
for further research.
Bronchial Blood Circulation:
The supply to the walls of the bronchi and smaller air passages is through branches of the right
and left bronchial arteries and the venous return is mainly through the bronchial veins. On the
right side they empty into the azygos vein and on the left into the superior intercostals vein. The
lung receives the entire cardiac output and thus is the best perused organ in the body. However,
only the alveolar region and respiratory bronchioles are supplied by the pulmonary circulation.
Larger airways(trachea to terminal bronchioles) is via the systemic circulation and these airways
receive approximately 1%of the cardiac output. The role of the bronchial circulation

indistributing aerosolized drugs to regions distal from the original site of deposition or to
nonventilated regions of the lung is unknown. The endobronchial circulation is recirculated to
theperipheral airways and lung parenchyma via the bronchial veins and right atrium. Bronchial
blood flow is augmented in diseases, such as bronchiectasis, from 1% to as much as 30% of
cardiac output. In sheep, bronchial blood flow increased with antigen- and histamine-induced
bronchoconstriction. Theoretically, inhaled drugs that are absorbed into the circulation from the
tracheobronchial regions can be redistributed downstream and peripheral to airway obstructions,
into otherwise. Poorly accessible areas of the lung which may aid in the drug's efficacy. Thus far,
no experimental work in humans has been done to investigate the role of bronchial circulation in
lung distribution of inhaled medications or its influence on their efficacy.[7]
Pathophysiology
Asthma is related with T aide cell type-2 (Th2) resistant reactions, which are normal of other
atopic conditions. Different unfavorably susceptible (e.g., clean bugs, cockroach buildup, furred
creatures, molds, dusts) and non-allergic (e.g., diseases, tobacco smoke, cold discuss,
exercise)triggers create a cascade of immune-mediated events leading to persistent aviation route
aggravation. Lifted levels of Th2 cells within the aviation routes discharge particular cytokines
including interleukin (IL)-4, IL-5, IL-9 and IL-13,that promote eosinophilic aggravation and
immunoglobulin (IgE) generation by pole cells. IgE generation, in turn, triggers the discharge of
fiery mediators, such as histamine and cysteinyl leukotrienes, that cause bronchospasm
(contraction of the smooth muscle in the airways), edema (swelling) and increased mucous
secretion (mucous hypersecretion), which lead to the characteristic symptoms of asthma. The
mediators and cytokines released during the early phase of an immune response to an inciting
allergen, trigger a further inflammatory response (late-phase asthmatic response) that leads to
further airway inflammation and bronchial hyper reactivity. Evidence suggests that there may be
a genetic predisposition for the development of asthma. A number of chromosomal regions
associated with asthma susceptibility have been identified, such as those related to the production
of IgE antibodies, expression of airway hyper responsiveness, and the production of
inflammatory mediators. However, further study is required to determine specific genes involved

in asthma as well as the gene-environment interactions that may lead to expression of the disease
.[31-32]
Cliniocal Presentation
The diagnosis of asthma is made based on history, clinical features, and objective evidence of
reversible airflow obstruction [33]. None of the typical symptoms of asthma exacerbation such as
breathlessness, cough, wheezing, chest tightness, or worsening exercise tolerance are either
sensitive or specific for diagnosis (Table 3) [34]. The symptom-free periods are interrupted by
episodes of exacerbation precipitated by infection, environmental irritants, cold air, exercise, or
other allergens. During severe exacerbations patients often develop chest tightness or heaviness.
Table 1 lists the sensitivity and specificity for individual symptoms of asthma. Using a
combination of the individual symptoms increases the sensitivity and specificity for diagnosis,
but only up to 60% and 66%, respectively [35]. Therefore, a comprehensive history is critical for
the assessment and diagnosis of asthma. Table 2 lists the signs. Symptoms that suggest
alternative diagnoses other than asthma. Evidence of airflow limitation can be measured by a
decline in peak expiratory flow rate (PEFR) or forced expiratory volume in the first second
(FEV1), and often increase in symptoms [36,37]. Exacerbations, just like symptoms, are caused
by a variety of triggers depending on endotype of the asthmatic (i.e. classic eosinophilic or Type
2 vs. non-eosinophilic or Type 1). Triggers and risks for severe exacerbation of asthma are
innumerable, of which viral upper respiratory infections have been reported to be the most
common (rhinovirus, coronavirus and influenza) [38]. Allergen exposures including dust mites,
pollen, and animal dander are well known environmental factors that can precipitate asthma
[40,34,38,39]. Specific populations are at risk for more profound exacerbations and should be
within the radar of healthcare providers of first contact. African or Puerto Rican descent, lower
socioeconomic status, and pregnancy not only have higher frequency of exacerbations but also
do not get hospitalized until symptoms get severe [38,41]. Location of residence and air quality
have been correlated to a higher incidence of asthma exacerbations and hospitalizations,
especially in children [42,43]. Therefore, demographic evaluation may be helpful to predict
control of asthma and future severe exacerbations requiring hospitalizations. Co-morbid
conditions such as obesity, psychologic disease, rhinosinusitis, smoking, food or environmental
allergies, LPR, and GERD should also be adequately managed along with the asthma

exacerbation [38,41]. Many of the alternative diagnoses listed in Table 4 can not only confound
asthma diagnosis but also contribute to exacerbations. Therefore, a hospitalized patient found to
have an alternative diagnosis should also be evaluated for asthma exacerbation.
Table3: Sensitivity and specificity of common symptoms during asthma exacerbations.
Symptom Sensitivity Specificity
Cough 16-66% 26-64%
Wheezing 9-76% 34-87%
Dyspnea in adults 11-73% 33-71%

Table 4: Differential diagnoses for asthma exacerbation
Symptoms Diagnosis
A prominent cough without Chronic cough syndrome, Paroxysmal vocal cord

changes in lung function dysfunction, angiotensin converting enzyme inhibitors
or angiotensin receptor blocker intake.
Dizziness/light- Hyperventilation syndrome (dysfunctional breathing
headedness/peripheral tingling disorder)
Prominent nasal symptoms Rhinitis
without changes in lung function
Postural and/or food-related Gastro-esophageal reflux disease Laryngopharyngeal
symptoms reflux
Orthopnea*/paroxysmal nocturnal Decompensated heart failure, obstructive sleep apnea*
dyspnea*/ edema/known cardiac
disease
Fine crackles on auscultation Pulmonary fibrosis
Smoking >30 pk/yrs, symptom Chronic obstructive pulmonary disease

onset >35 years of age
Chronic productive cough without Bronchiectasis, inhaled foreign body, obliterative
wheezing or breathlessness bronchiolitis
New onset weight loss or systemic Lung cancer or sarcoidosis

symptoms /hemoptysis

Diagnosis:
The diagnosis of asthma involves a thorough medical history, physical examination, and
objective assessments of lung function (spirometry preferred) to confirm the diagnosis (see Table
1). Broncho provocation challenge testing and assessing for markers of airway inflammation may
also be helpful for diagnosing the disease, particularly when objective measurements of lung
function are normal despite the presence of asthma symptoms. [44,45,46]
Diagnosing Asthma
Common symptoms and signs include:
• Wheezing
• Coughing
• Breathing difficulty
• Tightness in the chest
• Worsening symptoms at night
• Worsening symptoms due to cold air
• Symptoms while exercising
• Symptoms after exposure to allergens
It is also wise to make note of health conditions that can interfere with asthma management such
Medical history:
The diagnosis of asthma should be suspected in patients with recurrent cough, wheeze, chest
tightness and shortness of breath. Symptoms that are variable, occur upon exposure to allergens
or irritants, that worsen at night, and that respond to appropriate asthma therapy are strongly
suggestive of asthma [44,46]. Alternative causes of suspected asthma symptoms should be
excluded, such as chronic obstructive pulmonary disease (COPD), bronchitis, chronic sinusitis,
gastroesophageal reflux disease, recurrent respiratory infections, and heart disease. A positive
family history of asthma or other atopic diseases and/or a personal history of atopic disorders,
particularly allergic rhinitis, can also be helpful in identifying patients with asthma. During the
history, it is also important to examine for possible triggers of asthma symptoms, such as dust
mites, cockroaches, animal dander, moulds, pollens, exercise, and exposure to tobacco smoke or
cold air. Exposure to agents encountered in the work environment can also cause asthma. If work
related asthma is suspected, details of work exposures and improvements in asthma symptoms
during holidays should be explored. It is also important to assess for comorbidities that can
aggravate asthma symptoms, such as allergic rhinitis, sinusitis, obstructive sleep apnea and
gastroesophageal reflux disease [46]. The diagnosis of asthma in young children is often more
difficult since episodic wheezing and cough are common in this patient population and
spirometry is unreliable in patients under 6 years of age. A useful method of confirming the
diagnosis in young children is a trial of treatment with short-acting bronchodilators and inhaled
corticosteroids (ICSs). Marked clinical improvement during treatment and deterioration upon
cessation of therapy supports a diagnosis of asthma [44,47,48]
Physical Examination
Given the variability of asthma symptoms, the physical examination of patients with suspected
asthma is often unremarkable. Physical findings are usually only evident if the patient is
symptomatic. Therefore, the absence of physical findings does not rule out a diagnosis of asthma.
The most common abnormal physical finding is wheezing on auscultation, which confirms the
presence of airflow limitation [44]. Physicians should also examine the upper respiratory tract
and skin for signs of concurrent atopic conditions such as allergic rhinitis or dermatitis [46].
Objective measurements of lung function
Spirometry is the preferred objective measure to assess for reversible airway obstruction (i.e.,
rapid improvement in lung function after inhalation of a rapid-acting bronchodilator) and to
confirm a diagnosis of asthma. It is recommended for all patients over 6 years of age who are
able to undergo lung function testing [44,46]. Spirometry must be performed according to proper
protocols. It is commonly performed in pulmonary function laboratories, but can also be
performed in primarycare offices. During spirometry, the patient is instructed to take the deepest
breath possible and then to exhale as hard and as fully as possible into the mouthpiece of the
spirometer. Spirometry measures the forced vital capacity (FVC, the maximum volume of air
that can be exhaled) and the forced expiratory volume in 1 second (FEV1). The ratio of FEV1 to
FVC provides a measure of airflow obstruction. A diagnosis of asthma is confirmed when there
is: (1) an improvement in FEV1 of at least 12% and at least 200 mL 15–20 minutes after
administration of an inhaled rapidacting bronchodilator, or (2) an improvement in FEV1 of at
least 20% and at least 200 mL after 2 weeks of treatment with an anti-inflammatory agent. In the
general population, the FEV1/FVC ratio is usually greater than 0.80 (and possibly greater than

0.90 in children) and, therefore, any values less than these suggest airflow limitation and also
support a diagnosis of asthma. Because of the variability of asthma symptoms, patients will not
exhibit reversible airway obstruction at every visit. Therefore, to increase sensitivity, spirometry
should be repeated, particularly when patients are symptomatic [45,46]. Peak expiratory flow
(PEF) monitoring is an acceptable alternative when spirometry is not available, and can also be
useful for diagnosing occupational asthma and/ or monitoring response to asthma treatments.
PEF is usually measured in the morning and in the evening. A diurnal variation in PEF of more
than 20% or an improvement of at least 60 L/min or at least 20% after inhalation of a rapid-
acting bronchodilator suggests asthma [46]. Although simpler to perform than spirometry, PEF is
not as reliable. Therefore, as mentioned earlier, spirometry is the preferred method of
documenting airflow limitation and confirming the diagnosis of asthma.
Allergy skin testing
Allergy skin testing is also recommended to determine the allergic status of the patient and to
identify possible asthma triggers. Testing is typically performed using the allergens relevant to
the patient’s geographic region. Although allergen-specific IgE tests that provide an in vitro
measure of a patient’s specific IgE levels against particular allergens have been suggested as an
alternative to skin tests, these tests are less sensitive and more expensive than skin tests [44,45].

Treatment
The primary goal of asthma management is to achieve and maintain control of the disease in
order to prevent exacerbations (abrupt and/or progressive worsening of asthma symptoms that
often require immediate medical attention and/or the use of oral steroid therapy) and reduce the
risk of morbidity and mortality. The level of asthma control should be assessed at each visit
using the criteria in Table 2, and treatment should be tailored to achieve control. In most asthma
patients, control can be achieved through the use of both avoidance measures and
pharmacological interventions. The pharmacologic agents commonly used for the treatment of
asthma can be classified as controllers (medications taken daily on a long-term basis that achieve
control primarily through anti-inflammatory effects) and relievers (medications used on an as-
needed basis for quick relief of bronchoconstriction and symptoms). Controller medications
include ICSs, leukotriene receptor antagonists (LTRAs), long-acting beta2-agonists (LABAs) in
combination with an ICS, and anti-IgE therapy. Reliever medications include rapid-acting
inhaled beta2agonists and inhaled anticholinergics (LTRAs), long-acting beta2-agonists
(LABAs) in combination with an ICS, and anti-IgE therapy. Reliever medications include rapid-
acting inhaled beta2-agonists and inhaled anticholinergics. Allergen-specific immunotherapy
may also be considered in most patients with allergic asthma, but must be prescribed by
physicians who are adequately trained in the treatment of allergies Systemic corticosteroid
therapy may also be required for the management of acute asthma exacerbations.
Table 2 Criteria for Assessing Asthma Control [44,46]
1. No exacerbations
2. Fewer than 3 doses per week of a rapid-acting beta2-agonist bronchodilator
3. Daytime symptoms < 3 days per week
4. No nighttime symptoms
5. Normal physical activity

When asthma control has been achieved, ongoing monitoring is essential to establish the
minimum maintenance doses required to maintain control. However, because asthma is a
variable disease, treatment may need to be adjusted periodically in response to loss of control (as
indicated by failure to meet the control criteria in Table 2) [44]. It is also imperative that all
asthma patients be empowered to take an active role in the management of their disease. This can
be accomplished by providing patients with a personalized written action plan for disease
management and by educating the patient about the nature of the disease, the role of medications,
the importance of adhering to controller therapy, and the appropriate use of inhaler devices [46].
Pulmonary Delivery Devices:

The lung has served as a route of drug administration for thousands of years. The origin of
inhaled therapies can be traced back 4000 years ago to India, where people smoked the leaves of
the Atropath belladonna plant to suppress cough. In the 19 and early 20th centuries, asthmatics
smoked asthma cigarettes that contained stramonium powder mixed with tobacco to treat the
symptoms of their disease. The development of modern inhalation devices can be divided into
three different categories, the refinement of the nebulizer and the evolution of two types of
compact portable devices, the metered-dose inhaler (MDI) and the dry powder inhaler (DPI). The
advantages and disadvantages of each system will be discussed below and are summarized in.
More detailed reviews of inhalation technology have been previously published.
Nebulizers:
Nebulizers have been used for many years to treat asthma and other respiratory diseases. There
are two basic types of nebulizer, jet and ultrasonic nebulizers. The jet nebulizer functions by the
Bernoulli principle by which compressed gas (air or oxygen) passes through a narrow orifice
creating an area of low pressure at the outlet of the adjacent liquid feed tube. This results in drug
solution being drawn up from the fluid reservoir and shattered into droplets in the gas stream.
The ultrasonic nebulizer uses a piezoelectric crystal vibrating at a high frequency (usually 1–3
MHz) to generate a fountain of liquid in the nebulizer chamber; the higher the frequency, the
smaller the droplets produced. Constant output jet nebulizers can aerosolize most drug solutions
and provide large doses with very little patient coordination or skill. Treatments using these
nebulizers can be time-consuming but are also inefficient, with large amounts of drug wastage

(50% loss with continuously operated nebulizers). While these disposable nebulizers are
inexpensive, the compressors supplying the air or oxygen are not. Most of the prescribed
drugnever reaches the lung with nebulization.The medicine inside an inhaler goes straight into
the airways. Therefore it needs much smaller dose than took the medicine as a tablet or liquid by
mouth. Inhalation represents an attractive, rapid and patient-friendly route for the delivery of
systemically acting drugs, as well as for drugs that are designed to act locally on the lungs
themselves.
Fig.5 Nebulizers nhalers

Metered-dose inhalers:
The MDI was a revolutionary invention that overcame the problems of the hand-bulb nebulizer,
as the first portable outpatient inhalation device and is the most widely used aerosol delivery
device today. The MDI emits a drug aerosol driven by propellants, such as chlorofluorocarbons
(CFC) and more recently, hydrofluoroalkanes (HFAs) through a nozzle at high velocity (> 30 m
s−1). MDIs deliver only a small fraction of the drug dose to the lung. Typically, only 10–20% of
the emitted dose is deposited in the lung.
Fig 6 Metered-dose inhalers

Pressurized metered-dose inhalers:

The pMDI is not available for all drugs or dosages, making it difficult for clinicians to prescribe
the same type of device for diverse inhaled medications. This is exacerbated by the trend of
many pharmaceutical companies not to release newer inhaled drugs as pMDIs. The design of the
CFCpropellantpMDI requires initial and frequent priming. Failure to prime the device results in
administration of a substantially lower dose than that prescribed. Unfortunately, frequent priming
tends to waste drug to atmosphere.
Fig 7 Pressurized metered-dose inhalers

Dry powder inhalers:

Interest in DPIs as an effective, efficient and environmentally friendly way of delivering drugs to
the lung has accelerated in recent years. A fundamental difficulty with developing solid state
aerosols, or DPIs, is managing both the ubiquitous and the transient forces contained in powder
beds. Indeed, managing such particulate forces, for example via particle engineering techniques,
is now considered central to successful DPI formulation and production.[48]
Fig 8 Dry powder inhaler

Result & Discussion:
Pulmonary Drug Delivery for Asthma Management: A Discussion Pulmonary drug delivery is
undeniably a game-changer in asthma management. Let's delve deeper and discuss its pros, cons,
and exciting advancements. Direct Hit Medications go straight to the inflamed airways,
providing faster relief of wheezing and shortness of breath. Fewer Side Effects:- Compared to
oral medications, inhaled drugs have a lower risk of side effects because they bypass the
bloodstream to a large extent. Convenience Champions: Inhalers and nebulizers are portable and
user-friendly, allowing for discreet and convenient symptom management on-the-go. Results We
See: Breathable Relief: Inhaled medications improve lung function by relaxing airways and
reducing inflammation, leading to easier breathing. Symptom SOS: Regular use significantly
reduces asthma symptoms, allowing patients to participate more fully in daily life without
worrying about asthma attacks.

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Name of Student Name of Guide

Miss. Pratiksha Sanjay Mapari Miss. Jayshri B. Sanap
(Student B. Pharm Final Year) (M. Pharm, PhD)

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Pulmonary Drug Delivery System For Asthma Management

Sr. No. Chapter Page No.

3. Review Of Literature 7-8

5. Pulmonary drug delivery system 10-18

7. Treatment & Pulmonary 28-33

8. Result & Discussion 34

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Drug delivery systems:

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●Various Type Drug Delivery System

Fig.1 Various Type Of Drug Delivery System

Researchers have recognized the potential benefits of nanotechnology in vastly improving

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Asthma is defined as an inflammatory disease of the respiratory tract. Hypersensitivity is

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Harish Kumar, K. Rathod, VinayakA.Katekar, Yashkumar, R. Dhole .and Prashant S.

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Aim And Objective

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Pulmonary Drug Delivery System:

Anatomy and Physiology of Human Respiratory Tract:

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Figure 2: Human Respiratory System

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Mechanisms of Particle Deposition in the Respiratory Tract:

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● Aerosol AD smaller than 5 μm, to minimize oropharyngeal

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Mechanism of drug accumulation (deposition) in pulmonary airways:

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Asthma is defined as an inflammatory disease of the respiratory tract. Hypersensitivity is

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environmental pollutants/irritants, strong odors, foods, weather, exercise, sinusitis/respiratory

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Table3: Sensitivity and specificity of common symptoms during asthma exacerbations.

Symptom Sensitivity Specificity

Cough 16-66% 26-64%

Wheezing 9-76% 34-87%

Dyspnea in adults 11-73% 33-71%

A prominent cough without Chronic cough syndrome, Paroxysmal vocal cord

Smoking >30 pk/yrs, symptom Chronic obstructive pulmonary disease

New onset weight loss or systemic Lung cancer or sarcoidosis

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Objective measurements of lung function

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Allergy skin testing

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Table 2 Criteria for Assessing Asthma Control [44,46]

2. Fewer than 3 doses per week of a rapid-acting beta2-agonist bronchodilator

3. Daytime symptoms < 3 days per week

5. Normal physical activity

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