Changing delivery methods for obstructive lung diseases

Current Opinion in Pulmonary Medicine

Volumn 3, Issue 3, 1997, Pages 177-189

  Dolovich, Myrna ^a  

^a MCMASTER UNIVERSITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

BRONCHODILATING AGENT; PROPELLANT;

ADULT; AEROSOL; ASTHMA; CHILD; CHRONIC OBSTRUCTIVE LUNG DISEASE; DRUG DELIVERY SYSTEM; EQUIPMENT DESIGN; HUMAN; INHALATIONAL DRUG ADMINISTRATION; NEBULIZER; REVIEW;

ADMINISTRATION, INHALATION; ADULT; AEROSOL PROPELLANTS; AEROSOLS; ASTHMA; BRONCHODILATOR AGENTS; CHILD; DRUG DELIVERY SYSTEMS; EQUIPMENT DESIGN; HUMANS; LUNG DISEASES, OBSTRUCTIVE; NEBULIZERS AND VAPORIZERS;

EID: 0031132701     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-199705000-00001     Document Type: Article

References (112)

1. Swift DL: Dose distribution of pharmaceutical aerosols. Aerosol Sci Technol 1983, 18:272-278.
2. Smaldone GC, Fuhrer J, Steilbigel RT, McPeck M: Factors determining pulmonary deposition of aerosolized pentamidine in patients with human immunodeficiency virus infection. Am Rev Respir Dis 1991, 143:727-737.
3. Dolovich MB, Newhouse MT: Aerosols: generation, methods of administration and therapeutic applications in asthma. In Allergy: Principles and Practice, edn 4. Edited by Middleton E Jr, Reed CE, Ellis EF, Adkinson NF Jr, Yunginger JW, Busse WW. Philadelphia: CV Mosby Co; 1993:712-739.
4. Byron PR: Respiratory Drug Delivery. Boca Raton, FL: CRC Press; 1990.
5. Dolovich M: Inhalation technique and inhalation devices. In Beta2-Agonists in Asthma Treatment. Edited by Pauwels R, Lofdahl C-G, O'Byrne P. Lung Biology in Health and Disease series. New York: Marcel Dakker; 1997:229-255.
6. Pedersen S: Inhalers and nebulizers: which to choose and why. Respir Med 1996, 90:69-77. Review of aerosol delivery systems used for children and reasons for selecting systems for administering inhalant therapy.
7. Dolovich M: Lung dose, distribution and clinical response to therapeutic aerosols. Aerosol Sci Technol 1993, 18:230-240.
8. Zanen P, Go LT, Lammers JW: Optimal particle size for beta 2 agonist and anticholinergic aerosols in patients with severe airflow obstruction. Thorax 1996, 51:977-980.
9. Leach CL: Approaches and challenges to use Freon propellant replacements. Aerosol Sci Technol 1995, 22:328-334.
10. Berg E: In vitro properties of pressurized metered dose inhalers with and without spacer devices. J Aerosol Meod 1995, 8(suppl 3):S3-S11.
11. June D: A new generation of inhaler technology. Brit J Clin Prac 1995, (suppl 79):18-21.
12. Dockhorn R, Vanden Burgt JA, Ekholm BP, Donnell D, Cullen MT: Clinical equivalence of a novel non-chlorofluorocarbon-containing salbutamol sulfate metered-dose inhaler and a conventional chlorofluorocarbon inhaler in patients with asthma. J Allergy Clin Immunol 1995, 96:50-56. Randomized, double-blind, double-dummy, crossover, dose-response study in 26 adults with chronic, stable asthma, demonstrating equivalent safety and efficacy of the replacement propellant (HFA134a) formulation of albuterol.
13. Clark AR: MDIs: physics of aerosolized formulation. J Aerosol Med 1996, 9(suppl 1):S19-S26.
14. Schultz RK: Drug delivery characteristics of metered-dose inhalers. J Allergy Clin Immunol 1995 96:284-287. Discussion of some of the physical operating mechanisms of pMDIs that can affect drug delivery.
15. Cyr TD, Graham SR, Li KYR, Lovenng EG: Low first-spray drug content in albuterol metered-dose inhalers. Pharmacol Res 1991, 8:658-660.
16. June D, Carlson S, Ross D: The effect of temperature on drug delivery characteristics of chlorofluorocarbon (CFC) and hydrofluoroalkane (HFA) metered dose inhalers (MDIs). Respir Drug Delivery V 1996:354-356.
17. Leach C: Enhanced drug delivery through reformulating MDIs with HFA propellants-drug deposition and its effect on preclinical and clinical programs. Proc Respir Drug Delivery V 1996:133-144.
18. Crompton GK: Problems patients have using pressurized aerosol Inhalers. Eur J Respir Dis 1982, 63(suppl 119):101-104.
19. De Blaquiere P, Christensen DP, Carter WB, Martin TR: Use and misuse of metered-dose inhalers by patients with chronic lung disease. Am Rev Respir Dis 1989, 140:910-916.
20. Dolovich M: Influence of inhalation technique on response and compliance. Eur Respir Rev 1995, 5:166-169.
21. Dolovich M, Ruffin R, Corr D, Newhouse M: Clinical evaluation of a simple demand inhalation MDI aerosol delivery device. Chest 1983, 84:36-44.
22. Meeran K, Burrin JM, Noonan KA, Price CP, Ind PW: A large volume spacer significantly reduces the effect of inhaled steroids on bone formation. Postgrad Med J 1995, 71:156-159. Double-blind, randomized, placebo-controlled, crossover study performed in 26 healthy adult men. Inhalation of 500-μg baclomethasone dipropionate through a spacer resulted in a smaller decrease in plasma osteocalcin levels. The reduced systemic effect is presumably due to the reduced oropharyngeal dose when the spacer is used.
23. Everard ML, Clark AR, Milner AD: Drug delivery from holding chambers with attached facemask. Arch Dis Child 1992, 67:580-585.
24. Fuller HD, Dolovich MB, Posmituck G, Wong Pack W, Newhouse MT: Pressurized aerosol versus jet aerosol delivery to mechanically ventilated patients: comparison of dose to the lungs. Am Rev Respir Dis 1990, 141:440-444.
25. Fok TF, Monkman S, Dolovich M, Gray S, Coatea G, Paes B, Rashid F, Newhouse MT, Kirpalani H: Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia. Pediatr Pulmonol 1996, 21:301-309.
26. Dhand R, Jurban A, Tobin MJ: Bronchodilator delivery by metered-dose inhaler in ventilator-supported patients. Am J Respir Crit Care Med 1995, 151:1827-1833. The safety and efficacy of administering 10 puffs of albuterol pMDI through a spacer to seven ventilated patients was demonstrated. Resistance decreased significantly and no adverse effects were noted, supporting the use of this relatively high dose of bronchodilator in these patients.
27. Dolovich M, Chambers C: Effect of a pause prior to inhaling a MDI aerosol on drug availability through an open tube spacer. J Allergy Clin Immunol 1994, 93(part 2):169.
28. Dolovich M, Chambers C, Girard L, Newhouse M: Aerosol delivery through an open tube spacer: importance of inhalation technique. Am Rev Respir Dis 1989, 139:A144.
29. Newman SP, Millar AB, Lennard-Jones TR, Moren F, Clarke SW: Improvement of pressurized aerosol deposition with Nebuhaler spacer device. Thorax 1984, 39:935-941.
30. Vidgren MT, Paronen TP, Kärkkäinen A, Karjalainen P: Effect of extension devices on the drug deposition from inhalation aerosols. Int J Pharmacol 1987, 39:107-112.
31. Newman SP, Talaee N, Clarke SW: Salbutamol aerosol delivery on man with the Rondo spacer. Acta Ther 1991, 17:49-58.
32. Salzman GS, Pyszczynski DR: Oral pharyngeal candidiasis in patients treated with beclomethasone dipropionate delivered by metered-dose inhaler alone and with aerochamber. J Allergy Clin Immunol 1988, 81:424-428.
33. Dolovich M: Characterization of medical aerosols: physical and clinical requirements for new inhalers. Aerosol Sci Technol 1995, 22:392-399.
34. Barry PW, O'Callaghan: Inhalational drug delivery from seven different spacer devices. Thorax 1996, 51:835-840. In vitro measurements of drug delivery efficiencies of a variety of spacers with different pMDI drugs. Results demonstrate the importance of evaluating the drug/spacer combination performance before recommending a device for the drug prescribed.
35. Newman SP: Scintigraphic assessment of therapeutic aerosols. Crit Rev Ther Drug Carrier Syst 1993, 10:65-109.
36. Hindle M, Chrystyn H: Relative bioavailabillty of salbutamol to the lung following inhalation using metered dose inhalation methods and spacer devices. Thorax 1994, 49:549-553.
37. Konig P, Gayer D, Kantak A, Kreutz C, Douglass B, Hordvik NL: A trial of metaproterenol by metered-dose inhaler and two spacers in preschool asthmatics. Pediatr Pulmonol 1988, 5:247-251.
38. Laurikainen K, Poukkula A, Korhonen P, Lehtonen L, Vidgren M, Silvasti M: Comparison of two beclomethasone dipropionate aerosol spacer combinations in the treatment of asthma. Int J Clin Pharmacol Ther 1994, 32:293-298.
39. Newman SP, Clark AR, Talaee N, Clarke SW: Lung deposition of 5 mg Intal from a pressurized metered-dose inhaler assessed by radiotracer technique. Int J Pharmacol 1991, 74:203-208.
40. Pedersen S: Optimal use of tube spacer aerosols in asthmatic children. Clin Allergy 1985, 15:473-478.
41. Thomas SH, O'Doherty MJ, Fidler HM, Page CJ, Treacher DF, Nunan TO: Pulmonary deposition of a nebulised aerosol during mechanical ventilation. Thorax 1993, 48:154-159.
42. Harvey CJ, O'Doherty MJ, Page CJ, Thomas SHL, Nunan TO, Treacher DF: Effect of a spacer in pulmonary aerosol deposition from a jet nebuliser during mechanical ventilation. Thorax 1995, 50:50-53. Radiolabeled deposition, crossover study in 10 mechanically ventilated, post-surgery patients demonstrating that the addition of a spacer to an in-line jet nebulizer increased aerosolized drug delivery to the lung.
43. Dolovich M, Fok TF, Monkman S, Gray S, Rashid F, Paes B, Newhouse M, Kirpalani H: Relationship between infant weight and lung deposition of aerosol. Eur Respir J 1995, B(suppl 19):201S.
44. Gervais A, Bégin P: Bronchodilatation with a metered-dose inhaler plus an extension, using tidal breathing vs jet nebulization. Chest 1987, 92:822-824.
45. Gleeson JGA, Price JF: Nebuhaler technique. Br J Dis Chest 1988, 82:172-174.
46. Barry PW, Robertson CF, O'Callaghan C: Optimum use of a spacer device. Arch Dis Child 1993, 69:693-694.
47. O'Callaghan C, Lynch J, Cant M, Robertson C: Improvement in sodium cromoglycate delivery from a spacer device by use of an antistatic lining, immediate inhalation, and avoiding multiple actuations of drugs. Thorax 1993, 48:603-606.
48. Clark DJ, Lipworth BJ: Effect of multiple actuations, delayed inhalation and antistatic treatment on the bioavallabllity of salbutamol via a spacer device. Thorax 1996, 51:981-984. Ten healthy volunteers inhaled 1200 μg (12 × 100 μg puff) of albuterol via the pMDI and large-volume spacer using four different models. Plasma albuterol levels showed that patients should be instructed to inhale doses one at a time and not to delay between actuation of the pMDI and inhalation of the aerosol.
49. Bisgaard H, Anhoj J, Klug B, Berg E: A non-electrostatic spacer for aerosol delivery. Arch Dis Child 1995, 73:226-230.
50. Dolovich MB, Mitchell JP, Nagel M: Comparison of performance of aluminum with plastic holding chambers with four drugs used in Inhalation therapy. Eur Respir J 1995, 8(suppl 19):201S.
51. Wildhaber JH, Devadson SG, Hayden MJ, James R, Dufty AP, Fox RA, Summers QA, LeSouef PN: Electrostatic charge on a plastic spacer device influences the delivery of salbutamol. Eur Respir J 1996, 9:1943-1946.
52. Colacone A, Afilalo M, Wolkove N, Kreisman H: A comparison of albuterol administered by metered-dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Am Rev Respir Dis 1993, 104:835-841.
53. Idris AH, McDermott NF, Raucci JC, Morrabel A, McGorray S, Hendeles SL: Emergency department treatment of severe asthma: metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1988, 103:665-672.
54. Lee H, Arnon S, Silverman M: Bronchodilator aerosol administered by metered-dose inhaler and spacer in subacute respiratory distress syndrome. Arch Dis Child 1994, 70:F218-F222.
55. Cunningham SJ, Crain EF: Reduction of morbidity in asthmatic children given a spacer device. Chest 1994, 106:753-757.
56. Giep T, Raibble P, Zuerlein T, Schwartz ID: Trial of beclomethasone dipropionate by metered-dose inhaler in ventilator-dependent neonates less than 1500 grams. Am J Perinatol 1996, 13:5-9. Placebo-controlled, double-blind study in 19 ventilated infants with BPD in whom beclomethasone dipropionate was delivered via pMDI and an in-line spacer to 10 infants. Significantly more extubations occurred following seven days of treatment with the steroid aerosol. No adverse events were reported in the treated group.
57. Rubin BK, Nakanishi A, Smith E, Lamb B: Salbutamol by metered dose inhaler plus holding chamber is more effective than salbutamol by jet nebulizer for the treatment of acute childhood asthma. Eur Resp J 1995, 8(suppl 19):13S.
58. Newman SP, Weisz AWB, Talaee N, Clarke SW: Improvement of drug delivery with a breath actuated pressurized aerosol for patients with poor inhaler technique. Thorax 1991, 46:712-716.
59. Ruggins NR, Milner AD, Swarbrick A: An assessment of a new breath actuated inhaler device in acutely wheezy children. Thorax 1993, 68:477-480.
60. Schecker MH, Wilson AF, Mukai DS, Hahn M, Crook D, Novey H: A device for overcoming discoordination with metered-dose inhalers. J Allergy Clin Immunol 1993, 92:783-789.
61. Chapman KR, Love L, Brubaker H: A comparison of breath-actuated and conventional metered dose inhaler inhalation techniques in elderly subjects. Chest 1993, 104:1332-1337.
62. Morén F: Aerosol dosage forms and formulation. In Aerosols in Medicine: Principles, Diagnosis and Therapy, edn 2. Edited by Morén F, Dolovich MB, Newhouse MT, Newman SP. Amsterdam: Elsevier; 1993:321-350.
63. Barry PW, O'Callaghan C: The use of the chlorofluorocarbon free salbutamol preparation, Alromir, with different spacer devices. Thorax 1995, 50:P112.
64. Ganderton D, Kassem NM: Dry powder inhalers. In Advances in Pharmaceutical Sciences. Edited by Ganderton D, Jones T. London: Academic Press; 1992:165-191.
65. Timsina MP, Martin GP, Marriott C, Ganderton D, Yianneskis M: Drug delivery to the respiratory tract using dry powder inhalers. Int J Pharmacol 1994, 101:1-13.
66. Clark AR: Medical aerosol inhalers: past, present and future. Aerosol Sci Technol 1995, 22:374-391. Overview of inhaler designs, properties, and functions.
67. Ganderton D: The generation of respirable clouds from coarse powder aggregates. J Biopharm Sci 1992, 3:101-105.
68. Löfdahl C-G, Andersson L, Bondesson E, Carlsson LG, Friberg K, Hörnblad Y, Jemsby P, Rosenborg J, Werner S, Svedmyr N: Salbutamol doses inhaled via Turbuhaler gives a better bronchodilating effect than when given via a pressurized metered dose inhaler. Eur Respir J 1994, 7(suppl 18):49S.
69. Borgström L, Newman SP: Total and regional lung deposition of terbutaline sulphate inhaled via a pressurized MDI or Turbuhaler. Int J Pharmacol 1993, 97:47-53.
70. Clark AR, Hollingworth A: The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers-implications for in vitro testing. J Aerosol Med 1993, 6:99-110.
71. Clark AR: Effect of powder inhaler resistance upon inspiratory profiles in health and disease. In Respiratory Drug Delivery IV. Edited by Byron PR, Dalby RN, Farr SJ. Buffalo Grove, Illinois: Interpharm Press; 1994:117-123.
72. Olsson B, Asking L: Critical aspects of the function of inspiratory flow driven inhalers. J Aerosol Med 1994, 7(suppl 1):S43-S47.
73. Tennesen F, Laursen LC, Ibsen T, Evald T, Ståhl E, Ibsen TB: Bronchodilating effect of terbutaline powder in acute severe bronchial obstruction. Chest 1994, 105:697-700.
74. Svartengren K, Undestad P-Å, Svartengren M, Philipson K, Bilin G, Camner P: Added external resistance reduces oropharyngeal deposition and increases lung deposition of aerosol particles in asthmatics. Am J Respir Crit Care Med 1995, 152:32-37. Results following inhalation of aerosol through a high resistance suggests that drug inhaled from a DPI with high resistance design would result in greater deposition in the lung than with low resistance DPIs.
75. Thorsson L, Edsbäcke S, Conradson TB: Lung deposition from Turbuhaler is twice that from a pressurized metered dose inhaler (pMDI). Eur Respir J 1994, 7:1839-1844.
76. Pauwels R: Inhalation device, pulmonary deposition and clinical effects of inhaled therapy. J Aerosol Med 1997,10(suppl 1):S17-S22.
77. Stahl E, Ribeiro LB, Sandahl G: Dose response to inhaled terbutaline powder and peak inspiratory flow through Turbuhaler in children with mild to moderate asthma. Pediatr Pulmonol 1996, 22:106-110.
78. Goren A, Noviski N, Avital A, Maayan C, Stahl E, Godfrey S, Springer C: Assessment of the ability of young children to use a powder inhaler device (Turbuhaler). Pediatr Pulmonol 1994, 18:77-80.
79. Meakin BJ, Cainey J, Woodcock PM. Letter to the Editor: Effect of exposure to humidity on terbutaline delivery from turbuhaler dry powder inhalation devices. Eur Respir J 1993, 6:760-761.
80. Rajkumari NJ, Byron PR, Dalby RN: Testing of dry powder aerosol formulations in different environmental conditions. Int J Pharmacol 1995, 113:123-130.
81. ™. J Aerosol Med 1995, 8(suppl 2):S11-S17.
82. Hindle M, Byron PR: Dose emissions from marketed dry powder inhalers. Int J Pharmacol 1995, 116:169-177.
83. Kim CS, Garcia L: Delivery characteristics of albuterol powder aerosol by rotahaler. J Aerosol Med 1993, 6:199-211.
84. Jaegfeld H, Andersoon JAR, Trofart E, Wetterlin KIL: Particle size distribution from different modifications of Turbuhaler. In A New Concept in Inhalation Therapy. Edited by Newman SP, Moren F, Crompton GK. Bussom, The Netherlands: Medicom; 1987:90-99.
85. Pitcaim GR, Lankinen T, Valkila E, Newman SP: Lung deposition of salbutamol from the Leiras metered dose powder inhaler. J Aerosol Med 1995, 8:307-311.
86. Hill M, Vaughan L, Dolovich M: Dose targeting for dry powder inhalers. Proceedings of the Respiratory Drug Delivery V Meeting 1996. Interpharm Press, Buffalo Grove, IL; 1996:197-208.
87. Borgström L, Derom E, Stahl E, Wåhlin-Boll E, Pauwels R: The inhalation device influences lung deposition and bronchodilating effect of terbutaline. Am J Respir Crit Care Med 1996, 153:1636-1640.
88. Agertoft L, Pedersen S: Importance of the inhalation device on the effect of budesonide. Arch Dis Child 1993, 69:130-133.
89. Toogood JH, White FA, Baskerville JC, Fraher LJ, Jennings B: Comparison of the antiasthmatic, oropharyngeal, and systemic glucocorticoid effects of budesonide administered through a pressurized aerosol plus spacer or the Turbuhaler dry powder inhaler. J Allergy Clin Immunol 1997, 98:186-193. Open, parallel group trial of inhaled steroid in 58 adults with moderate to severe asthma. Efficacy was dose-dependent and similar with both inhalation devices, but systemic side effects on serum osteocalcin production ware higher from the DPI. Because of the greater lung deposition from the Turbuhaler, if conversion from the pMDI to the powder inhaler was to be considered, a 50% reduction in dose given by the DPI could be indicated.
90. Chapman KR, Friberg K, Balter MS, Hyland RH, Alexander M, Abboud RT, Peters S, Jennings BH: Albuterol via Turbuhaler versus albuterol via pressurized metered-dose inhaler in asthma. Ann Allergy Asthma Immunol 1997, 78:59-63. Randomized, double-blind, double-dummy, crossover study in 37 adults with stable but symptomatic asthma demonstrated that equivalent responses to albuterol inhaled via the Turbuhaler could be obtained using one half the dose of drug prescribed via the pMDI.
91. Dolovich M, Rhem R, Rashid F, Coates G, Hill M, Bowen B: Measurement of the particle size and dosing characteristics of a radiolabelled albuterol-sulphate lactose blend used in the SPIROS dry powder inhaler. Proceedings of the Respiratory Drug Delivery V Meeting 1996. Interpharm Press: Buffalo Grove, IL; 1996:332-335.
92. Schreurs AJ, Sinninghe Damste HE, de Graaff CS, Greefhorst AP: A dose-response study with formoterol Turbuhaler as maintenance therapy in asthmatic patients. Eur Respir J 1996, 9:1678-1683.
93. van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL: Evaluation of the effectiveness of four different inhalers in patients with chronic obstructive pulmonary disease. Thorax 1995, 50:1183-1187.
94. Schreier H, Mobley WC, Concessio N, Hickey AJ, Niven RW: Formulation and in vitro performance of liposome powder aerosols. STP Pharmacol Sci 1994, 4:38-44.
95. Laube BL, Georgopoulos A, Adams GK III: Preliminary study of efficacy of insulin aerosol delivered by oral inhalation in diabetic patients. JAMA 1993, 269:2106-2109.
96. Coutelle C, Williamson R: Liposomes and viruses for gene therapy of cystic fibrosis. J Aerosol Med 1996, 9:79-88.
97. Hung JCC, Hambleton G, Super M: Evaluation of two commercial jet nebulizers and three compressors for the nebulization of antibiotics. Arch Dis Child 1994, 71:335-338.
98. Baker PG, Stimpson PG: Electronically controlled drug delivery systems based on piezo electric crystal. In Respiratory Drug Delivery IV. Edited by Byron PR, Dalby RN, Farr SJ. Buffalo Grove, IL: Interpharm Press; 1994:273-285.
99. Dahlbäch M: Behavior of nebulizing solutions and suspensions. J Aerosol Med 1994, 7(suppl 1):S13-S18.
100. Hess D, Fisher D, Williams P, Pooler S, Kacmarek RM: Medication nebulizer performance: effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996, 110:498-505. In vitro comparison of aerosol delivery characteristics of a number of nebulizers, all of which are used for inhalation therapy in patients. Results demonstrate the variability among nebulizers and the need to be aware of these differences when choosing or recommending a system for therapy.
101. Alvine GF, Rodgers P, Fitzsimmons EM, Ahrens RC: Disposable jet nebulizers: how reliable are they? Chest 1992, 101:316-319.
102. Ahrens RC: Inhaled drugs for treatment of asthma: nothing is as simple as it seems. Ann Allergy Asthma Immunol 1996, 77:260-262. Guest editorial discussing the need for providing physicians with better information describing drug delivery systems to allow them to make informed decisions regarding treatment methods.
103. MacNeish C, Meisner D, Thibert R, Kelemen S, Vadas E, Coates A: A comparison of pulmonary availability between Ventolin (albuterol) nebules and Ventolin (albuterol) respirator solution. Chest 1997, 111:204-208.
104. Clay MM, Clarke SW: Wastage of drug from nebulizers: a review. J R Soc Med 1987, 80:38-39.
105. Newnham DM, Lipworth BJ: Nebuliser performance, pharmacokinetics, airways and systemic effects of salbutamol given via a novel nebuliser delivery system ("Ventstream"). Thorax 1994, 49:762-770.
106. Newman SP, Steed KP, Reader SJ, Hooper G, Zierenberg B: Efficient delivery to the lungs of flunisolide aerosol from a new portable hand-held multidose nebulizer. J Pharmacol Sci 1996, 85:960-964.
107. Farr SJ, Schuster JA, Lloyd P, Lloyd LJ, Okikawa JK, Rubsamen R: AERx-development of a novel liquid aerosol delivery system: concept to clinic. In Respiratory Drug Delivery V. Buffalo Grove, IL: Interpharm Press; 1996:175-185.
108. US Department of Health and Human Services: Guidelines for the Diagnosis and Management of Asthma. Expert Panel Report. [Publication no. 91-3042. August, 1991.] Consensus statement on the diagnosis and treatment of asthma; updated guideline to be available in 1997.
109. Tatsumura T, Koyama S, Tsujimoto M, Kitagawa M, Kagaminori S: Further study of nebulisation chemotherapy, a new chemotherapeutic model in the treatment of lung carcinomas: fundamental and clinical. Br J Cancer 1993, 68:1146-1149.
110. Farncombe M, Chater S, Gillin A: The use of nebulized opioids for breathlessness: a chart review. Palliat Med 1994, 84:306-312.
111. Fiel SB, Fuchs HJ, Johnson C, Gonda I, Clark AR: Comparison of three jet nebulizer aerosol delivery systems used to administer recombinant human Dnase to patients with cystic flbrosis. Chest 1995, 108:153-166.
112. Schwarz LA, Johnson JL, Black M, Cheng SH, Hogan ME, Waldrep JC: Delivery of DNA-cationic liposome complexes by small-particle aerosol. Hum Gene Ther 1996, 7:731-741.