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Do airway clearance mechanisms influence the local and systemic effects of inhaled corticosteroids?

Edsbacker, S; Wollmer, Per LU ; Selroos, O; Borgstrom, L; Olsson, Bo and Ingelf, J (2008) In Pulmonary Pharmacology & Therapeutics 21(2). p.247-258
Abstract
The role of airway clearance in inhaled drug therapy is complex. Disease-induced bronchoconstriction results in a central drug-deposition pattern where mucociliary clearance is most efficient. When drug-induced bronchodilation is achieved, deposition and uptake becomes more peripheral, and because there is less mucociliary clearance in the periphery, this will lead to an unintentional increase in lung exposure and enhance the risk of systemic side effects. In addition, mucociliary clearance is pathologically reduced in both asthma and chronic obstructive pulmonary disease. Among inhaled corticosteroids, rate of dissolution and lung uptake differs considerably. For the slowly dissolving, lipophilic steroids, the contribution of mucociliary... (More)
The role of airway clearance in inhaled drug therapy is complex. Disease-induced bronchoconstriction results in a central drug-deposition pattern where mucociliary clearance is most efficient. When drug-induced bronchodilation is achieved, deposition and uptake becomes more peripheral, and because there is less mucociliary clearance in the periphery, this will lead to an unintentional increase in lung exposure and enhance the risk of systemic side effects. In addition, mucociliary clearance is pathologically reduced in both asthma and chronic obstructive pulmonary disease. Among inhaled corticosteroids, rate of dissolution and lung uptake differs considerably. For the slowly dissolving, lipophilic steroids, the contribution of mucociliary clearance to these findings appears significant, and variability in lung and systemic exposure resulting from variable mucociliary function appears to be amplified. In addition, dose optimisation of non-stable asthma becomes more complex. The present review highlights the impact of mucociliary clearance on inhaled corticosteroid disposition and identifies critical areas where more research is needed. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pulmonary Pharmacology & Therapeutics
volume
21
issue
2
pages
247 - 258
publisher
Elsevier
external identifiers
  • pmid:17950641
  • wos:000262943500001
  • scopus:40049086856
ISSN
1522-9629
DOI
10.1016/j.pupt.2007.08.005
language
English
LU publication?
yes
id
06e88230-5658-4415-9d24-df4448d3cfd7 (old id 1138826)
date added to LUP
2008-08-19 11:58:35
date last changed
2017-01-01 07:44:16
@article{06e88230-5658-4415-9d24-df4448d3cfd7,
  abstract     = {The role of airway clearance in inhaled drug therapy is complex. Disease-induced bronchoconstriction results in a central drug-deposition pattern where mucociliary clearance is most efficient. When drug-induced bronchodilation is achieved, deposition and uptake becomes more peripheral, and because there is less mucociliary clearance in the periphery, this will lead to an unintentional increase in lung exposure and enhance the risk of systemic side effects. In addition, mucociliary clearance is pathologically reduced in both asthma and chronic obstructive pulmonary disease. Among inhaled corticosteroids, rate of dissolution and lung uptake differs considerably. For the slowly dissolving, lipophilic steroids, the contribution of mucociliary clearance to these findings appears significant, and variability in lung and systemic exposure resulting from variable mucociliary function appears to be amplified. In addition, dose optimisation of non-stable asthma becomes more complex. The present review highlights the impact of mucociliary clearance on inhaled corticosteroid disposition and identifies critical areas where more research is needed.},
  author       = {Edsbacker, S and Wollmer, Per and Selroos, O and Borgstrom, L and Olsson, Bo and Ingelf, J},
  issn         = {1522-9629},
  language     = {eng},
  number       = {2},
  pages        = {247--258},
  publisher    = {Elsevier},
  series       = {Pulmonary Pharmacology & Therapeutics},
  title        = {Do airway clearance mechanisms influence the local and systemic effects of inhaled corticosteroids?},
  url          = {http://dx.doi.org/10.1016/j.pupt.2007.08.005},
  volume       = {21},
  year         = {2008},
}