ECFS 2020 - Optimizing pharmaceutical care in cystic fibrosis

European Cystic Fibrosis Society    121  OPTIMIZING PHARMACEUTICAL CARE IN CYSTIC FIBROSIS AEROSOL THERAPY FOR CF LUNG DISEASE: THE BASICS CHAPTER 7 results in more turbulence in the central airways, meaning that a larger fraction of the inhaled drug is deposited in the upper airways [10]. Conversely, a slow inhalation maneuver will result in less turbulence in the central airways and a greater probability that aerosol particles will bypass the central large airways. Ideally, an aerosol should be inhaled with slow and deep inhalation, so that even large particles containing a high drug mass have a greater probability of bypassing the turbulent central large airways to reach the diseased small airways. The third patient-related factor that deter- mines particle deposition is the presence of structural abnormalities of the airways and/or mucus in the airways, which disturb the airflow pattern and increase deposi- tion at the sites of obstruction [10-12]. The fourth patient-related factor is the ability of the lung to expand homogeneously. Recent modelling studies have shown that lobes with substantial structural damage receive less inhaled drug particles [9, 12]. It is likely that structural abnormalities such as fibrosis in CF lungs have a negative impact on lung expansion [13] ( Figure 2 ). As a result, there is a preferential airflow to the healthier regions of the lungs. In order to select the most appropriate inhalation device for a patient we should not only take into account the aerosol char- acteristics of the inhaled drug, but also the patient´s age, the required inhalation flow pattern associated with the device, and the severity of CF lung disease.