Immunization

Vaccination against viruses, such as influenza and measles, commonly involves parenteral (subcutaneous or intramuscular) administration of a live, attenuated virus or a killed virus. The inhalation route is being examined as a means of immunizing patients because it circumvents logistical problems associated with parenteral administration, such as needle sterility issues, patient aversion to needles, and the need for administration by a health care professional. In very young children, maternally derived IgG antibodies may prevent successful immunization [118]. The inhalation route may allow vaccination of these children because the immunological response of the airways is less likely to be influenced by maternal antibodies [118]. Aerosol immunization has been shown to be effective against measles [119] and, in some respects, is more efficacious than parenteral immunization [120].

WHAT LIMITS AEROSOL USE? Patient Compliance

Although aerosol administration is an extremely effective means of delivering a drug to the airways, the oral route remains the preferred means of drug delivery for a variety of airway diseases. This course of therapeutic action relates primarily to patient preference and compliance. Breathing pattern determines the amount and the pattern of drug deposition in the airways [1]. Indeed, when using patient-actuated metered-dose inhalers (MDIs), coordination of dose release with inspiration constitutes a problem for approximately 50% of patients [121]. It is important, therefore, that the patient be well versed in the correct technique for aerosol inhalation, especially those generated by metered-dose inhalers. Dry powder inhalers, by their design, simplify timing of drug delivery with inspiration. However, dose preparation (e.g., puncturing dosage blister pack) can be more complicated than for an MDI. The advent of spacers and inspiration-activated devices have simplified the maneuvers required to be performed by the patient during aerosol administration, and the resultant subjective improvement in aerosolized drug efficacy may be envisioned to improve patient compliance. Patient perception also affects their use of inhaled medication (and medications in general). For example, the beneficial effects of inhaled corticosteroids develop over a period of weeks. Poor patient compliance with therapy is though to be caused by the failure of these agents to elicit a discernable physiological or beneficial effect with each use, leading the patients cease to using the medication because they perceive no benefit [122].

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