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Open AccessArticle

Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study

1
Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chiayi 61301, Taiwan
2
Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi 61301, Taiwan
3
Department of Pediatrics, National Cheng Kung University Hospital, Tainan 70402, Taiwan
4
Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi 61301, Taiwan
5
Department of Respiratory Therapy, Chang Gung University, Taoyuan 33302, Taiwan
6
Aerogen Pharma Corp., San Mateo, CA 94402, USA
*
Author to whom correspondence should be addressed.
Pharmaceutics 2020, 12(3), 291; https://doi.org/10.3390/pharmaceutics12030291
Received: 1 March 2020 / Revised: 20 March 2020 / Accepted: 21 March 2020 / Published: 24 March 2020
(This article belongs to the Special Issue Drug Delivery Through Pulmonary)
We aimed to quantify Soft Mist Inhalers (SMI) delivery to spontaneous breathing model and compare with different adapters via endotracheal tube during mechanical ventilation or by manual resuscitation. A tiotropium SMI was used with a commercial in-line adapter and a T-adapter placed between the Y-adapter and the inspiratory limb of the ventilator circuit during mechanical ventilation. The SMI was actuated at the beginning of inspiration and expiration. In separate experiments, a manual resuscitator with T-adapter was attached to endotracheal tube, collecting filter, and a passive test lung. Drug was eluted from collecting filters with salt-based solvent and analyzed using high-performance liquid chromatography. Results showed the percent of SMI label dose inhaled was 3-fold higher with the commercial in-line adapter with actuation during expiration than when synchronized with inspiration. SMI with T-adapter delivery via ventilator was similar to inhalation (1.20%) or exhalation (1.02%), and both had lower delivery dose than with manual resuscitator (2.80%; p = 0.01). The inhaled dose via endotracheal tube was much lower than inhaled dose with spontaneous breathing (22.08%). In conclusion, the inhaled dose with the commercial adapter was higher with SMI actuated during expiration, but still far less than reported spontaneous inhaled dose. View Full-Text
Keywords: Soft mist inhaler; mechanical ventilation; adapter; inhaled dose; in vitro Soft mist inhaler; mechanical ventilation; adapter; inhaled dose; in vitro
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MDPI and ACS Style

Fang, T.-P.; Chen, Y.-J.; Yang, T.-M.; Wang, S.-H.; Hung, M.-S.; Chiu, S.-H.; Li, H.-H.; Fink, J.B.; Lin, H.-L. Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study. Pharmaceutics 2020, 12, 291.

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