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Aerosol Therapy During Non-invasive Ventilation: Challenges and Opportunities

Hindle M, Wei X, Spence B, Golshahi L, Longest P.

Respiratory Drug Delivery 2018. Volume 1, 2018: 137-148.

Abstract:

Non-invasive ventilation (NIV) is an important clinical respiratory support modality for both adult and pediatric patients, which avoids the need for invasive intubation. Clinical scenarios exist in which patients who receive NIV may also benefit from inhaled aerosol therapy. However, there is a lack of clear clinical evidence supporting this application and lung deposition studies reveal low lung aerosol deposition during NIV. Three main challenges to drug delivery during NIV have been identified. Firstly, preventing drug aerosol deposition within the ventilation circuit and delivering a therapeutic dose to the patient. Secondly, minimizing deposition in the extrathoracic airways (nasal or oral) during inhalation. And thirdly, avoiding exhalation losses. Strategies to overcome these challenges include streamlining ventilation components, reducing aerosol size and improving the coordination of aerosol delivery with the inhalation cycle. Using a combination of these approaches it should be possible to significantly improve drug delivery to the lungs during NIV.