ABSTRACT
Asthma and chronic obstructive pulmonary diseases (COPDs) such as bronchitis and emphysema are major and growing disease areas where the major route of administration is topically, at the site of action, in the lung. Asthma is a common, chronic disease with a prevalence of more than 5% in adults and 15% to 20% in children, and is increasing in many parts of the world. The prevalence of COPD is even higher, and mortality rates are 10 times higher than those for asthma. At present, similar drugs are used for both diseases, with steroids, short-and long-acting b2s, and anticholinergics being the most common therapies. Combination products with two actives are gaining importance. Inhalation allows the delivery of smaller doses directly to the lungs, with the advantage of reduced systemic side effects. There are also other illnesses in which pulmonary delivery is appropriate, such as cystic fibrosis, human immunodeficiency virus (HIV), lung cancer, pain, and infections. In addition, the lung is being viewed as a possible route to the systemic circulation for the treatment of nonrespiratory diseases, where normal oral administration is not technically possible. This is especially relevant to the delivery of peptides and proteins. The latter has recently been shown to be technically possible with insulin, although the inhaled insulin product ExuberaTM has surprisingly been withdrawn after only one year on the market for a variety of reasons.
