Initial Development of an Air-Jet Dry Powder Inhaler for Rapid Delivery of Pharmaceutical Aerosols to Infants

Characterizing the Effects of Nasal Prong Interfaces on Aerosol Deposition in a Preterm Infant Nasal Model

“…Bianco et al (34) recently showed 10 to 20% estimated lung deposition when applying continuous high-dose aerosolized surfactant with eFlow Neos nebulizer through 8 different bi-nasal short prongs affixed to a preterm NT airway (PrINT) during simulated pre-term infant breathing and nasal CPAP. For the dry powder air-jet delivery system of Howe et al (13) with a single-prong nasal interface, nasal depositional loss of an aerosol with a 1.7 µm MMAD delivered at 2.7 LPM was approximately 20%, and when considered with other losses, resulted in a tracheal filter delivery efficiency of approximately 50% of the inhaler loaded powder dose.…”

“…Delivery of highdose aerosols such as inhaled bronchodilators, antibiotics, or surfactants is often proposed via nasal prong interfaces during NIV as a means to maintain respiratory support during expected long nebulization times (6,7,(10)(11)(12). Alternatively, high-dose aerosols may be delivered directly to infants before, during, or after NIV respiratory support using nasal prong interfaces and rapid dry powder aerosol delivery systems (13)(14)(15)(16). For example, Howe et al (13) proposed a direct-to-infant dry powder delivery strategy that employs a single nasal prong interface and administers both a full inhalation breath and aerosol bolus with short (approximately 0.2 s) actuation times.…”

“…Alternatively, high-dose aerosols may be delivered directly to infants before, during, or after NIV respiratory support using nasal prong interfaces and rapid dry powder aerosol delivery systems (13)(14)(15)(16). For example, Howe et al (13) proposed a direct-to-infant dry powder delivery strategy that employs a single nasal prong interface and administers both a full inhalation breath and aerosol bolus with short (approximately 0.2 s) actuation times. As part of the aerosol delivery strategy implemented in the in vitro study of Howe et al (13), the nostril without the nasal prong was held closed during device actuation and then opened to allow for exhalation similar to the infant resuscitation strategy of te Pas et al (17).…”

“…For example, Howe et al (13) proposed a direct-to-infant dry powder delivery strategy that employs a single nasal prong interface and administers both a full inhalation breath and aerosol bolus with short (approximately 0.2 s) actuation times. As part of the aerosol delivery strategy implemented in the in vitro study of Howe et al (13), the nostril without the nasal prong was held closed during device actuation and then opened to allow for exhalation similar to the infant resuscitation strategy of te Pas et al (17). Using this approach, lung delivery efficiency was on the order of 50% of a loaded 10 mg powder dose based on in vitro experiments with a realistic nose-throat (NT) model of a term newborn infant and open filter system (13).…”

“…As part of the aerosol delivery strategy implemented in the in vitro study of Howe et al (13), the nostril without the nasal prong was held closed during device actuation and then opened to allow for exhalation similar to the infant resuscitation strategy of te Pas et al (17). Using this approach, lung delivery efficiency was on the order of 50% of a loaded 10 mg powder dose based on in vitro experiments with a realistic nose-throat (NT) model of a term newborn infant and open filter system (13). In human subjects, N2L administration of high-dose pharmaceutical aerosols through nasal prong interfaces has progressed to clinical testing (3,7,11,12), largely focused on the administration of nebulized liquid surfactants combined with NIV (i.e., nCPAP).…”