Drug Delivery over the last 100 years…and the future

Federico Lavorini, M.D. Ph.D.

Department of Experimental and Clinical Medicine, University of Florence,

Largo Brambilla 3, Florence, 50134, Italy

Summary

Inhalation therapy is one of the oldest approaches to the therapy of diseases of the respiratory tract. It is well recognised today that the most effective and safe means of treating the lungs is to deliver drugs directly to the airways. Surprisingly, the delivery of therapeutic aerosols has a rich history dating back more than 2000 years to ayurvedic medicine in India. In the late 18th and in the 19th century, earthenware inhalers were popular for the inhalation of air drawn through infusions of plants and other ingredients. Atomizers and nebulizers were developed in the mid-1800s in France and were thought to be an outgrowth of the perfume industry as well as a response to the fashion of inhaling thermal waters. The marketing of the first pressurized metered-dose inhaler for epinephrine and isoproterenol, by Riker Laboratories in 1956, was a milestone in the development of inhaled drugs. The first dry powder inhaler (DPI) was developed in the mid-19th century, but DPIs did not gain market prominence until the 1990s. The signing of the Montreal Protocol in 1987 led to a surge in innovation that resulted in the diversification of inhaler technologies with significantly enhanced delivery efficiency, including modern pMDIs, dry powder inhalers, and nebuliser systems. There is also great interest in tailoring particle size and deliver to treat specific areas of the respiratory tract. One challenge that has been present since antiquity still exists, however, and that is ensuring that the patient has access to the medication and understands how to use it effectively. patient compliance will likely lead to market acceptance of smart inhalers. However, the desire for high-tech inhalers will be countered by the increasing healthcare cost pressures and will likely ensure that MDI and DPI therapies remain important components of therapeutic aerosol delivery