Drug delivery via aerosol systems: concept of "aerosol inhaled".

The mass of aerosol inhaled is primarily a function of the patient's breathing pattern and the aerosol delivery system. Once inhaled, deposition is governed by factors related to the properties of the aerosol and the individual characteristics of the patient (e.g., particle size distribution, airway geometry, and residence time). This paper will center upon the actual generation and delivery of clinical aerosols by jet nebulizers and assess variability in aerosol delivery. Because of the practical difficulties in predicting nebulizer function from first principles, it will be advocated that nebulizer function be directly measured for each clinical situation. Terms like "nebulizer output", "efficiency", etc. are to be avoided. The following definition is proposed: "aerosol inhaled" represents that quantity of drug actually delivered by a given nebulizer for a defined breathing pattern and period of time. The concept of "aerosol inhaled" allows a direct comparison of the quantity of drug delivered by different nebulizer systems and adjustment of dose of a given therapeutic agent. Bench testing of aerosol systems and measurement of "aerosol inhaled" can be made in the laboratory if careful attention is paid to the relationship between laboratory conditions and actual use, including the particle distribution and the accuracy of a radiolabel in estimating the quantity of drug nebulized.