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Pulmonary diseases induced by drugs include bronchial asthma, pulmonary infiltration with eosinophilia, diffuse fibrosing alveolitis, vasculitis, and pleural diseases. (1-4) Most such diseases recede when the drug is withdrawn, although [...]

It is known that obstructive sleep apnea syndrome (OSAS) can affect right ventricular (RV) performance even in the absence of systemic hypertension and other known cardiac or obstructive pulmonary disease. The purpose of the present study was to assess RV function in OSAS using 3-D echocardiography and speckle tracking echocardiography (STE) and evaluate changes after continuous positive airway pressure (CPAP) treatment.

An important determinant of clinical outcome of a lower respiratory tract infection may be sterilization of the infected lung, which is also dependent on sustained antibacterial concentrations achieved in the lung. For this reason, recently there has been increased interest in measuring the concentration of antimicrobial agents at different potential sites of infection in the lung. Levels of antibacterials are now measured in bronchial mucosa, epithelial lining fluid (ELF) and alveolar macrophages, as well as in sputum. Penicillins and cephalosporins reach only marginal concentrations in bronchial secretions, whereas fluoroquinolones and macrolides have been shown to achieve high concentrations. The extent of penetration of different antibacterials into the bronchial mucosa is relatively high. This is also true for β-lactams, although their tissue concentrations never reach blood concentrations. Antibacterials penetrate less into the ELF than into the bronchial mucosa, but fluoroquinolones appear to concentrate more into alveolar lavage than into bronchial mucosa.

Metered dose inhalers (MDIs) which have a valve holding chamber plus a mouthpiece or mask have, in recent years, markedly improved the ease, speed and reliability of aerosol therapy for reversible airflow obstruction in adults, children and infants. MDIs, effective and easily accessible when patients are away from home, are the gold standard for the treatment of reversible airflow obstruction since they provide reliable, reproducible, effort-independent dosing, protection of their contents from environmental humidity and bacterial infection and at the same time are the most readily pocketable, efficient and least expensive aerosol therapy devices available. When combined with add-on devices they are also the most versatile delivery system because they are well suited to a variety of patients and virtually any therapeutic task. With our improved understanding of the importance of drug targeting to the site of action, the most important aspects of the relationship between particle size and drug deposition throughout the lower respiratory tract are discussed. This review also looks at add-on devices and training issues related to the proper co-ordination of drug delivery with inhalation, and reports on new technology and non-ozone depleting propellants.