Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics
Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics
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DOI：
10.1177/0194599817742126
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发表时间：
2018-03-01
影响因子：
3.4
通讯作者：
Kimbell, Julia S.
中科院分区：
文献类型：
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作者：
Perkins, Elizabeth L.;Basu, Saikat;Kimbell, Julia S.
目的声带肉芽肿是喉的良性病变，通常由胃食管反流、插管和声部损伤引起。目前的医学治疗包括吸入皮质类固醇靶向炎症导致肉芽肿的形成。常用吸入器的颗粒大小范围在1到4 μ m之间。研究目的是利用计算流体动力学来研究针对喉部和声带肉芽肿的吸入皮质类固醇颗粒大小范围内的沉积模式。研究设计：回顾性、特定病例的计算研究。三级学术中心设置。对象/方法通过3次计算机断层扫描，建立了正常成人从口腔到气管的三维解剖学模型。不同大小和位置的虚拟肉芽肿沿声带被纳入基础模型。假设稳态、吸气、湍流气流速度为30 L/min，采用计算流体动力学方法模拟吸入1 ~ 20 μ m的皮质类固醇颗粒的呼吸运输和沉积。结果在基本模型中，粒径为8 ~ 10 μ m（2.8% ~ 3.5%）的颗粒喉部沉积达到峰值。小、中、大肉芽肿的理想尺寸分别为6 ~ 10 μ m、7 ~ 13 μ m和7 ~ 14 μ m。后部大肉芽肿9 μ m颗粒声门沉积最大，为10.8%，是正常模型（3.5%）的3倍。结论随着虚拟肉芽肿大小的增大和位置的后移，声门沉积和理想颗粒大小普遍增大。本初步研究提示较大粒径吸入器如丙酸氟替卡松干粉吸入器可改善喉部药物沉积。大多数市售吸入器的颗粒比这里建议的要小。
Objectives Vocal fold granulomas are benign lesions of the larynx commonly caused by gastroesophageal reflux, intubation, and phonotrauma. Current medical therapy includes inhaled corticosteroids to target inflammation that leads to granuloma formation. Particle sizes of commonly prescribed inhalers range over 1 to 4 mu m. The study objective was to use computational fluid dynamics to investigate deposition patterns over a range of particle sizes of inhaled corticosteroids targeting the larynx and vocal fold granulomas.Study Design Retrospective, case-specific computational study.Setting Tertiary academic center.Subjects/Methods A 3-dimensional anatomically realistic computational model of a normal adult airway from mouth to trachea was constructed from 3 computed tomography scans. Virtual granulomas of varying sizes and positions along the vocal fold were incorporated into the base model. Assuming steady-state, inspiratory, turbulent airflow at 30 L/min, computational fluid dynamics was used to simulate respiratory transport and deposition of inhaled corticosteroid particles ranging over 1 to 20 mu m.Results Laryngeal deposition in the base model peaked for particle sizes 8 to 10 mu m (2.8%-3.5%). Ideal sizes ranged over 6 to 10, 7 to 13, and 7 to 14 mu m for small, medium, and large granuloma sizes, respectively. Glottic deposition was maximal at 10.8% for 9-mu m-sized particles for the large posterior granuloma, 3 times the normal model (3.5%).Conclusion As the virtual granuloma size increased and the location became more posterior, glottic deposition and ideal particle size generally increased. This preliminary study suggests that inhalers with larger particle sizes, such as fluticasone propionate dry-powder inhaler, may improve laryngeal drug deposition. Most commercially available inhalers have smaller particles than suggested here.