急重疫病危機管理

The beginnings of lung-targeted therapies for treating respiratory tract and lung disease go back to Hippocrates, who suggested inhaling steam to improve cough symptoms. During the late 19th and well into the 20th century, patients were treated for a variety of lung diseases with saline aerosols in centers such as Bad Reichenhall between periods of programmed rest and exercise. Companies such as Bosch and Pari in Germany and DeVilbiss and others in the US developed compressor-driven electrical nebulizers. These were initially a "modern" replacement for "Grossmutters Dampftopf" (grandmother's steam kettle) since relatively little was known about particle size-deposition relationships or where aerosols went in the lungs. Indeed, into the early '60s, some pulmonologists from the tuberculosis era believed that aerosols' effect on the airways resulted from absorption from the buccal mucosa and, thus, systemic administration. A study by Dr. Richard Ruffin in the McMaster Medical Aerosol Lab showed that this was not the case by comparing the same dose of beta-agonist bronchodilator gargled and inhaled as an aerosol. There was very little science behind these early "treatments," which were mainly psychological and, at best, temporarily made the patient feel better. It was not until about 1956 that "modern" aerosol therapy began with the development of the pressurized metered-dose inhaler (pMDI), a brilliant concept that has stood the test of time with continued improvements, particularly with the banning of chlorofluorocarbons (CFCs) and their replacement by hydrofluorolkane (HFA) 134 and 227 that required a complete redesign and testing for Food and Drug Administration (FDA) approval. New applications were also discovered using the lung, not only for treating lung disease but also for needleless and rapid systemic administration of such medications as preprandial insulin for diabetes, nitroglycerine for angina, and ergotamine for migraine. It was evident that to complete the satisfactory, considerable input from aerosol physics, airway physiology, receptor sites for various effects, and standardization of scintigraphic aerosol distribution in the airways are necessary. The various centers that first became scientifically and clinically involved with aerosol medicine during the past 50 years and who were still led by their founders, or were no more than the 2nd "generation" from their founding, should each contribute a short "executive summary" encompassing the founding and development of their labs. Fortunately, most agreed and have contributed to this history. This course wishes to dip into its pages from time to time to see how aerosol medicine and science got its start and grew into healthy middle age.

Homework: 40%, Attendance: 10%, Presentation: 50%

1. Aerosol Technology 2nd., 1999 by W. Hinds 2. International Society for Aerosols in Medicine Textbook