Devices for aerosol delivery to treat sinusitis.

Compared to research into aerosolized delivery of drugs to treat lung disease, research into nasal delivery of aerosolized drugs to treat sinusitis has been significantly neglected. This is despite the fact that more individuals suffer from sinusitis in the United States than suffer from asthma, and its consequences lead to considerable amounts of discomfort, lost work days, and money spent on health care. A number of studies have shown that a high proportion of aerosolized medications delivered by metered dose inhalers (MDIs) and aqueous spray devices deposits in the anterior one-third of the nasal cavity. However, the important targets for treating sinusitis lie beyond this region. These include the middle meatus, the superior and posterior regions of the nasal cavity and the sinuses themselves. This review examines the particle-related and device-related factors that are known to improve intranasal delivery of aerosolized medications to these targets and their efficacy in patients with disease. Based on this review, it is recommended that companies that are interested in improving aerosol delivery to treat sinusitis utilize both in vivo imaging modalities and in vitro models of the nasal cavity and sinuses to assess intranasal aerosol delivery and device performance during the development stage. Once device design has been optimized, it is recommended that device manufacturers and pharmaceutical companies move beyond the current reliance on anecdotal reporting and uncontrolled studies to clinical trials that are randomized and placebo-controlled and that quantify changes both in symptoms and in functional parameters to determine drug efficacy with their device.