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Inhaled insulin: A model for pulmonary systemic absorption? - 19/10/10

L’insuline par voie inhalée : un modèle pour l’absorption systémique pulmonaire ?

Doi : 10.1016/j.rmr.2010.04.004 
M.-H. Becquemin a, , J.-P. Chaumuzeau b
a UPRES 2397, faculté de médecine, université Denis-Diderot, Paris VII, groupe hospitalier Pitié-Salpétrière, 75013 Paris, France 
b Groupe aérosol thérapie, société de pneumologie de langue française, 75006 Paris, France 

Corresponding author. Service central d’explorations fonctionnelles respiratoires, groupe hospitalier Pitié-Salpétrière, 75651 Paris cedex 13, France.

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Summary

The European Union recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former, and both show the same intra-individual variability. The total bioavailability is definitely lower with the inhaled route but is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies, and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term innocuousness of repeated inhalation of such a mitogen, especially in children and former smokers, remains to be fully proven.

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Keywords : Insulin, Nebulisation, Pulmonary absorption


Plan


 To cite the present paper, use exclusively the following reference: Becquemin MH, Chaumuzeau JP. L’insuline par voie inhalée : un modèle pour l’absorption systémique pulmonaire ? (full text in English on rmr). Rev Mal Respir 2008;25:209–22. Doi: RMR-02-2008-25-2-01761-8425-101019-200802951.


© 2010  SPLF. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 27 - N° 8

P. e54-e65 - octobre 2010 Retour au numéro
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