title: Acute passive cigarette smoke exposure and inhaled human insulin (Exubera) pharmacokinetics.
abstract: BACKGROUND
  Active cigarette smoking is associated with increased permeability of the pulmonary alveolar epithelium, resulting in faster absorption of inhaled drugs such as Exubera (EXU). Absorption of EXU is increased approximately twice to four times as much in chronic smokers compared with nonsmokers. The rate of clearance of radioaerosols such as technetium-labelled diethylenetriamine penta-acetic acid is decreased in response to passive smoke exposure.
  
  
  CONCLUSIONS
  Passive smoke exposure causes a decrease in lung permeability, an effect opposite to that of active smoking. Acute passive smoke exposure results in a decrease in EXU bioavailability and does not create a risk of hypoglycaemia. These results are consistent with previous studies of radioaerosol lung clearance. AIMS Relative to nonsmokers, the bioavailability of inhaled human insulin (Exubera(R); EXU) is markedly increased in chronic smokers. The pharmacokinetics of EXU following passive cigarette smoke exposure is unknown. METHODS In an open-label, crossover study, healthy nonsmoking volunteers received two treatments in randomized sequence separated by a 2-week wash-out: (i) EXU 3 mg with no passive smoke exposure and (ii) EXU 3 mg after passive smoke exposure (atmospheric nicotine levels 75-125 mug m(-3)) for 2 h. Blood samples were obtained at prespecified times up to 6 h after EXU administration.
  
  
  RESULTS
  Twenty-seven subjects completed both study periods. Mean plasma insulin AUC(0-360) decreased by 17% [ratio 83%, 95% confidence interval (CI) 68.8, 99.5] and mean C(max) by 29% (ratio 71%, 95% CI 59.8, 83.1) after passive cigarette smoke exposure. The median (range) t(max) was 60 min (20-120 min) and 75 min (20-360 min) in the EXU with no exposure and EXU passive exposure groups, respectively. EXU was well tolerated.
  
  
  CONCLUSIONS
  Unlike active chronic smoking, acute passive cigarette smoke exposure modestly decreases EXU bioavailability and thus should not increase hypoglycaemia risk. These results are consistent with those from published literature involving technetium-labelled diethylenetriamine penta-acetic acid and suggest that passive cigarette smoke exposure causes an acute decrease in lung permeability vs. active smoking, which causes an increase in permeability.
authors.affiliation: Pfizer Global Research and Development, Groton, CT and Environmental Medicine Incorporated, Westwood, NJ, USA. robert.j.fountaine@pfizer.com
authors.forename: Robert
authors.initials: R
authors.lastname: Fountaine
authors.forename: Ashley
authors.initials: A
authors.lastname: Milton
authors.forename: Tina
authors.initials: T
authors.lastname: Checchio
authors.forename: Greg
authors.initials: G
authors.lastname: Wei
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stolar
authors.forename: John
authors.initials: J
authors.lastname: Teeter
authors.forename: Rudolph
authors.initials: R
authors.lastname: Jaeger
authors.forename: David
authors.initials: D
authors.lastname: Fryburg
mesh_terms: D000042:Absorption / Q000502:physiology; D000280:Administration, Inhalation; D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D007328:Insulin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D014026:Nicotiana; D014028:Tobacco Smoke Pollution
chemical_list: D001786:Blood Glucose; C473734:Exubera; D007004:Hypoglycemic Agents; D007328:Insulin; D014028:Tobacco Smoke Pollution