title: The devil's advocacy: when and why inhaled therapies for tuberculosis may not work.
abstract: Factors that are inimical to the success of inhaled therapies for tuberculosis (TB) include: (i) lack of access of inhaled therapies to poorly-aerated areas of the tubercular lung; (ii) limited ability to penetrate biofilms formed by extracellular bacilli; (iii) selection for resistant bacilli on account of administration of low doses of anti-TB agents; (iv) induction of inflammation and/or immunopathology in the airways and lungs; and (v) anomalies in antigen processing and presentation of vaccines delivered to the lungs. Further, the claim that inhaled therapies rescue alternatively-activated macrophages may not be applicable to all individuals. Fortunately, there are ways and means to address each of the above factors.
authors.affiliation: Pharmaceutics Division, Central Drug Research Institute, CSIR, Lucknow 226001, India.
authors.forename: Awadh Bihari
authors.initials: AB
authors.lastname: Yadav
authors.forename: Amit K
authors.initials: AK
authors.lastname: Singh
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Verma
authors.forename: Mradul
authors.initials: M
authors.lastname: Mohan
authors.forename: Atul K
authors.initials: AK
authors.lastname: Agrawal
authors.forename: Amit
authors.initials: A
authors.lastname: Misra
mesh_terms: D000280:Administration, Inhalation; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000494:pharmacology*; D018441:Biofilms; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000473:pathology; D008264:Macrophages / Q000187:drug effects; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000472:pathogenicity; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000995:Antitubercular Agents