title: Further experimentation of inhaled; LANTUS, ACTRAPID and HUMULIN with todays' production systems.
abstract: BACKGROUND
  Several aerosol production systems have been used for aerosol insulin production. However; since the first studies several new models of jet-nebulizers and ultrasound nebulizers have been introduced in the market.
  
  
  METHODS
  Three different models of jet-nebulizers (different brands, same properties) and three different ultrasound nebulizers (different brands, same properties). Six residual cups (2 small ≤ 6 ml and 3 large ≤ 8 ml) were used for the jet-nebulizers. The ultrasound nebulizers were used with their facemasks or with their inlets which were included in the purchase package.
  
  
  RESULTS
  Ultrasound nebulizers; LANTUS produces by far the lowest mean droplets (2.44) half the size of the other two drugs (4.43=4.97). GIMA nebulizer is the most efficient producing one third of the droplet size of SHIMED and one second of EASYNEB (2.06<3.15<6.62). Finally, the 4 ml loading concentration is more suitable for supporting the production of smaller droplets (3.65<4.24). Drugs and nebulizers act interactively yielding very large droplets when ACTRAPID and HUMULIN are administered in joint with SHIMED nebulizer (9.59=7.72). Jet-nebulizers; HUMULIN again is the least preferred insulin since it hardly reaches the low but equal performance of others at the loading level of 6 ml. Residual cups E and B produce uniquely lower mean droplets at loading level 6.
  
  
  CONCLUSIONS
  Ultrasound nebulizers; the best suggested combination should be LANTUS insulin, GIMA nebulizer administered at loading dose of 4 ml jet-nebulizers. A global review can give the best combination: the lowest mean droplets are produced when the drugs LANTUS (mostly) and ACTRAPID are administered, applying the SUNMIST nebulizer in concert with residual cup B at loading levels of 6 ml.
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany. Electronic address: pzarog@hotmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Petridis
authors.forename: Christos
authors.initials: C
authors.lastname: Ritzoulis
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Haidong
authors.initials: H
authors.lastname: Huang
authors.forename: Yunye
authors.initials: Y
authors.lastname: Ning
authors.forename: Kaid
authors.initials: K
authors.lastname: Darwiche
authors.forename: Lutz
authors.initials: L
authors.lastname: Freitag
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
mesh_terms: D000336:Aerosols / Q000737:chemistry*; D004867:Equipment Design / Q000295:instrumentation*; D007328:Insulin / Q000737:chemistry; D009330:Nebulizers and Vaporizers; D010316:Particle Size; D014465:Ultrasonics / Q000295:instrumentation*
chemical_list: D000336:Aerosols; D007328:Insulin
keywords: Actrapid (PubChem SID: 135350514); Aerosol insulin; Carboplatin (PubChem CID: 10339178); Cisplatin (PubChem CID: 84093); Docetaxel (PubChem CID: 148124); Doxorubicin (PubChem CID: 31703); Gemcitabine (PubChem CID: 60750); Humulin Regular (PubMed CID: 16129672); Jet-nebulizers; Lantus (PubChem CID: 44146714); Paclitaxel (PubChem CID: 36314); Tobramycin (PubChem CID: 36294); Ultrasound