By analogy with asthma, a disease that affects all airways, it has been presumed that the inhaled route of delivery is preferred for the treatment of patients with COPD. However, the disease process in COPD is predominantly in small airways and in the lung parenchyma, which may not be efficiently targeted by the inhalers designed to treat asthma. This may lead to the development of new inhaler devices with particles that have the optimal distribution for peripheral lung delivery. Furthermore, there is a strong argument in favour of oral drug delivery, in order to target lung parenchyma. A further approach is to develop cell-directed therapies. For example, alveolar macrophages appear to play a critical role in COPD and may be targeted by drugs that are designed to be engulfed by these cells, using specially designed liposomes or coated particles of drug. Much more research is needed to optimize drug delivery in COPD patients.
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