TY - JOUR T1 - Inhaled Medicines: Past, Present, and Future JF - Pharmacological Reviews JO - Pharmacol Rev SP - 48 LP - 118 DO - 10.1124/pharmrev.120.000108 VL - 74 IS - 1 AU - Sandra Anderson AU - Paul Atkins AU - Per Bäckman AU - David Cipolla AU - Andrew Clark AU - Evangelia Daviskas AU - Bernd Disse AU - Plamena Entcheva-Dimitrov AU - Rick Fuller AU - Igor Gonda AU - Hans Lundbäck AU - Bo Olsson AU - Jeffry Weers A2 - Page, Clive Y1 - 2022/01/01 UR - http://pharmrev.aspetjournals.org/content/74/1/48.abstract N2 - The purpose of this review is to summarize essential pharmacological, pharmaceutical, and clinical aspects in the field of orally inhaled therapies that may help scientists seeking to develop new products. After general comments on the rationale for inhaled therapies for respiratory disease, the focus is on products approved approximately over the last half a century. The organization of these sections reflects the key pharmacological categories. Products for asthma and chronic obstructive pulmonary disease include β-2 receptor agonists, muscarinic acetylcholine receptor antagonists, glucocorticosteroids, and cromones as well as their combinations. The antiviral and antibacterial inhaled products to treat respiratory tract infections are then presented. Two “mucoactive” products—dornase α and mannitol, which are both approved for patients with cystic fibrosis—are reviewed. These are followed by sections on inhaled prostacyclins for pulmonary arterial hypertension and the challenging field of aerosol surfactant inhalation delivery, especially for prematurely born infants on ventilation support. The approved products for systemic delivery via the lungs for diseases of the central nervous system and insulin for diabetes are also discussed. New technologies for drug delivery by inhalation are analyzed, with the emphasis on those that would likely yield significant improvements over the technologies in current use or would expand the range of drugs and diseases treatable by this route of administration.Significance Statement This review of the key aspects of approved orally inhaled drug products for a variety of respiratory diseases and for systemic administration should be helpful in making judicious decisions about the development of new or improved inhaled drugs. These aspects include the choices of the active ingredients, formulations, delivery systems suitable for the target patient populations, and, to some extent, meaningful safety and efficacy endpoints in clinical trials. ER -