A few weeks ago, our updated review on the state of drug development in Idiopathic Pulmonary Fibrosis (IPF) was published in Drug Discovery Today. This update highlights the untapped potential of inhaled drug delivery in the treatment of IPF, a disease with poor prognosis and limited treatment options. It’s worth contrasting this therapeutic scenario with that of asthma, where multiple effective therapies—many delivered by inhalation—have been available for decades. Despite this abundance, challenges persist, as successful asthma management depends heavily on proper inhaler use.
This challenge was particularly emphasized in the European Respiratory Society (ERS) meeting back in September, during a session called “Inhaler Technique – Actually Making a Difference.” Misuse of inhalers in asthma and COPD is associated with poor control and significant healthcare costs, reminding us that efficient inhalation technique is key to achieving optimal therapeutic outcomes.
Learning from Asthma: Implications for IPF Inhalation Therapies
So, what can asthma’s experience with inhaled delivery teach us about managing IPF? Notably, the major inhaler errors in asthma are linked to devices like Dry Powder Inhalers (DPIs) that require “quick and deep” inhalation, and Pressurised Metered-Dose Inhalers (pMDIs), which demand coordination and “slow and steady” breathing techniques.
In contrast, AP01, the most advanced inhaled agent currently in development for IPF, comes with a simpler delivery method. Using nebulisation, AP01 requires normal tidal breathing over several minutes and is therefore less dependent on patient technique or coordination. As inhaled therapies evolve for IPF, particularly as more sophisticated devices like DPIs come into play, lessons from asthma’s experience will be critical—including the need for focused training and patient adherence.
Mitigating Systemic Side Effects: A Shared Challenge
A key advantage of inhaled therapies is the reduction of systemic drug exposure and the accompanying side effects—a major reason for the success of inhaled corticosteroids (ICS) in asthma. However, a session at the ERS meeting, “Clinical and Biological Outcomes in Asthma,” illustrated that high doses of inhaled corticosteroids can still be linked to systemic side effects, even when locally administered to the lungs.
As clinical data in IPF builds with the increasing use of inhaled agents, it’s possible that the same challenges may arise. Still, with AP01 being a repurposed inhaled formulation of pirfenidone, the systemic side effect profile of the oral version is already well understood and can be closely monitored. This could provide a smoother pathway to clinical adoption, but careful study is needed for future innovations.
Anticipating the Future of IPF Inhalation Therapies
The experiences and lessons gathered from decades of asthma treatment create a critical foundation for the next generation of inhalation therapies in IPF. Patient adherence, training, and advanced device designs will be essential as more inhaled options are developed. Combining this historical insight with a deep understanding of IPF’s unique challenges will help realize the tremendous therapeutic potential inhaled therapies offer for patients battling this life-threatening disease.