This will also open up opportunities to reduce the duration of treatment in both drug susceptible and drug resistant TB. It is also likely to result in better treatment compliance versus injectables and/or oral therapy.
Inhalers are easy to store and transport without refrigeration. They are easier to administer as compared to injections and thereby reduce the work burden on the resource strapped and understaffed health delivery systems. This would be especially advantageous in high burden and resource limited settings. Lastly and most importantly, the inhalation therapy has the potential to use existing treatment regimens that are already approved by the WHO to have anti-mycobacterial activity, but which cannot be given systematically due to high toxicity.
In perspective
Professor Bernard Fourie, Professor in Medical Microbiology at the University of Pretoria, with the help of others, has already initiated consultations with the parties that will engage with the end product. He shared that in establishing whether health care staff and patients are ready for inhaled anti-TB drugs, over 92% of patients noted that they would be comfortable using an inhaler and 84% found it easy to use, with indications that it will help in administration of medication in elderly patients too.
Although there are no major foreseeable barriers (medical or cultural) to this product adoption, 22% respondents did voice concerns about durability in repeated use of the inhaler and 26% queried about the safety and hygiene of the procedure.however, let us not forget that patients with asthma have used inhalers for a very long time now and certainly with the similarities, lessons can be drawn to ensure safety and hygiene in case of anti TB inhalers.
Areas to consider in the inhaled drug therapy for TB would be:
- Prophylactic inhalers for high risk populations, including persons working in active TB hot spots, for treatment of latent TB rather than wait for active TB development. Low dosage drugs introduced in the airway may target quick absorption and minimal toxicity.
- Investigation of lung toxicity and airway sensitivity as a conduit for potentially toxic and high dose TB drugs.
- Positive impact of the therapy on the high rate of comorbidities that TB has and its linkages with other conditions like HIV, diabetes, smoking, etc. Already, these conditions have some drugs that adversely interact with TB drugs and if not, they add to the toxicity and pill burden.
- Inter-tracheal administration of TB medication may only offer protection for pulmonary TB and not extra-pulmonary TB.
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