Ligament/tendon tissue engineering has the potential to provide therapies that overcome the limitations of incomplete natural healing responses and inadequate graft materials. While ligament/tendon fibroblasts are an obvious choice of cell type for these applications, difficulties associated with finding a suitable cell source have limited their utility. Mesenchymal stem cells/marrow stromal cells (MSCs) are seen as a viable alternative since they can be harvested through routine medical procedures and can be differentiated toward a ligament/tendon fibroblast lineage. Further study is needed to create an optimal biomaterial/biomechanical environment for ligament/tendon fibroblastic differentiation of MSCs. The overall goal of this dissertation was to improve the understanding of the role that biomechanical stimulation and the biomaterial environment play, both independently and combined, on human MSC (hMSC) differentiation toward a ligament/tendon fibroblast phenotype. Specifically, the effects of cyclic tensile stimuli were studied in a biomaterial environment that provided controlled presentation of biological moieties. The influence of an enzymatically-degradable biomaterial environment on hMSC differentiation was investigated by creating biomaterials containing enzymatically-cleavable moieties. The role that preculture may play in tensile responses of hMSCs was also explored. Together, these studies provided insights into the contributions of the biomaterial and biomechanical environment to hMSC differentiation toward a ligament/tendon fibroblast phenotype.

The present work aimed at assessing the dose emission and aerodynamic particle size characteristics of formoterol fumarate from Atimos Modullite, a metered dose inhaler (MDI) and Foradil Aeroliser, Easyhaler, and Oxis Turbuhaler dry powder inhalers (DPI) at different inhalation flow rates and volumes using in vitro methodology. Recognised methods have been adopted and validated to generate the results. The in vitro characteristics of formoterol were measured according to standard pharmacopeial methodology with adaptation to simulate routine patient use. The dose emission from the Atimos Modulite was determined using inhalation volumes of 4 and 2 L and inhalation flows of 10, 28.3, 60, and 90 L/min. The %nominal dose emitted was consistent between the various flow rates and inhalation volumes of 4 and 2L. The particle size distribution was measured using an Anderson Cascade Impactor (ACI) combined with a mixing inlet valve to measure particle size distribution at inhalation flow rates below 30 L/min. The particle size distribution of formoterol from Atimos Modulite was measured using inhalation flows of 15, 28.3, 50, and 60 L/min with and without different spacers, Aerochamber and Volumatic. The mean fine particle dose (%nominal dose) through an Atimos without spacer were 53.52% (2.51), 54.1% (0.79), 53.37% (0.81), 50.43% (1.92) compared to Aerochamber 63.62% (0.44), 63.86% (0.72), 64.72% (0.47), 59.96% (1.97) and Volumatic 62.40% (0.28),63.41% (0.52), 64.71% (0.61), 58.43% (0.73), respectively. A small decrease in the fine particle dose was observed as the inhalation flow increased, but this was not significant. The respective mean mass aerodynamic diameter (MMAD) increased as the flow rate was increased from 15 of 60 L/min. Results also suggests that the use of spacers provides better lung deposition for patients with problems using MDI. The dose emission from the Foradil Aeroliser was determined using inhalation volumes of 4 and 2 L, at inhalation flows of 10, 15, 20, 28.3, 60, and 90 L/min plus two inhalations per single dose. The %nominal dose emitted using 2 L inhalation volume was approximately half when compared to results obtained using inhalation volume of 4 L. A significantly (p<0.001) higher amount of drug was also emitted from Easyhaler® at inhalation volume of 4 L through flow rates of 10, 20, 28.3, 40, and 60 L/min compared 2 L. Similar results were observed through Oxis Turbuhaler at inhalation flow rates of 10, 20, 28.3, 40, and 60 L/min. Comparative studies were also carried out to evaluate the particle size distribution of formoterol through the DPIs. The nominal fine particle dose through Aeroliser using inhalation flows of 10, 20, 28.3, 60 and 90 L/min were 9.23%, 14.70 %, 21.37%, 28.93%, and 39.70% for the 4 L and 4.17%, 5.55%, 7.28%, 8.41%, and 11.08% for the 2 L, respectively. The respective MMAD significantly (p<0.001) decreased with increasing flow rates. Aeroliser performance showed significant (p<0.001) increase in the % nominal fine particle dose for two inhalations compared to one inhalation at both 4 and 2 L. The Easyhaler was measured using inhalation flows of 10, 20, 28.3, 40, 60 L/min. The nominal fine particle dose were 19.03%, 27.09%, 36.89%, 49.71% and 49.25% for the 4 L and 9.14%, 15.44%, 21.02%, 29.41%, 29.14% for the 2 L, respectively. The respective MMAD significantly (p<0.001) decreased with increasing flow rates. Easyhaler performance at both 4 and 2 L showed no significant differences between one and two inhalations at low flow rates (10, 20, 28.3), but this was significant (p<0.05) at higher flow rates (40 and 60 L/min). The Oxis Turbuhaler was also measured using inhalation flows of 10, 20, 28.3, 40, 60 L/min. The nominal fine particle dose were 12.87%, 24.51%, 28.25%, 34.61%, 40.53% for the 4 L and 8.55%, 15.31%, 21.36%, 19.53%, 22.31% for the 2 L, respectively. Turbuhaler performance showed significant (p<0.05) differences between one and two inhalations at varying flow rates 2 L inhalation volumes, but not at 4 L. The use of Foradil Aeroliser delivers small particles as the Oxis Turbuhaler using two inhalations hence delivering formoterol deep into the lungs. Also, this thesis shows that high flow resistance of Turbuhaler will indeed influence the ability of patients with severe asthma or children to use the system. Beside, Easyhaler produced the highest drug delivery to the lungs, thus, making it a more desirable system to use, especially for children and asthma sufferers.

Background: The high prevalence of iron deficiency and anaemia among South African children highlights the need for iron fortification, especially with a highly bioavailable iron compound. Fortification of staple foods is an adequate strategy to provide additional iron to populations at risk. In South Africa it is mandatory to fortify maize meal and wheat flour with iron, as well as other micronutrients. Elemental iron, specifically electrolytic iron, is currently the preferred choice but other compounds that might be more effective in alleviating iron deficiency are under consideration. Objectives: The objective of this study was to provide information about the bioavailability of ferrous fumarate and NaFeEDTA from maize meal porridge in young children, which would assist in selecting a bioavailable alternative to electrolytic iron in the South African National Food Fortification Programme, Methods: A randomized parallel study design was used, with each of the 2 groups further randomised to receive either one of two test regimens in a crossover design in which each child acted as his/her own control. Iron bioavailability was measured with a stable-isotope technique based on erythrocyte incorporation 15 days after intake. Results: The mean absorption of iron from NaFeEDTA and ferrous fumarate from the maize porridge meal was 11.5% and 9.29% respectively. NaFeEDTA and ferrous fumarate are both sufficiently bioavailable from a maize based meal rich in phytates. Conclusion: Both NaFeEDTA and ferrous fumarate would provide a physiologically important amount of iron should they replace electrolytic iron as fortificant in maize flour fortification. The final choice between ferrous fumarate and NaFeEDTA as when it comes to finding the alternative iron fortificant will depend on factors such as technical compatibility, bioavailability, relative cost and organoleptic characteristics. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Background: The high prevalence of iron deficiency and anaemia among South African children highlights the need for iron fortification, especially with a highly bioavailable iron compound. Fortification of staple foods is an adequate strategy to provide additional iron to populations at risk. In South Africa it is mandatory to fortify maize meal and wheat flour with iron, as well as other micronutrients. Elemental iron, specifically electrolytic iron, is currently the preferred choice but other compounds that might be more effective in alleviating iron deficiency are under consideration. Objectives: The objective of this study was to provide information about the bioavailability of ferrous fumarate and NaFeEDTA from maize meal porridge in young children, which would assist in selecting a bioavailable alternative to electrolytic iron in the South African National Food Fortification Programme, Methods: A randomized parallel study design was used, with each of the 2 groups further randomised to receive either one of two test regimens in a crossover design in which each child acted as his/her own control. Iron bioavailability was measured with a stable-isotope technique based on erythrocyte incorporation 15 days after intake. Results: The mean absorption of iron from NaFeEDTA and ferrous fumarate from the maize porridge meal was 11.5% and 9.29% respectively. NaFeEDTA and ferrous fumarate are both sufficiently bioavailable from a maize based meal rich in phytates. Conclusion: Both NaFeEDTA and ferrous fumarate would provide a physiologically important amount of iron should they replace electrolytic iron as fortificant in maize flour fortification. The final choice between ferrous fumarate and NaFeEDTA as when it comes to finding the alternative iron fortificant will depend on factors such as technical compatibility, bioavailability, relative cost and organoleptic characteristics. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Orientador: Alexandrina Sartori / Resumo: A Esclerose múltipla é uma doença autoimune degenerativa que acomete jovens adultos, causando danos neuroaxonais e áreas de desmielinização no sistema nervoso central (SNC) devido a uma resposta autoimune mediada por linfócitos Th1, Th17 e T citotóxicos. A encefalomielite autoimune experimental (EAE) constitui seu principal modelo de estudo e mastócitos parecem contribuir para os processos inflamatórios envolvidos na patogênese da EM/EAE. Seguindo este raciocínio, substâncias estabilizadoras de mastócitos, como o fumarato de cetotifeno, poderiam afetar o desenvolvimento destas doenças através do bloqueio dos processos de exocitose e desgranulação. O objetivo principal deste trabalho foi avaliar o efeito desta droga no desenvolvimento da EAE. Para isto, camundongos C57BL/6 fêmeas submetidas à indução da EAE através da imunização com MOG/CFA e injeção de toxina pertussis, foram tratados com fumarato de cetotifeno (0,4 mg/kg via intraperitoneal) durante 11 dias, a partir do 7º dia após a indução. O efeito do tratamento no desenvolvimento clínico da EAE foi determinado pela avaliação de peso corporal e escore clínico. Posteriormente, parâmetros histopatológicos e imunológicos associados à doença, bem como a quebra da função da barreira hematoencefálica (BHE) foram avaliados. As comparações dos valores de incidência, escores clínicos diários e máximos, e de variação de peso corpóreo revelaram que o tratamento com cetotifeno reduziu a incidência e a gravidade da EAE. Este efeito pr... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Magister Scientiae - MSc (Pharmaceutical Chemistry) / The rapid increase in access to new antiretrovirals (ARVs) worldwide and, especially in sub-Saharan Africa, coupled with the well-documented problem of poor quality ARVs in developing countries has underscored the need for quality assessment of these medicines. South Africa has the worst human immunodeficiency virus (HIV) epidemic profile in the world; consequently, it has rolled out the world's largest antiretroviral ARV programme. With increasing market penetration of generic medicine in South Africa and especially ARVs, there is a call for stringent quality control mechanisms following the marketing approval (post-market quality control) of these medications. Unfortunately, evidence suggests that the World Health Organisation (WHO) recommendations for this aspect of quality assurance is not met by most Medicine Regulatory Authorities. In South Africa and many other countries this is attributed to a lack of physical and financial resources to enforce effective post-marketing surveillance (PMS) of all pharmaceuticals available in the country.

Leishmania é um protozoário parasito flagelado responsável pelas Leishmanioses, classificadas como doenças negligenciadas, que causam um risco a 350 milhões de pessoas em todo o mundo. As fumarato hidratases (FHs) são enzimas que catalisam a hidratação reversível da molécula de fumarato em S-malato e estudos recentes em tripanosomatídeos, utilizando Trypanosoma brucei como modelo, apontam essas enzimas como potenciais alvos para o planejamento de compostos com ação tripanossomicida e leishmanicida. O presente trabalho visou à caracterização funcional e estrutural das enzimas fumarato hidratase de Leishmania major através da determinação da estrutura por técnicas de difração de raios-X em monocristais, aliadas a técnicas espectroscópicas, de mutagênese sítio dirigida e simulação de dinâmica molecular. A susceptibilidade dessa classe de enzimas ao oxigênio devido a presença de um complexo do tipo [4Fe-4S] exigiu a utilização de técnicas modernas para a realização dos experimentos em condição de anaerobiose. A estrutura da isoforma citosólica da FH em L. major (LmFH-2) foi determinada por técnicas de difração de raios-X em monocristais e consiste na primeira estrutura de uma proteína da classe I das FHs a ser determinada. O enovelamento de LmFH-2 foi descrito como novo e consiste em uma proteína dimérica na qual cada monômero apresenta dois domínios denominados domínios N- e C- terminais, que possuem grande mobilidade entre si. A análise das estruturas cristalográficas de LmFH-2 em complexo com o substrato malato e os inibidores malonato e succinato, associada aos estudos de dinâmica molecular, nos permitiu propor que a mobilidade entre os domínios está associada à entrada do substrato no sítio ativo. Os dados estruturais corroborados pelos dados espectroscópicos e bioquímicos foram utilizados para mapear o sítio ativo e construirmos um modelo para descrever o mecanismo de ação enzimática adotado por essa classe de enzimas. Na tentativa de dar ínicio à validação do nosso modelo, o resíduo conservado Thr467, pertencente ao sítio ativo da LmFH-2 e identificado como importante na interação com o substrato, teve seu papel catalítico avaliado através da combinação de técnicas de mutação sítio-dirigida associada a estudos cinéticos e estruturais. A perda significativa na atividade da proteína mutante LmFH-2-T467A fortaleceu nossas hipóteses de que a Thr467 poderia atuar como ácido ou base no mecanismo RESUMO | II de ação das FHs da classe I. Os resultados obtidos nesse trabalho nos fornecerão as bases estruturais para o mapeamento acerca do mecanismo catalítico adotado pelas enzimas fumarato hidratase da classe I, assim como, para o planejamento de ligantes específicos como uma importante ferramenta na avaliação do potencial desta classe de enzimas como alvo para o desenvolvimento de novas terapias contra a Leishmaniose. / Leishmania parasites are the casual agent of leishamaniasis, classified as neglected tropical diseases, with 350 million people at risk of infection. Fumarate hydratases (FH) are enzymes that catalyze the stereospecific reversible hydratation of fumarate to S-malate and recent studies in trypanosomatids, using Trypanosoma brucei as a model suggest that the fumarate hydratase enzymes are essential for the parasite survival and should be exploited as potential targets for the development of new therapies against trypanosomatid related diseases. The present work focused the functional and structural characterization of both fumarate hydratase enzymes from Leishmania major by a combination of crystallographic, spectroscopic, site-direct mutagenesis and molecular dynamics techniques. The susceptibility to oxygen observed for this class of proteins due to the presence of a [4Fe-4S] cluster required the use of state-of-art infrastructure to perform the experiments under anaerobic environment. The structure of LmFH-2 has been determined by X-ray diffraction techniques and consists of the first class I FH structure to be reported. LmFH-2 folding has been found to be unique and consists of a dimer with each monomer composed of two major domains named N- and C-terminal domains. The analysis of the crystallographic structure of LmFH-2 in complex with the substrate malate and with both inhibitors malonate and succinate has allowed us to propose that the movement observed between both N- and C-domains is associated to the entrance of the substrate into the active site. The structural data corroborated with biochemical and spectroscopic studies have been used to map the active site and to build a model to describe the mechanism of action adopted by this class of enzymes. As our first attempt to validate our model, the residue Thr467 that belongs to the active site and has been identified as important in the interaction with the substrate, had its catalytic role evaluated by site-direct mutagenesis in combination with kinetic and structural studies. The significant loss in activity observed for the mutant LmFH-2-T467A supports our hypothesis that Thr467 can act as either acid or base during catalysis. Our results have provided the structural basis for the complete mapping of the catalytic mechanism adopted by fumarate hydratase enzymes, as well as for the design of specific ligands as an important tool for evaluating FHs as drug targets in development of new therapies against Leishmaniasis.

Trypanosoma cruzi é um protozoário flagelado que ao infectar seres humanos causa a doença de Chagas, uma doença tropical negligenciada que afeta milhões de pessoas no mundo todo. As fumarato hidratases (FH), ou fumarases, são enzimas que catalisam a reação estéreo-específica reversível de hidratação do fumarato em S-malato, e foram recentemente consideradas essenciais para a viabilidade do parasito Trypanosoma brucei, sugerindo seu potencial como alvo macromolecular para o desenvolvimento de novos fármacos tripanocidas. O presente trabalho visou à caracterização funcional, bioquímica, biofísica e estrutural das fumarases de T. cruzi (TcFHs) e humana (HsFH) de forma a avaliar o papel das TcFHs para o parasito Trypanosoma cruzi, mapear o mecanismo de ação e identificar as diferenças entre TcFHs e a enzima humana de forma a serem exploradas no planejamento de inibidores seletivos às fumarases do parasito. Análise das sequências mostrou que TcFHs pertencem à classe I das fumarases (enzimas diméricas dependentes de ferro) e não são homólogas à HsFH que pertence a classe II (tetraméricas independentes de ferro). Estudos de localização celular confirmaram a existência de duas fumarases em T. cruzi, uma citosólica (TcFHc) e uma mitocondrial (TcFHm), e experimentos de nocaute gênico sugeriram que essas enzimas são essências para o parasito. A caracterização cinética das enzimas TcFHc, TcFHm e HsFH mostrou que as fumarases de T. cruzi são sensíveis ao oxigênio enquanto a enzima humana se mantém ativa em condições aeróbicas. Estudos de ressonância eletrônica paramagnética mostraram a presença de um cluster de ferro-enxofre, sensível a oxidação por oxigênio, envolvido no mecanismo enzimático das enzimas TcFHs. Modelos estruturais das TcFHs, construídos por homologia à estrutura cristalográfica da fumarase de Leishmania major, foram comparados à estrutura cristalográfica obtida para a fumarase humana e as diferenças entre as duas estruturas foram utilizadas no planejamento de ligantes seletivos às fumarases do parasito. O ligante planejado inibiu a fumarase citosólica de T. cruzi na faixa de 1 ?M e não apresentou efeito na atividade da enzima humana. Testes in vivo demonstraram o efeito tripanocida do inibidor provavelmente por interferir na produção de ATP pela mitocôndria do T. cruzi. Os resultados obtidos com o desenvolvimento desse projeto apresentam uma proposta inovadora no desenvolvimento de novas terapias contra a doença de Chagas, o uso da enzima fumarase como alvo macromolecular, assim como apresenta um inibidor potente e seletivo para a enzima do parasito a ser utilizado como protótipo no desenvolvimento de fármacos contra Trypanosoma cruzi. A síntese de moléculas análogas ao inibidor de forma a melhorar suas propriedades farmacológicas encontra-se em andamento / Trypanosoma cruzi is a flagellate protozoan parasite that infects humans and causes Chagas disease, a tropical neglected disease that affects millions of people worldwide. Fumarate hydratases (FH), or fumarases, are enzymes responsible for the reversible stereo-specific hydration of fumarate into S-malate, and were recently considered to be essential to Trypanosoma brucei viability, suggesting, therefore, a potential role for FHs as macromolecular targets to the drug development against trypanosomatids. The present work focused on the functional, biochemical, biophysical and structural characterization of T. cruzi fumarases (TcFHs) and human fumarase (HsFH) to evaluate TcFHs role for T. cruzi, map the reaction mechanism and identify and exploit differences between the parasite and host enzymes in order to design selective inhibitors to the parasite enzyme. Sequence analysis revealed that TcFHs belong to class I fumarases (dimeric and iron-sulfur containing enzymes) and are not homologous to HsFH which belongs to class II fumarases (tetrameric iron independent enzymes). Cellular sub-localization studies confirmed the presence of a cytosolic and a mitochondrial fumarases in T. cruzi and gene knockout experiments suggested TcFHs are essential to the parasite. The kinetic characterization showed that TcFHs activity is highly sensitive to oxygen whereas HsFH activity remained stable in aerobic conditions. Electron paramagnetic experiments further revealed the presence of an iron-sulfur cluster highly sensitive to oxidation and involved in the catalytic mechanism in both TcFHm and TcFHc. TcFHs structural models, built by homology modeling using the Leishmania major fumarase crystal structure as template, were compared to the HsFH crystal structure and the differences were used to design a selective ligand to the parasite fumarases. The designed ligand showed to inhibit TcFHc with an IC50 of 1 ?M and showed no effect on the human fumarase activity. In vivo assays using T. cruzi epimastigotes demonstrated the trypanocidal effect of the designed inhibitor probably caused by stalling ATP production. The results obtained with the development of this project represent an innovative proposal on the development of new therapies against Chagas disease, the use of fumarase enzyme as a macromolecular target, as well as present a potent and selective inhibitor to the parasite enzyme to be further used as a prototype in the development of drugs against Chagas disease. The synthesis of inhibitor analogues with optimized pharmacological properties are currently in progress.

The present work aimed at assessing the dose emission and aerodynamic particle size characteristics of formoterol fumarate from Atimos Modullite, a metered dose inhaler (MDI) and Foradil Aeroliser, Easyhaler, and Oxis Turbuhaler dry powder inhalers (DPI) at different inhalation flow rates and volumes using in vitro methodology. Recognised methods have been adopted and validated to generate the results. The in vitro characteristics of formoterol were measured according to standard pharmacopeial methodology with adaptation to simulate routine patient use. The dose emission from the Atimos Modulite was determined using inhalation volumes of 4 and 2 L and inhalation flows of 10, 28.3, 60, and 90 L/min. The %nominal dose emitted was consistent between the various flow rates and inhalation volumes of 4 and 2L. The particle size distribution was measured using an Anderson Cascade Impactor (ACI) combined with a mixing inlet valve to measure particle size distribution at inhalation flow rates below 30 L/min. The particle size distribution of formoterol from Atimos Modulite was measured using inhalation flows of 15, 28.3, 50, and 60 L/min with and without different spacers, Aerochamber and Volumatic. The mean fine particle dose (%nominal dose) through an Atimos without spacer were 53.52% (2.51), 54.1% (0.79), 53.37% (0.81), 50.43% (1.92) compared to Aerochamber 63.62% (0.44), 63.86% (0.72), 64.72% (0.47), 59.96% (1.97) and Volumatic 62.40% (0.28),63.41% (0.52), 64.71% (0.61), 58.43% (0.73), respectively. A small decrease in the fine particle dose was observed as the inhalation flow increased, but this was not significant. The respective mean mass aerodynamic diameter (MMAD) increased as the flow rate was increased from 15 of 60 L/min. Results also suggests that the use of spacers provides better lung deposition for patients with problems using MDI. The dose emission from the Foradil Aeroliser was determined using inhalation volumes of 4 and 2 L, at inhalation flows of 10, 15, 20, 28.3, 60, and 90 L/min plus two inhalations per single dose. The %nominal dose emitted using 2 L inhalation volume was approximately half when compared to results obtained using inhalation volume of 4 L. A significantly (p<0.001) higher amount of drug was also emitted from Easyhaler® at inhalation volume of 4 L through flow rates of 10, 20, 28.3, 40, and 60 L/min compared 2 L. Similar results were observed through Oxis Turbuhaler at inhalation flow rates of 10, 20, 28.3, 40, and 60 L/min. Comparative studies were also carried out to evaluate the particle size distribution of formoterol through the DPIs. The nominal fine particle dose through Aeroliser using inhalation flows of 10, 20, 28.3, 60 and 90 L/min were 9.23%, 14.70 %, 21.37%, 28.93%, and 39.70% for the 4 L and 4.17%, 5.55%, 7.28%, 8.41%, and 11.08% for the 2 L, respectively. The respective MMAD significantly (p<0.001) decreased with increasing flow rates. Aeroliser performance showed significant (p<0.001) increase in the % nominal fine particle dose for two inhalations compared to one inhalation at both 4 and 2 L. The Easyhaler was measured using inhalation flows of 10, 20, 28.3, 40, 60 L/min. The nominal fine particle dose were 19.03%, 27.09%, 36.89%, 49.71% and 49.25% for the 4 L and 9.14%, 15.44%, 21.02%, 29.41%, 29.14% for the 2 L, respectively. The respective MMAD significantly (p<0.001) decreased with increasing flow rates. Easyhaler performance at both 4 and 2 L showed no significant differences between one and two inhalations at low flow rates (10, 20, 28.3), but this was significant (p<0.05) at higher flow rates (40 and 60 L/min). The Oxis Turbuhaler was also measured using inhalation flows of 10, 20, 28.3, 40, 60 L/min. The nominal fine particle dose were 12.87%, 24.51%, 28.25%, 34.61%, 40.53% for the 4 L and 8.55%, 15.31%, 21.36%, 19.53%, 22.31% for the 2 L, respectively. Turbuhaler performance showed significant (p<0.05) differences between one and two inhalations at varying flow rates 2 L inhalation volumes, but not at 4 L. The use of Foradil Aeroliser delivers small particles as the Oxis Turbuhaler using two inhalations hence delivering formoterol deep into the lungs. Also, this thesis shows that high flow resistance of Turbuhaler will indeed influence the ability of patients with severe asthma or children to use the system. Beside, Easyhaler produced the highest drug delivery to the lungs, thus, making it a more desirable system to use, especially for children and asthma sufferers.

No description available.