Investigating the Challenges of Managing Coexisting Subglottic Stenosis and Bronchopulmonary Diseases Medically Using Computational Modeling.

OBJECTIVE: Subglottic stenosis (SGS) coexists with bronchopulmonary disease, complicating topical therapy given the distinct anatomical targets. Optimizing inhaled medication delivery to both regions remain a therapeutic challenge. This study evaluates the ability of orally inhaled aerosol particles to achieve dual‑site deposition in SGS and bronchopulmonary regions. STUDY DESIGN: Computational modeling of orally inhaled drug particle delivery. SETTING: Academic Medical Center. METHODS: Digitally modified airways simulating 8 SGS variants, combining McCaffrey Stage I (5 mm) and II (15 mm) subglottic lengths with Cotton‑Myer Grade I (10%, 30%), Grade II (60%), and Grade III (90%) luminal constrictions. Oral inhalation at 15 L/min and particle transport were simulated for fluticasone propionate (FP; mean aerosol velocity 9.19 m/s, particle size range 1-8 μm) and ciclesonide (CIC; mean aerosol velocity 4.26 m/s, particle size range 1-4 μm) inhaler characteristics, and 6 particle‑size distributions M1(1-5 μm), M2(6-10 μm), M3(1-10 μm) while maintaining the respective parent (CIC and FP) mean aerosol velocity. RESULTS: In the normal airway, CIC and FP inhalers achieved >80% bronchial deposition but ≤0.02% subglottic delivery. Among modified devices, M2CIC optimized dual targeting, providing the highest subglottic deposition (0.09%) with preserved bronchial efficiency (69.46%). In SGS models, M2CIC and M2FP consistently achieved the most balanced delivery, with maximum deposition of M2CIC = 8.4% and M2FP = 7.86% at subglottic region, and M2CIC = 69.89% and M2FP = 61.02% at bronchial site. M3 variants offered intermediate dual deposition at advanced and Grade III stenosis stages. CONCLUSION: M2CIC and M2FP inhaler modifications optimized dual-site supporting tailored device strategies for SGS with coexisting bronchopulmonary disease.

Duke Scholars

Author Dennis Onyeka Frank-Ito Rhinology and Skull Base Surgery

Author Seth Morris Cohen Laryngology