Monovalent metal cation dry powders for inhalation

225398/2

MONOVALENT METAL CATION DRY POWDERS FOR INHALATION

BACKGROUND OF THE INVENTION

Pulmonary delivery of therapeutic agents can offer several advantages over other modes of delivery. These advantages include rapid onset of drug action, the convenience of patient self-administration, the potential for reduced drug side-effects, ease of delivery, the elimination of needles, and the like. With these advantages, inhalation therapy is capable of providing a drug delivery system that is easy to use in an inpatient or outpatient setting.

Metered dose inhalers (MDIs) are used to deliver therapeutic agents to the respiratory tract. MDIs are generally suitable for administering therapeutic agents that can be formulated as solid respirable dry particles in a volatile liquid under pressure. Opening of a valve releases the suspension at relatively high velocity. The liquid then volatilizes, leaving behind a fast-moving aerosol of dry particles that contain the therapeutic agent. MDIs are reliable for drug delivery to the upper and middle airways but are limited because they typically deliver only low doses per actuation. However, it is the bronchioles and alveoli that are often the site of manifestation of pulmonary diseases such as asthma and respiratory infections.

Liquid aerosol delivery is one of the oldest forms of pulmonary drug delivery. Typically, liquid aerosols are created by an air jet nebulizer, which releases compressed air from a small orifice at high velocity, resulting in low pressure at the exit region due to the Bernoulli effect. See, e.g., U.S. Pat. No. 5,511,726. The low pressure is used to draw the fluid to be aerosolized out of a second tube. This fluid breaks into small droplets as it accelerates in the air stream. Disadvantages of this standard nebulizer design include relatively large primary liquid aerosol droplet size often requiring impaction of the primary 1 225398/2 droplet onto a baffle to generate secondary splash droplets of respirable sizes, lack of liquid aerosol droplet size uniformity, significant recirculation of the bulk drug solution, and low densities of small respirable liquid aerosol droplets in the inhaled air.

Ultrasonic nebulizers use flat or concave piezoelectric disks submerged below a liquid reservoir to resonate the surface of the liquid reservoir, forming a liquid cone which sheds aerosol particles from its surface (U.S. 2006/0249144 and U.S. 5,551,416). Since no airflow is required in the aerosolization process, high aerosol concentrations can be achieved, however the piezoelectric components are relatively expensive to produce and are inefficient at aerosolizing suspensions, requiring active drug to be dissolved at low concentrations in water or saline solutions. Newer liquid aerosol technologies involve generating smaller and more uniform liquid respirable dry particles by passing the liquid to be aerosolized through micron-sized holes. See, e.g., U.S. Pat. No. 6,131,570; U.S. Pat. No. 5,724,957; and U.S. Pat. No. 6,098,620. Disadvantages of this technique include relatively expensive piezoelectric and fine mesh components as well as fouling of the holes from residual salts and from solid suspensions. WO03/035028 describes methods for preparing spray-dried, drug-containing particles.

Dry powder inhalation has historically relied on lactose blending to allow for the dosing of particles that are small enough to be inhaled, but aren't dispersible enough on their own. This process is known to be inefficient and to not work for some drugs. For example, the drug loading in the overall dry powder is low due to the presence of the lactose carrier which is typically large and bulky. Several groups have tried to improve on these shortcomings by developing dry powder inhaler (DPI) formulations that are respirable and dispersible and thus do not require lactose blending. Dry powder formulations for inhalation therapy are described in U.S. Pat. No. 5,993,805 to Sutton et al.; U.S. Pat. No. 6,9216527 to Platz et al.; WO 0000176 to Robinson et al.; WO 9916419 to Tarara et al.; WO 0000215 to Bot et al; U.S. Pat. No. 5,855,913 to Hanes et al.; and U.S. Pat. Nos. 6,136,295 and 5,874,064 to Edwards et al.

Broad clinical application of dry powder inhalation delivery has been limited by difficulties in generating dry powders of appropriate particle size, particle density, and dispersibility, in keeping the dry powder stored in a dry state, and in developing a convenient, 2 WO 2012/044736 PCT/US2011/053829 hand-held device that effectively disperses the respirable dry particles to be inhaled in air. In addition, the particle size of dry powders for inhalation delivery is inherently limited by the fact that smaller respirable dry particles are harder to disperse in air. Dry powder formulations, while offering advantages over cumbersome liquid dosage forms and propellant-driven formulations, are prone to aggregation and low flowahility which considerably diminish dispersibility and the efficiency of dry powder-based inhalation therapies. For example, interparticular Van der Waals interactions and capillary condensation effects are known to contribute to aggregation of dry particles. Hickey, A. et a!., “Factors Influencing the Dispersion of Dry Powders as Aerosols”, Pharmaceutical Technology, August, 1994, [0008j The propensity for particles to aggregate or agglomerate increases as particle size decreases. In order to deaggregate particles of a smaller size, a relatively larger dispersion energy is needed. This can he described as inhaled flowrate dependency since the degree of dispersion of the agglomerated particles is a function of inhaled flowrate. What this means to a clinician and a patient is that the dose the patient receives varies depending on their inspiratory flowrate.

[00091 One example of how the art has dealt with the need for a high dispersion energy is to require the patient to inhale on a passive dry powder inhaler (DPI) at a high inspiratory flow rate. In Anderson, et al. European Respiratory Journal, 1997, Nov; 10(11):2465-73, micronized sodium chloride was delivered to patients to cause broncho-provocation. Patients were required to breathe forcefully on the DPI in order to receive the broncho-provocative dose. Flowrates of greater than or equal to 50 LPM on a standard DPI and greater than 28 LPM on a high-resistance DPI were required, both produce higher dispersion energies.

[0010J Requiring a patient to inspire at a high flowrate is not always possible, or predictable, e.g., due to patient’s disease state or physical condition. Previously, the problem of delivering active agents to the respiratory tract at a relatively constant dose across various flowrates was addressed i) by adding large carrier particle (e.g., typically with an average particle size in excess of 40 pm), such as lactose, ii) by manufacturing particles that are large and porous (e.g,, tap density of less than 0.4 g/cc), or iii) by using active dry powder devices -3- WO 2012/044736 PCT/US2011/053829 that apply significant force to disperse the powders. The first method is still subject to significant variability at varying inspiratory flowrates. The second method requires large volumes of powder to deliver a relatively large dose of powder. The third method requires an expensive inhaler to be purchased, that may also be subject to technical failure.

[0011] To overcome inteiparticle adhesive forces, Batycky et al. in U.S, Patent No. 7,182,961 teach production of so called “aerodynamically light respirable particles,” which have a volume median geometric diameter (VMGD) of greater than 5 microns (gm) as measured using a laser diffraction instrument such as HELOS (manufactured by Sympatec, Princeton, N.J.) and a tap density of less than 0.4 g/cc. See Batycky et al., column 4, lines 21-45, and column 7, lines 42-65.

[0012] Similar to Batycky, et al., Lipp et al., in U.S. Patent No. 7,807,200 teach production of “aerodynamically light respirable particles” that possess a tap density of less than 0.4 g/cc. See Lipp et al., column 4, line 65 to column 5, line 47 where the use of a carboxylate moiety, e.g., citric acid and sodium citrate, a multivalent salt, e.g., a divalent salt, and a phospholipid, e.g., a phospholipid that is endogenous to the lung is taught. Due to the presence of the three components, as well as porous nature of the particle, as indicated by a tap density which is less than 0.4 g/cc, the formulations in Lipp et al. would be difficult to prepare with a high loading of active agents.

[0013] Another approach to improve dispersibility of respirable particles of average particle size of less than 10 gm, involves the addition of a water soluble polypeptide or addition of suitable excipients (including amino acid excipients such as leucine) in an amount of 50% to 99.9% by weight of the total composition. Eljamal et al., U.S. Patent No. 6,582,729, column 4, lines 12-19 and column 5, line 55 to column 6, line 31. However, this approach reduces the amount of active agent that can be delivered using a fixed amount of powder. Therefore, an increased amount of dry powder is required to achieve the intended therapeutic results, for example, multiple inhalations and/or frequent administration may be required. Still other approaches involve the use of devices that apply mechanical forces, such as pressure from compressed gasses, to the small particles to disrupt interparticular adhesion during or just prior to administration. See, e.g., U.S. Pat. Nos. 7,601,336 to Lewis et al., 6,737,044 to „ 4 - WO 2012/044736 PCT/US2011/053829

Dickinson et al, 6,546,928 to Ashurst et al, or U.S. Pat. Applications 20090208582 to Johnston et al.

[00141 A further limitation that is shared by each of the above methods is that the aerosols produced typically include substantial quantities of inert carriers, solvents, emulsifiers, propellants, and other non-drug material. In general, large quantities of non-drug material are required for effective formation of respirable dry particles small enough for alveolar delivery (e.g. less than 5 microns and preferably less than 3 microns). However, these amounts of non-drug material also serve to reduce the purity and amount of active drug substance that can be delivered. Thus, these methods remain substantially incapable of introducing large active drug dosages accurately to a patient for systemic delivery.

[0015) Therefore, there remains a need for the formation of small particle size aerosols that are highly dispersible. In addition, methods that produce aerosols comprising greater quantities of drug and lesser quantities of non-drug material are needed. Finally, a method that allows a patient to administer a unit dosage rapidly with one or two, small volume breaths is needed.

SUMMARY OF THE INVENTION

[0016] The invention relates to respirable dry particles that contain one or more monovalent metal cations (such as Na') and to dry powders that contain the respirable particles. In particular, aspects of the invention relate to respirable dry powders that contain respirable dry particles that comprise a monovalent metal cation salt in an amount of at least about 3% by weight of the dry particle; the respirable dry particles have a volume median geometric diameter (VMGD) of about 10 microns or less and a dispersibility ratio (1/4 bar) of less than about 2 as measured by laser diffraction (RODOS/HELOS system). Respirable dry particles that consist of 10% leucine and 90% NaCl; or 60% leucine and 40% NaCl; and respirable dry particles that contain a divalent metal cation in an amount of 3% or more by weight of the dry particle are not included in the invention. Preferably, the respirable dry particles have a volume median geometric diameter (VMGD) of about 5.0 microns or less. -5- WO 2012/044736 PCT/VS2011/053829 [0017] The respirable dry powder can have a dispersibility ratio (1/4 bar) of less than about 1,5 as measured at the 1 bar and 4 bar dispersion settings on the HELOS/RODOS laser diffraction system. The respirable dry powder can have a Fine Particle Fraction (FPF) of less than 5.6 microns of at least 45% and/or a Fine Particle Fraction (FPF) of less than 3.4 microns of at least 30%, and/or a Fine Particle Fraction (FPF) of less than 5.0 microns of at least 45%. The respirable dry powder can have a mass median aerodynamic diameter (MMAD) of about 5 microns or less.

[0018] The monovalent metal cation salt present in the respirable dry particles can have a solubility of > 0.5 g/L in water or > 400 g/L in water at 25°C, 1 bar. In some embodiments, the monovalent metal salt is selected from the group consisting of a sodium salt, a potassium salt, a lithium salt, and combinations thereof. Preferred salts include sodium chloride, sodium lactate, sodium citrate, sodium sulfate or combinations thereof. Other preferred salts include potassium chloride, potassium citrate and combinations thereof.

[0019] The respirable dry powder can further comprise at least one pharmaceutically acceptable excipient. The excipient can be present in any desired amount. In some embodiments, the excipient is selected from the group consisting of leucine, maltodextrin, mannitol and combinations thereof.

[0020] The respirable dry powder can have a tap density of greater than 0.4 g/ce, greater than 0.5 g/cc or greater than 0.6 g/cc.

[0021] If desired, the respirable dry powder can comprise a pharmaceutically active agent. The pharmaceutically active agent can be a component of the respirable dry particles, or can be blended with the respirable dry particles. In some embodiments, the pharmaceutically active agent is an antibiotic, a LABA, a LAMA, a corticosteroid, or any combination thereof. In other embodiments, the pharmaceutically active agent is a macromolecule. For example, the macromolecule can be a cytokine, chemokine, growth factor, hormone or antibody. -6- WO 2012/044736 PCT/US2011/053829 [0022] Aspects of the invention also relate to a method for treating a respiratory disease comprising administering to the respiratory tract of a patient in need thereof an effective amount of a respirable dry powder as described herein.

[0023] Aspects of the invention also relate to a method for treating or preventing an acute exacerbation of a respiratory disease comprising administering to the respiratory tract of a patient in need thereof an effective amount of a respirable dry powder as described herein.

[0024] Aspects of the invention also relate to a method for treating or preventing an infectious disease of the respiratory tract comprising administering to the respiratory tract of a patient in need thereof an effective amount of a respirable dry powder as described herein.

[0025] Aspects of the invention also relate to a dry powder as described herein for use in therapy and for the treatment or prevention of a disease as described herein.

[0026] Described herein are respirable dry particles that contain one or more monovalent metal cations (such as Na+ or K+) and dry powders that contain the respirable particles, in particular, aspects of the invention relate to respirable dry powders that contain respirable dry particles that comprise a monovalent metal cation salt in an amount of at least about 3% by weight of the dry particle. The respirable dry particles and respirable dry powders can further contain a pharmaceutically active agent (e.g. therapeutic and/or prophylactic agent). For example, one or more active agents are co-formulated (e.g., co-spray dried, co-freeze-dried, processed via super-critical fluid-based technologies, etc.) with the one or more monovalent salt(s) and optionally one or more excipient(s) to make respirable dry particles. In another example, the respirable dry powders are comprised of respirable dry particles containing the one or more monovalent metal cations, and can be used as carrier particles to deliver one or more pharmaceutically active agents (e.g., as a blend of the respirable dry particles and the one or more pharmaceutically active agents). In a further example, one or more active agents are co-formulated with the one or more monovalent salts to make respirable dry particles. These co-formulated respirable dry particles (comprising a first, second, etc. active agent) can be used as such, or as carrier particles, to deliver one or more additional active agents (a second, third, fourth, etc. active agent). The additional active agent(s) may be, for example, -7- WO 2012/044736 PCT/US2011/053829 in micronized form. The one or more additional active agent(s) can be the same active agent(s) that are co-formulated in the dry particle, different active agent(s), or a combination thereof.

[0027] Suitable active agents include, but are not limited to, mucoactive or mucolytic agents, surfactants, antibiotics, antivirals, antihistamines, cough suppressants, bronchodilators, antiinflammatory agents, steroids, vaccines, adjuvants, expectorants, macromolecules, or therapeutics that are helpful for chronic maintenance of cystic fibrosis (CF). Preferred active agents include, but are not limited to, LABAs (e.g., formoterol, salmeterol), short-acting beta agonists (e.g., albuterol), corticosteroids (e.g., fluticasone), LAMAs (e.g., tiotropium), antibiotics (e.g., levofloxacin, tobramycin), antibodies (e.g., therapeutic antibodies), hormones (e.g. insulin), cytokines, chemokines, growth factors, and combinations thereof. When the dry powders are intended for treatment of CF, preferred additional active agents are short-acting beta agonists (e.g., albuterol), antibiotics (e.g., levofloxacin), recombinant human deoxyribonuclease I (e.g., domase alfa, also known as DNase), sodium channel blockers (e.g., amiloride), and combinations thereof.

[0028] The respirable dry particles of the invention are generally small and dispersible, and can be used to administer pharmaceutically active agent to the lungs, including the deep lung, for local action in the lung and/or for absorption through the lung for systemic action. The respirable dry particles can also be large and dispersible.

[0029] In certain embodiments, the respirable dry powders and dry particles described herein are small and highly dispersible, and have other properties that enable them to be delivered to the respiratory tract, including the upper airway and the deep lung upon inhalation, such as high dispersibility, flowrate independence and/or minimized oropharyngeal deposition. Accordingly, the dry powders and dry particles described herein are suitable for delivery of pharmaceutically active agents to the upper airway or deep lung for local or systemic activity, [0030] In addition to being small and dispersible, the respirable dry particles are generally monovalent metal cation (e.g., Na+ or K+) dense and/or pharmaceutically active agent dense. For example, the dry particles can contain a high percentage of monovalent metal cation salt -8- WO 2012/044736 PCT/US2011/053829 (i.e., be dense in monovalent metal cation salt) and/or contain monovalent metal cation salts that dissociate to release two or more moles of monovalent metal cation per mole of salt. Alternatively, or in addition, the dry particles can contain a high percentage of one or more pharmaceutically active agents. Accordingly, in some aspects, the respirable dry particles of the invention may be monovalent metal cation salt (e.g., a sodium salt or a potassium salt) and/or active agent dense and are small and dispersible.

[0031] In another aspect, the respirable dry particles are mass dense (e.g. have a tap density or envelope mass density of greater than about 0.4 g/cc, or at least about 0.45 g/cc or greater, about 0.5 g/cc or greater, about 0.55 g/cc or greater, about 0.6 g/cc or greater, about 0.7 g/cc or greater or about 0.8 g/cc or greater), small, and dispersible.

[0032] The respirable dry particles are generally small, e.g., they possess a geometric diameter (VMGD) of less than about 10 microns, between 0.5 microns and 10 microns, between 1 micron and 7 microns or between 1 micron and 5 microns. Optionally, the MMAD of the dry powder may be less than 10 microns, less than 5 microns, between 0.5 and 10 microns, more preferably between 1 and 5 microns, more preferably between 1 and 3 microns or between 3 and 5 microns. The particles optionally have a tap density or envelope mass density greater than 0.4 g/cc, greater than 0.45 g/cc, greater than 0.55 g/cc, between 0.45 g/cc and 1.2 g/cc, or between 0.55 g/cc and 1.0 g/cc. They are also generally dispersible.

[0033] The respirable dry particles may also be large, e.g., they may possess a VMGD between 10 microns and 30 microns, or between 10 microns and 20 microns. Optionally, the MMAD of the dry powder may be between 0.5 and 10 microns, more preferably between 1 and 5 microns. The particles optionally have a tap density or envelope mass density between 0.01 g/cc and 0.4 g/cc, or between 0.05 g/cc and 0.25 g/cc. They are also generally dispersible.

[0034] Respirable dry powders that contain small particles and that are dispersible in air, and preferably dense (e.g., dense in monovalent metal cation and/or pharmaceutically active agent) are a departure from the conventional wisdom. It is well known that the propensity for -9- WO 2012/044736 PCT/US2011/053829 particles to aggregate or agglomerate increases as particle size decreases. See, e.g., Hickey, A, et al., “Factors Influencing the Dispersion of Dry Powders as Aerosols”, Pharmaceutical Technology, August, 1994.

[0035J Respirable dry powder and dry particles described herein that are small, dispersible and dense (e.g., dense in monovalent metal cations (e.g., sodium containing salt(s)), active agent) and/or mass dense) provide advantages for administration and/or therapeutic uses. For example, a desired therapeutically effective dose of an active agent can be delivered when a subject inhales a small volume of dry powder. Accordingly, in comparison to conventional dry powders, such as powders that contain lactose carrier particles a smaller amount of powder will need to be administered in order to deliver the desired dose of pharmaceutically active agent. For example, the desired dose can be delivered with one or two inhalations from a capsule-type or blister-type inhaler.

[0036] In certain embodiments, provided herein are respirable dry powders that contain respirable particles that are small and dispersible in air without the need for additional energy sources beyond the subject's inhalation. Thus, the respirable dry powders and respirable dry particles can be used to deliver active agents to the respiratory tract, without including large amounts of non-active components (e.g., excipients such as lactose earner particles) in the particles or powders, or by using devices that apply mechanical forces to disrupt aggregated or agglomerated particles during or just prior to administration. For example, devices such as passive dry powder inhalers may be used to deliver a dry powder comprised of one or more monovalent cation salts and one or more active agents described herein. In some embodiments, the respirable dry powders and respirable dry particles do not include any excipient (e.g., leucine) in the particles or powders.

[0037j Provided herein, in certain embodiments, are respirable dry particles that contain one or more divalent metal cation salts, such as magnesium or calcium-containing salts, where the divalent metal cation is present in an amount of less than 3% by weight.

[0038] In one aspect, the respirable particles are not only small and highly dispersible, but can contain a large amount of active agent, e.g., 5% or more, 10% or more, 20% or more, -10- WO 2012/044736 PC T/US 2011/053829 30% or more, 40% or more, 50% or more, 60% or more, 70% or more, 80% or more, 90% or more, 95% or more, or 97% or more by weight of the dry particle. When an excipient is included in the respirable dry powder or particles, the excipient may comprise about, 50% or less by weight, about 40% or less by weight, about 30% or less by weight, about 20% or less by weight, about 12% or less by weight, about 10% or less by weight, about 8% or less by weight, about 5% or less by weight, about 3% or less by weight, about 2% or less by weight or about 1% or less by weight).

BRIEF DESCRIPTION OF THE DRAWINGS

[0039] FIGS. 1A-1E are graphs illustrating the aerodynamic particle size distribution of exemplary dry powders of the invention as measured by an eight stage Andersen Cascade impactor (AC1). The graphs indicate that all five dry powders were of a respirable size.

[0040] FIGS. 2A and 2B are graphs illustrating the efficacy of a monovalent cation-based dry powder formulation of FP/SX (fluticasone propionate/ salmeterol xinafoate) in reducing total cell (FIG 2B) and eosinophil cell (FIG 2B) counts in a ovalbumin (OVA) mouse model of allergic asthma. The graphs indicate that the spray dried drug (FP/SX) remained effective in treating inflammation.

[0041] FIGS. 3A-3C are graphs illustrating the efficacy of a monovalent cation-based dry powder formulation of FP/SX in reducing total cell (FIG 3A) and eosinophil cell (FIG 3B) counts and airway hyperreactivity (FIG 3C) in an ovalbumin mouse model of allergic asthma. The graphs indicate that the spray dried drug (FP/SX) remained effective in treating both inflammation and airway hyperreactivity.

[0042] FIG. 4 is a graph illustrating the efficacy of a monovalent cation-based dry powder formulation of FP/SX in reducing airway hyperreactivity in an ovalbumin mouse model of allergic asthma. The graph indicates that the spray dried drug (FP/SX) remained effective in treating airway hyperreactivity.

[0043] FIG. 5 is a graph illustrating the efficacy of a monovalent cation-based dry powder formulation of tiotroprium bromide (TioB) in reducing airway hyperreactivity in an -11 - WO 2012/044736 PCT/US2011/053829 ovalbumin mouse model of allergic asthma. The graph indicates that the spray dried drug (TioB) remained effective in treating airway hyperreactivity.

[0044] FIGS. 6A-6C are graphs illustrating the efficacy of a monovalent cation-based dry powder formulation of FP/SX in reducing total cell (FIG 6A) and eosinophil cell (FIG 6B) counts and airway hyperreactivity (FIG 6C) in a house dust mite (HDM) mouse model of allergic asthma. The graphs indicate that the spray dried drug (FP/SX) remained effective in treating both inflammation and airway hyperreactivity.

[0045] FIG. 7 is a graph illustrating the efficacy of a monovalent cation-based dry powder formulation of ciprofloxacin (Formulation IV) in treating bacterial pneumonia in vivo in a mouse model. The graph indicates that spray dried ciproflaxacin was active against P. aeruginosa.

[0046] FIGS. 8 and 9 are graphs illustrating the efficacy of monovalent cation-based dry powder formulations of insulin at a loading of 8% and 5%, respectively, at reducing the blood glucose levels in mice.

[0047] FIGS. 10A and 10B are graphs illustrating the ability of a monovalent cation-powder formulation of immunoglobulin G (IgG) to deliver IgG to both the lungs and serum of mice. These graphs indicate that delivery of a large protein to the lungs with a spray dried formulation of the protein and a monovalent cation salt is feasible.

DETAILED DESCRIPTION OF THE INVENTION

[0048] The invention relates to respirable dry particles that contain one or more monovalent metal cations (such as Na') and to dry powders that contain the respirable particles. The dry particles can further contain a pharmaceutically active agent, or can be used as carrier particles to deliver a pharmaceutically active agent. The respirable dry particles of the invention are generally small and dispersible, and can be used to administer pharmaceutically active agent to the lungs, including the deep lung, for local action in the lung or for absorption through the lung for systemic action. -12- WO 2012/044736 PCT/US2011/053829 [0049] In addition to being small and dispersible, the respirable dry particles are generally monovalent metal cation (e.g., Na+) dense and/or pharmaceutically active agent dense. Respirable diy powders that contain small particles and that are dispersible in air, and preferably dense (e.g., dense in monovalent metal cation and/or pharmaceutically active agent) are a departure from the conventional wisdom. It is well known that the propensity for particles to aggregate or agglomerate increases as particle size decreases. See, e.g., Hickey, A. et al., “Factors Influencing the Dispersion of Dry Powders as Aerosols”, Pharmaceutical Technology, August, 1994.

[OOSOj Provided herein are respirable dry powders that contain respirable particles that are small and dispersible in air without additional energy sources beyond the subject's inhalation. Thus, the respirable dry powders and respirable dry particles can be used to deliver active agents to the respiratory tract, without including large amounts of non-active components (e.g., excipients such as lactose carrier particles) in the particles or powders, or by using devices that apply mechanical forces to disrupt aggregated or agglomerated particles during or just prior to administration.

[0051] The respirable dry powders and respirable particles of the invention can be dense in monovalent metal cations (e.g., sodium containing salt(s)) and/or active agent). Thus, in one aspect, the respirable particles are not only small and highly dispersible, but can contain a large amount of monovalent metal cation and/or pharmaceutically active agent. Accordingly, a smaller amount of powder will need to be administered in order to deliver the desired dose of pharmaceutically active agent, in comparison to conventional dry powders, such as powders that contain lactose carrier particles. For example, the desired dose can be delivered with one or two inhalations from a capsule-type or blister-type inhaler.

[0052] The respirable dry powders and dry particles described herein are small and highly dispersible, and have other properties that enable them to he delivered to the respiratory tract, including the upper airway and the deep lung upon inhalation, such as high dispersibility, flowrate independence and minimized oropharyngeal deposition. Accordingly, the dry powders and dry particles described herein are suitable for delivering pharmaceutically active agents to the upper airway or deep lung for local or systemic activity. -13- WO 2012/044736 PCT/US2011/053829

Definitions [0053] The term “dry powder” as used herein refers to a composition that contains finely dispersed respirable dry particles that are capable of being dispersed in an inhalation device and subsequently inhaled by a subject. Such a dry powder may contain up to about 25%, up to about 20%, or up to about 15% water or other solvent, or be substantially free of water or other solvent, or be anhydrous.

[0054] The term “dry particles” as used herein refers to respirable particles that may contain up to about 25%, up to about 20%, or up to about 15% water or other solvent, or be substantially free of water or other solvent, or be anhydrous.

[0055] The term "respirable” as used herein refers to dry particles or dry powders that are suitable for delivery to the respiratory tract (e.g., pulmonary delivery) in a subject by inhalation. Respirable dry powders or dry particles have a mass median aerodynamic diameter (MMAD) of less than about 10 microns, preferably about 5 microns or less.

[0056] The term “small” as used herein to describe respirable dry particles refers to particles that have a volume median geometric diameter (VMGD) of about 10 microns or less, preferably about 5 microns or less. VMGD may also be called the volume median diameter (VMD), x50, or Dv50.

[0057] As used herein, the terms “administration” or “administering” of respirable dry particles refers to introducing respirable dry particles to the respiratory tract of a subject.

[0058] As used herein, the term “respiratory tract” includes the upper respiratory tract (e.g., nasal passages, nasal cavity, throat, and pharynx), respiratory airways (e.g., larynx, trachea, bronchi, and bronchioles) and lungs (e.g., respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli).

[00591 The term “dispersible” is a term of art that describes the characteristic of a dry powder or dry particles to be dispelled into a respirable aerosol. Dispersibility of a dry powder or dry particles is expressed herein as the quotient of the volume median geometric -14- WO 2012/044736 PCT/US2011/053829 diameter (VMGD) measured at a dispersion (i.e., regulator) pressure of 1 bar divided by the VMGD measured at a dispersion (i.e., regulator) pressure of 4 bar, VMGD at 0.5 bar divided by the VMGD at 4 bar as measured by HELOS/RODOS, VMGD at 0.2 bar divided by the VMGD at 2 bar as measured by HELOS/RODOS, or VMGD at 0.2 bar divided by the VMGD at 4 bar as measured by HELOS/RODOS. These quotients are referred to herein as “1 bar/4 bar,” "0.5 bar/4 bar," “0.2 bar/2 bar,” and “0.2 bar/4 bar,” respectively, and dispersibility correlates with a low quotient. For example, 1 bar/4 bar refers to the VMGD of respirable dry particles or powders emitted from the orifice of a RODOS dry powder disperser (or equivalent technique) at about 1 bar, as measured by a HELOS or other laser diffraction system, divided the VMGD of the same respirable dry particles or powders measured at 4 bar by HELOS/RODOS. Thus, a highly dispersible dry powder or dry particles will have a 1 bar/4 bar or 0.5 bar/4 bar ratio that is close to 1.0. Highly dispersible powders have a low tendency to agglomerate, aggregate or clump together and/or, if agglomerated, aggregated or clumped together, are easily dispersed or de-agglomerated as they emit from an inhaler and are breathed in by a subject. Dispersibility can also he assessed by measuring the size emitted from an inhaler as a function of flow rate. VMGD may also be called the volume median diameter (VMD), x50, or Dv50.

[0060j The terms “EPF (<5.6),” “FPF (<5.6 microns),” and “fine particle fraction of less than 5.6 microns” as used herein, refer to the fraction of a sample of dry particles that have an aerodynamic diameter of less than 5.6 microns. For example, FPF (<5.6) can be determined by dividing the mass of respirable dry particles deposited on the stage one and on the collection filter of a two-stage collapsed Andersen Cascade Impactor (ACI) by the mass of respirable dry particles weighed into a capsule for delivery to the instrument. This parameter may also he identified as “FPF_TD(<5.6),” where TD means total dose. A similar measurement can be conducted using an eight-stage ACI. The eight-stage ACI cutoffs are different at the standard 60 L/min flow rate, but the FPF TD(<5.6) can be extrapolated from the eight-stage complete data set. The eight-stage ACI result can also be calculated by the USP method of using the dose collected in the ACI instead of what was in the capsule to determine FPF. - 15- WO 2012/044736 PCT/US2011/053829 [0061] The terms “FPF (<5.0)”, “FPF<5pm”, “FPF (<5.0 microns),” and “fine particle fraction of less than 5.0 microns” as used herein, refer to the fraction of a mass of respirable dry particles that have an aerodynamic diameter of less than 5.0 micrometers. For example, FPF (<5.0) can be determined by using an eight-stage AC! at the standard 60 L/min flow rate by extrapolating from the eight-stage complete data set. This parameter may also be identified as “FPF_TD(<5.0),” where TD means total dose. When used in conjunction with a geometric size distribution such as those given by a Malvern Spraytec, Malvern Mastersizer or Sympatec HELOS particle sizer, “FPF (<5.0)” refers to the fraction of a mass of respirable dry particles that have a geometric diameter of less than 5.0 micrometers.

[0062] The terms “FPD(<4.4)”, £FPD<4.4pm”, FPD(<4.4 microns)” and “fine particle dose of less than 4.4 microns” as used herein, refer to the mass of respirable dry powder particles that have an aerodynamic diameter of less than 4.4 micrometers. For example, FPD<4.4u,rn can be determined by using an eight-stage ACI at the standard 60L/min flowrate and summing the mass deposited on the filter, and stages 6, 5, 4, 3, and 2 for a single dose of powder actuated into the ACL

[0063] The terms “FPF (<3.4),” “FPF (<3.4 microns),” and “fine particle fraction of less than 3.4 microns” as used herein, refer to the fraction of a mass of respirable dry particles that have an aerodynamic diameter of less than 3.4 microns. For example, FPF (<3.4) can be determined by dividing the mass of respirable dry particles deposited on the collection filter of a two-stage collapsed ACI by the total mass of respirable dry particles weighed into a capsule for delivery to the instrument. This parameter may also be identified as “FPF_TD(<3.4),” where TD means total dose. A similar measurement can be conducted using an eight-stage ACL The eight-stage ACI result can also be calculated by the USP method of using the dose collected in the ACI instead of what was in the capsule to determine FPF.

[0064] The terms “FPF (<5.0),” “FPF (<5.0 microns),” and “fine particle fraction of less than 5.0 microns” as used herein, refer to the fraction of a mass of respirable dry particles that have an aerodynamic diameter of less than 5.0 microns. For example, FPF (<5.0) can be -16- WO 2012/044736 PCT/US2011/053829 determined by using an eight-stage ACI at the standard 60 L/min flow rate by extrapolating from the eight-stage complete data set. This parameter may also be identified as “FPF_TO(<5.0)»” where TD means total dose.

[0065j As used herein, the term “emitted dose” or “ED” refers to an indication of the delivery of a drug formulation from a suitable inhaler device after a firing or dispersion event. More specifically, for dry powder formulations, the ED is a measure of the percentage of powder that is drawn out of a unit dose package and that exits the mouthpiece of an inhaler device. The ED is defined as the ratio of the dose delivered by an inhaler device to the nominal dose (i.e., the mass of powder per unit dose placed into a suitable inhaler device prior to firing). The ED is an experimentally-measured parameter, and can be determined using the method of USP Section 601 Aerosols, Metered-Dose Inhalers and Dry Powder Inhalers, Delivered-Dose Uniformity, Sampling the Delivered Dose from Dry Powder Inhalers, United States Pharmacopeia convention, Rockville, MD, 13th Revision, 222-225, 2007. This method utilizes an in vitro device set up to mimic patient dosing.

[0066] The term “capsule emitted powder mass” or “CEPM” as used herein, refers to the amount of dry powder formulation emitted from a capsule or dose unit container during an inhalation maneuver. CEPM is measured gravimetrically, typically by weighing a capsule before and after the inhalation maneuver to determine the mass of powder formulation removed. CEPM can be expressed either as the mass of powder removed, in milligrams, or as a percentage of the initial filled powder mass in the capsule prior to the inhalation maneuver.

[0067] The term “effective amount,” as used herein, refers to the amount of active agent needed to achieve the desired therapeutic or prophylactic effect, such as an amount that is sufficient to reduce pathogen (e.g., bacteria, vims) burden, reduce symptoms (e.g., fever, coughing, sneezing, nasal discharge, diarrhea and the like), reduce occurrence of infection, reduce viral replication, or improve or prevent deterioration of respiratory function (e.g., improve forced expiratory volume in 1 second FEVi and/or forced expiratory volume in 1 second FEVi as a proportion of forced vital capacity FEVi/FVC, reduce bronchoconstriction), produce an effective serum concentration of a pharmaceutically active -17- WO 2012/044736 PCT/US2011/053829 agent, increase mucociliary clearance, reduce total inflammatory cell count, or modulate the profile of inflammatory cell counts. The actual effective amount for a particular use can vary according to the particular dry powder or dry particle, the mode of administration, and the age, weight, general health of the subject, and severity of the symptoms or condition being treated. Suitable amounts of dry powders and dry particles to be administered, and dosage schedules for a particular patient can be determined by a clinician of ordinary skill based on these and other considerations.

[0068] The term “pharmaceutically acceptable excipient” as used herein means that the excipient can be taken into the lungs with no significant adverse toxicological effects on the lungs. Such excipients are generally regarded as safe (GRAS) by the U.S. Food and Drug Administration.

[0069] All references to salts (e.g., sodium containing salts) herein include anhydrous forms and all hydrated forms of the salt.

[0070] All weight percentages are given on a dry basis.

Dry Powders and Dry Particles [0071] Aspects of the invention relate to respirable dry powders and dry particles that contain one or more monovalent metal cation salts, preferably one or more sodium salts and/or potassium salts.

Chemical Composition [0072] In one aspect, the respirable dry particles of the invention contain one or more monovalent metal cation salts, such as a sodium salt, a potassium salt and/or a lithium salt, but do not contain a pharmaceutically active agent. These types of respirable dry particles can be used as carrier particles to deliver a pharmaceutically active agent to the respiratory tract (e.g., lungs) for local or systemic delivery. For example, this type of respirable dry -18“ WO 2012/044736 PCT/US2011/053829 particle can be blended with a pharmaceutically active agent, for example in the form of a micronized powder, to produce a dry powder of the invention.

[0073] In another aspect, the respirable dry particles of the invention contain one or more monovalent metal cation salts, such as a sodium salt and/or a potassium salt, and further contain a pharmaceutically active agent. These types of respirable dry particles can be prepared, for example, by spray drying a feed stock that contains the monovalent metal cation salt, the pharmaceutically active agent and optionally an excipient, as described herein. This type of dry particle can be used to deliver a pharmaceutically active agent to the respiratory tract (e.g., lungs) for local or systemic delivery.

[0074] In a further aspect, the respirable dry particles contain one or more monovalent metal cation salts and one or more active agents. These dry particles can be combined, additionally, with one or more active agents, e.g., by blending, to form a respirable dry powder.

[0075] The invention excludes respirable dry powders and respirable dry particles that consist of 10% leucine and 90% NaCl; or 60% leucine and 40% NaCl. The invention also excludes respirable dry powders and respirable dry particles that contain a divalent metal cation (e.g., in the form of a salt) in an amount of 3% or more or that contain a divalent metal cation salt in an amount of 5% or more. In some embodiments, the respirable dry powders and respirable dry particles do not include sodium chloride. In some embodiments, the respirable dry powders and respirable dry particles do not include sodium citrate or citric acid. In some embodiments, the respirable dry powders and respirable dry particles do not include potassium phosphate. In some embodiments, the respirable dry powders and respirable dry particles do not include potassium sulfate. In some embodiments, the respirable dry powders and respirable dry particles do not include a phospholipid as an excipient. Some examples of phospholipids include dipalmitoylphosphatidylcholine (DPPC) and 1.2-distearoyl-sn-glycero“3-phosphocholine (DSPC). In some embodiments, the respirable dry powders and respirable dry particles do not include a surfactant as an active agent. Some examples of surfactants include phospholipids such as dipalmitoylphosphatidylcholine (DPPC) and 1.2-distearoyl-sn~glycero-3“phosphocholine (DSPC), In some embodiments, the respirable dry powders and respirable dry particles do - 19- WO 2012/044736 PCT/US2011/053829 not include lactose as an excipient. In some embodiments, the respirable dry powders and respirable dry particles do not include leucine as an excipient. In some embodiments, the respirable dry powders and respirable dry particles do not include mannitol as an excipient. In some embodiments, the respirable dry powders and respirable dry particles do not include a divalent salt. Examples of divalent salts include a calcium salt and a magnesium salt.

[0076] Preferred monovalent metal salts (e.g., sodium salts, potassium salts) have one, or preferably two or more of the following characteristics: (i) can be processed into respirable dry powders, (ii) possess sufficient physicochemical stability in dry powder form to facilitate the production of a powder that is dispersible and physically stable over a range of conditions, including upon exposure to elevated humidity, (iii) undergo rapid dissolution upon deposition in the lungs, for example, half of the mass of the cation of the monovalent metal salt can he dissolved in less than 30 minutes, less than 15 minutes, less than 5 minutes, less than 2 minutes, less than 1 minute, or less than 30 seconds, and (iv) do not possess properties that can result in poor tolerability or adverse events, such as a significant exothermic or endothermic heat of solution (ΔΗ) for example, a ΔΗ lower than of about -10 kcal/mol or greater than about 10 kcal/mol. Rather, a preferred ΔΗ is between about -9 kcal/mol and about 9 kcal/mol, between about -8 kcal/mol and about 8 kcal/mol, between about -7 kcal/mol and about 7 kcal/mol, between about -6 kcal/mol and about 6 kcal/mol, between about -5 kcal/mol and about 5 kcal/mol, between about -4 kcal/mol and about 4 kcal/mol, between about -3 kcal/mol and about 3 kcal/mol, between about -2 kcal/mol and about 2 kcal/mol, between about -1 kcal/mol and about 1 kcal/mol, or about 0 kcal/mol.

[0077] Suitable sodium, potassium and lithium salts can have desired solubility characteristics. In general, highly or moderately soluble sodium and potassium salts are preferred. For example, sodium and potassium salts that are contained in the respirable dry particles and dry powders can have a solubility in distilled water at room temperature (20-30 °C) and 1 bar of at least about 0,4 g/L, at least about 0.85 g/L, at least about 0.90 g/L, at least about 0.95 g/L, at least about 1.0 g/L, at least about 2.0 g/L, at least about 5.0 g/L, at least about 6.0 g/L, at least about 10.0 g/L, at least about 20 g/L, at least about 50 g/L, at least about 90 g/L, at least about 120 g/L, at least about 500 g/L, at least about 700 g/L or at least -20- WO 2012/044736 PCT/US2011/053829 about 1000 g/L. Preferably, the sodium and potassium salts have a solubility greater than about 0.90 g/L, greater than about 2.0 g/L, or greater than about 90 g/L. Alternatively, the sodium and potassium salts that are contained in the respirable dry particles and dry powders can have a solubility in distilled water at room temperature (20-30 °C) and 1 bar of between at least about 0.4 g/L to about 200 g/L, between about 1.0 g/L to about 120 g/L, between 5.0 g/L to about 50 g/L, [0078) Suitable sodium salts that can be present in the respirable dry particles of the invention include, for example, sodium chloride, sodium citrate, sodium sulfate, sodium lactate, sodium acetate, sodium bicarbonate, sodium carbonate, sodium stearate, sodium ascorbate, sodium benzoate, sodium biphosphate, dibasic sodium phosphate, sodium phosphate, sodium bisulfite, sodium borate, sodium gluconate, sodium metasilicate, sodium propionate and the like. In a preferred aspect, the dry powders and dry particles include sodium chloride, sodium citrate, sodium lactate, sodium sulfate, or any combination of these salts. In another preferred aspect, the dry powders and dry particles include sodium lactate, sodium sulfate, or any combination of these salts. In another aspect, the dry powders and dry particles include sodium acetate, sodium carbonate, sodium gluconate, or any combination of these salts.

[00791 Suitable potassium salts include, for example, potassium chloride, potassium citrate, potassium bromide, potassium iodide, potassium bicarbonate, potassium nitrite, potassium persulfate, potassium sulfite, potassium sulfate, potassium bisulfite, potassium phosphate, potassium acetate, potassium citrate, potassium glutamate, dipotassium guanylate, potassium gluconate, potassium malate, potassium ascorbate, potassium sorbate, potassium succinate, potassium sodium tartrate and any combination thereof. For example, the dry powders and dry particles include potassium chloride, potassium citrate, potassium phosphare, potassium sulfate, or any combination of these salts. In a preferred aspect, the dry powders and dry particles include potassium chloride and/or potassium citrate.

[00801 Suitable lithium salts include, for example, lithium chloride, lithium bromide, lithium carbonate, lithium nitrate, lithium sulfate, lithium acetate, lithium lactate, lithium citrate, -21 - WO 2012/044736 PCT/US2011/053829 lithium aspartate, lithium gluconate, lithium malate, lithium ascorbate, lithium orotate, lithium succinate or and combination thereof.

[0081] Dry powder and particles of the invention can contain a high percentage of sodium salt and/or potassium salt in the composition, and can be sodium cation (Na+) and/or potassium cation (K+) dense. The dry particles may contain 3% or more, 5% or more, 10% or more, 15% or more, 20% ore more, 25% or more, 30% or more, 35% or more, 40% or more, 50% or more, 60% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, or 95% or more sodium salt or potassium salt by weight.

[0082] Alternatively or in addition, the respirable dry particles of the invention can contain a monovalent metal cation salt (e.g., sodium salt or potassium salt), which provides monovalent cation (e.g., Na‘ or K?) in an amount of at least about 3% by weight of the respirable dry particles. For example, the respirable dry particles of the invention can include a sodium salt or potassium salt which provides Na+ or K \ in an amount of at least about 5% by weight, at least about 7% by weight, at least about 10% by weight, at least about 11% by weight, at least about 12% by weight, at least about 13% by weight, at least about 14% by weight, at least about 15% by weight, at least about 17% by weight, at least about 20% by weight, at least about 25% by weight, at least about 30% by weight, at least about 35% by weight, at least about 40% by weight, at least about 45% by weight, at least about 50% by weight, at least about 55% by weight, at least about 60% by weight, at least about 65% by weight or at least about 70% by weight of the respirable dry particles.

[0083] In some embodiments, the dry particles are small, dispersible, and preferably dense in either monovalent metal cation (e.g., sodium, potassium), dense in monovalent metal cation salt (e.g. contain at least about 30% or at least about 40% (w/w) monovalent metal cation salt), and/or active agent dense. In a further aspect of the invention, the dry particles are small, dispersible, and dense in mass (e.g. tap density, envelope mass density). In this last aspect, the particles can be dense in monovalent metal cation salt (e.g. sodium, potassium), or can have low loading of metal cation salt in the formulation.

[0084] If desired, the respirable dry particles of the invention contain one or more other salts in addition to the sodium salt and/or potassium salt, such as one or more non-toxic salts of the -22- WO 2012/044736 PCT/US2011/053829 elements magnesium, calcium, aluminum, silicon, scandium, titanium, vanadium, chromium, cobalt, nickel, copper, manganese, zinc, tin, silver and the like.

[0085] Suitable magnesium salts that can be present in the respirable dry particles described herein include, for example, magnesium fluoride, magnesium chloride, magnesium bromide, magnesium iodide, magnesium phosphate, magnesium sulfate, magnesium sulfite, magnesium carbonate, magnesium oxide, magnesium nitrate, magnesium borate, magnesium acetate, magnesium citrate, magnesium gluconate, magnesium maleate, magnesium succinate, magnesium malate, magnesium taurate, magnesium orotate, magnesium glycinate, magnesium naphtbenate, magnesium acetylacetonate, magnesium formate, magnesium hydroxide, magnesium stearate, magnesium hexafluorsilicate, magnesium salicylate or any combination thereof. In a preferred aspect, the dry powder or dry particles include magnesium sulfate, magnesium lactate, magnesium chloride, magnesium citrate, and magnesium carbonate. Preferred magnesium salts are magnesium sulfate and magnesium lactate.

[0086] Suitable calcium salts that can be present in the respirable dry particles described herein include, for example, calcium chloride, calcium sulfate, calcium lactate, calcium citrate, calcium carbonate, calcium acetate, calcium phosphate, calcium alginate, calcium stearate, calcium sorbate, calcium gluconate and the like. In certain preferred aspects, the dry powder or dry particles of the invention do not contain calcium phosphate, calcium citrate, and/or calcium chloride.

[0087] When the respirable dry particles of the invention contain a divalent metal cation salt, such as a calcium salt or magnesium salt, and a monovalent cation salt, the divalent cation, as a component of one or more salts, is present in an amount of less than 5% by weight of dry particle, less than 3% by weight of dry particle, between 0.01% to about 2.9% by weight of dry particle, or between 0.1% to 2.9% by weight of dry particle.

[0088] The respirable dry particles of the invention can contain one or more monovalent metal cation salts (e.g., sodium salts and/or potassium salts) in a total amount of about 1% to about 20% by weight of the respirable dry particles, about 21% to about 60% by weight of the -23- WO 2012/044736 PCT/US2011/053829 respirable dry particles, or about 61% to about 100% by weight of the respirable dry particles. For example, the respirable dry particles of the invention can include one or more of the monovalent metal cation salts (e.g., sodium salts and/or potassium salts) in a total amount of between about 1% and about 5%, about 5% and about 25%, about 5% and about 15%, about 21% and about 50%, about 21% and about 40%, about 30% and about 40%, about 30% and about 50%, about 61% and about 99%, about 61% and about 90%, about 70% and about 100%, about 70% and about 99%, or about 80% and about 99% by weight of the respirable dry particles.

[0089] If desired, the respirable dry particles described herein can include a physiologically or pharmaceutically acceptable excipient. For example, a pharmaceutically-acceptable excipient includes any of the standard carbohydrates, sugar alcohols, and amino acids that are known in the art to be useful excipients for inhalation therapy, either alone or in any desired combination. These excipients are generally relatively free-flowing particulates, do not thicken or polymerize upon contact with water, are toxicologically innocuous when inhaled as a dispersed powder and do not significantly interact with the active agent in a manner that adversely affects the desired physiological action. Carbohydrate excipients that are useful in this regard include the mono- and polysaccharides. Representative monosaccharides include carbohydrate excipients such as dextrose (anhydrous and the monohydrate; also referred to as glucose and glucose monohydrate), galactose, mannitol, D-mannose, sorbose and the like. Representative disaccharides include lactose, maltose, sucrose, trehalose and the like. Representative trisaccharides include raffinose and the like. Other carbohydrate excipients include maltodextrin and cyclodextrins, such as 2-hydroxypropyl-beta-cyclodextrin can be used as desired. Representative sugar alcohols include mannitol, sorbitol and the like.

[0090] Suitable amino acid excipients include any of the naturally occurring amino acids that form a powder under standard pharmaceutical processing techniques and include the nonpolar (hydrophobic) amino acids and polar (uncharged, positively charged and negatively charged) amino acids, such amino acids are of pharmaceutical grade and are generally regarded as safe (GRAS) by the U.S. Food and Drug Administration. Representative examples of non-polar amino acids include alanine, isoleucine, leucine, methionine, -24- WO 2012/044736 PCT/US2011/053829 phenylalanine, proline, tryptophan and valine. Representative examples of polar, uncharged amino acids include cysteine, glycine, glutamine, serine, threonine, and tyrosine. Representative examples of polar, positively charged amino acids include arginine, histidine and lysine. Representative examples of negatively charged amino acids include aspartic acid and glutamic acid. These amino acids can he in the D or L optical isomer form, or a mixture of the two forms. These amino acids are generally available from commercial sources that provide pharmaceutical-grade products such as the Aldrich Chemical Company, Inc., Milwaukee, Wis. or Sigma Chemical Company, St. Louis, Mo.

[00911 Preferred amino acid excipients, such as the hydrophobic amino acid leucine, in the D or L optical form, or a mixture of the two forms, and can be present in the dry particles of the invention in an amount of about 99% or less by weight of respirable dry particles. For example, the respirable dry particles of the invention can contain the amino acid leucine in an amount of about 0.1% to about 10% by weight, 5% to about 30% by weight, about 10% to about 20% by weight, about 5% to about 20% by weight, about 11% to about 50% by weight, about 15% to about 50% by weight, about 20% to about 50% by weight, about 30% to about 50% by weight, about 11% to about 40% by weight, about 11% to about 30% by weight, about 11% to about 20% by weight, about 20% to about 40% by weight, about 51% to about 99% by weight, about 60% to about 99% by weight, about 70% to about 99% by weight, about 80% to about 99% by weight, about 51% to about 90% by weight, about 51% to about 80% by weight, about 51% to about 70% by weight, about 60% to about 90% by weight, about 70% to about 90% by weight, about 45% or less by weight, about 40% or less by weight, about 35% or less by weight, about 30% or less by weight, about 25% or less by weight, about 20% or less by weight, about 18% or less by weight, about 16% or less by weight, about 15% or less by weight, about 14% or less by weight, about 13% or less by weight, about 12% or less by weight, about 11% or less by weight, about 10% or less by weight, about 9% or less by weight, about 8% or less by weight, about 7% or less by weight, about 6% or less by weight, about 5% or less by weight, about 4% or less by weight, about 3% or less by weight, about 2% or less by weight, or about 1% or less by weight. -25- WO 2012/044736 FCT/US2011/053829 [0092] Preferred carbohydrate excipients, such as maltodextrin and mannitol, can be present in the dry particles of the invention in an amount of about 99% or less by weight of respirable dry particles. For example, the respirable dry particles of the invention can contain maltodextrin in an amount of about 0.1% to about 10% by weight, 5% to about 30% by weight by weight, about 10% to about 20% by weight by weight, about 5% to about 20% by weight, about 11% to about 50% by weight, about 15% to about 50% by weight, about 20% to about 50% by weight, about 30% to about 50% by weight, about 11% to about 40% by weight, about 11% to about 30% by weight, about 11% to about 20% by weight, about 20% to about 40% by weight, about 51% to about 99% by weight, about 60% to about 99% by weight, about 70% to about 99% by weight, about 80% to about 99% by weight, about 51% to about 90% by weight, about 51% to about 80% by weight, about 51% to about 70% by weight, about 60% to about 90% by weight, about 70% to about 90% by weight, about 45% or less by weight, about 40% or less by weight, about 35% or less by weight, about 30% or less by weight, about 25% or less by weight, about 20% or less by weight, about 18% or less by weight, about 16% or less by weight, about 15% or less by weight, about 14% or less by weight, about 13% or less by weight, about 12% or less by weight, about 11% or less by weight, about 10% or less by weight, about 9% or less by weight, about 8% or less by weight, about 7% or less by weight, about 6% or less by weight, about 5% or less by weight, about 4% or less by weight, about 3% or less by weight, about 2% or less by weight, or about 1% or less by weight.

[0093] In some preferred aspects, the dry particles contain an excipient selected from leucine, maltodextrin, mannitol and any combination thereof. In particular embodiments, the excipient is leucine, maltodextrin, or mannitol.

[0094] Aspects of the invention include respirable dry powders that contain respirable dry particles that contain one or more monovalent metal cation salts, such as a sodium salt and/or a potassium salt, but do not contain a pharmaceutically active agent, that are blended with a pharmaceutically active agent in powder form (e.g., micronized). These particles can be used as carrier particles. The respirable dry powder can include any desired pharmaceutically active agent, such as any of the pharmaceutically active agents described herein. -26- WO 2012/044736 PCT/US2011/053829 [0095] Aspects of the invention include, respirable dry particles that contain one or more monovalent metal cation salts, such as a sodium salt and/or a potassium salt, and further contain a pharmaceutically active agent, such as any of the pharmaceutically active agents described herein, in a co-formulation.

[0096] Suitable pharmaceutically active agents for use in the respirable dry powders and respirable dry particles include mucoactive or mucolytic agents, surfactants, antibiotics, antivirals, antihistamines, cough suppressants, bronchodilators, anti-inflammatory agents, steroids, vaccines, adjuvants, expectorants, macromolecules, or therapeutics that are helpful for chronic maintenance of cystic fibrosis (CF).

[0097] Preferred active agents include, but are not limited to, LABAs (e.g., formoterol, salmeterol), short-acting beta agonists (e.g., albuterol), corticosteroids (e.g., fluticasone), LAMAs (e.g., tiotropium), antibiotics (e.g., levofloxacin, tobramycin), antibodies (e.g., therapeutic antibodies), hormones (e.g. insulin), chemokines, cytokines, growth factors, and combinations thereof. When the dry powders are intended for treatment of CF, preferred additional active agents are short-acting beta agonists (e.g., albuterol), antibiotics (e.g., levofloxacin), recombinant human deoxyribonuclease 1 (e.g., domase alfa, also known as DNase), sodium channel blockers (e.g., amiloride), and combinations thereof. In certain embodiments, the pharmaceutically active agent(s) can be blended with the respirable dry particles described herein, or co-formulated (e.g., spray dried) as desired.

[0098] In some embodiments, the respirable dry particles and respirable dry powders can contain an agent that disrupts and/or disperses biofilms. Suitable examples of agents to promote disruption and/or dispersion of biofilms include specific amino acid stereoisomers, e.g., D-leucine, D-methionine, D-tyrosine, D-tryptophan, and the like. (Kolodkin-Gal, I., D. Romero, et al. "D-amino acids trigger biofilm disassembly." Science 328(5978): 627-629.) For example, all or a portion of the leucine in the dry powders described herein which contain leucine can be D-leucine.

[0099] Examples of suitable mucoactive or mucolytic agents include MXJC5AC and MUC5B mucins, DNase, N-acetylcysteine (NAC), cysteine, nacystelyn, domase alfa, -27- WO 2012/044736 PCT/US2011/053829 gelsolin, heparin, heparin sulfate, P2Y2 agonists (e.g. UTP, INS365), nedocromil sodium, hypertonic saline, and mannitol, [00100] Suitable surfactants include L-alpha-phosphatidylcholine dipalmitoyl ("DPPC”), diphosphatidyl glycerol (DPPG), l,2-Dipalmitoyl-sn-glycero-3-phospho-L-serine (DPPS), 1,2“Dipalmitoyl-sn~glycero-3-phosphocholine (DSPC), l,2-Distearoyl-sn-glycero-3-phosphoethanolamine (DSPE), l-palmitoyl-2-oleoylphosphatidylcholine (POPC), fatty alcohols, polyoxyethylene-9-Iauryl ether, surface active fatty, acids, sorbitan trioleate (Span 85), glycocholate, surfactin, poloxomers, sorbitan fatty acid esters, tyloxapol, phospholipids, and alkylated sugars.

[001011 If desired, the respirable dry particles and respirable dry powders can contain an antibiotic. The antibiotic can be suitable for treating any desired bacterial infection. The respirable dry particles and respirable dry powders that contain an antibiotic can be used to reduce the spread of infection, either within a patient or from patient to patient. For example, the respirable dry particles and respirable dry powders for treating bacterial pneumonia or VAT, can farther comprise an antibiotic, such as a macrolide (e.g., azithromycin, clarithromycin and erythromycin), a tetracycline (e.g., doxycycline, tigecycline), a fluoroquinolone (e.g., gemifloxacin, levofloxacin, ciprofloxacin and mocifloxacin), a cephalosporin (e.g., ceftriaxone, defotaxime, ceftazidime, cefepime), a penicillin (e.g., amoxicillin, amoxicillin with clavulanate, ampicillin, piperacillin, and ticarcillin) optionally with a β-lactamase inhibitor (e.g., sulbactam, tazobactam and clavulanic acid), such as ampicillin-sulbactam, piperacillin-tazobactam and ticarcillin with clavulanate, an aminoglycoside (e.g., amikacin, arbekacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin, streptomycin, tobramycin, and apramycin), a penem or carbapenem (e.g. doripenem, ertapenem, imipenem and meropenem), a monobactam (e.g., aztreonam), an oxazolidinone (e.g., linezolid), vancomycin, glycopeptide antibiotics (e.g. telavancin), tuberculosis-mycobacterium antibiotics and the like.

[Θ01Θ21 If desired, the respirable dry particles and respirable dry powders can contain an agent for treating infections with mycobacteria, such as Mycobacterium tuberculosis. Suitable agents for treating infections with mycobacteria (e.g., M. tuberculosis') include an -28- WO 2012/044736 PCT/US2011/053829 aminoglycoside (e.g. capreomycin, kanamycin, streptomycin), a fluoroquinolone (e.g. ciprofloxacin, levofloxacin, moxifloxacin), isozianid and isozianid analogs (e.g. ethionamide), aminosalicylate, cycloserine, diarylquinoline, ethamhutol, pyrazinamide, protionamide, rifampin, and the like.

[00103] If desired, the respirable dry particles and respirable dry powders can contain a suitable antiviral agent, such as oseltamivir, zanamavir, amantidine, rimantadine, ribavirin, gancyclovir, valgancyclovir, foscavir, Cytogam® (Cytomegalovirus Immune Globulin), pleconaril, rupintrivir, palivizumab, motavizumab, cytarabine, docosanol, denotivir, cidofovir, and acyclovir. The respirable dry particles and respirable dry powders can contain a suitable anti-influenza agent, such as zanamivir, oseltamivir, amantadine, or rimantadine.

[00104] Suitable antihistamines include clemastine, asalastine, loratadine, fexofenadine and the like.

[00105] Suitable cough suppressants include benzonatate, benproperine, clobutinal, diphenhydramine, dextromethorphan, dibunate, fedrilate, glaucine, oxalamine, piperidione, opiods such as codeine and the like.

[00106] Suitable brochodilators include short-acting beta2 agonists, long-acting beta? agonists (LABA), long-acting muscarinic anagonists (LAMA), combinations of LABAs and LAMAs, methylxanthines, short-acting anticholinergic agents (may also be referred to as short acting anti-muscarinic), long-acting bronchodilators, and the like.

[00107] Suitable short-acting beta?, agonists include albuterol, epinephrine, pirhuterol, levalbuterol, metaproteronol, maxair, and the like.

[00108] Examples of albuterol sulfate formulations (also called salhutamol) include Inspiryl (AstraZeneca Pic), Salbutamol SANDOZ (Sanofi-Aventis), Asmasal clickhaler (Vectura Group Pic.), Ventolin® (GlaxoSmithKline Pic), Salhutamol GLAND (GlaxoSmithKline Pic), Airomir® (Teva Pharmaceutical Industries Ltd.), Pro Air HFA (Teva Pharmaceutical Industries Ltd.), S alamo 1 (Teva Pharmaceutical Industries Ltd.), Ipramol (Teva Pharmaceutical Industries Ltd), Albuterol sulfate TEVA (Teva Pharmaceutical Industries -29- WO 2012/044736 FCT/US2011/053829

Ltd), and the like. Examples of epinephrine include Epinephine Mist KING (King Pharmaceuticals, Inc.), and the like. Examples of pirhuterol as pirbuterol acetate include Maxair© (Teva Pharmaceutical Industries Ltd.), and the like. Examples of levalbuterol include Xopenex® (Sepracor), and the like. Examples of metaproteronol formulations as metaproteronol sulfate include Alupent® (Boehringer Ingelheim GmbH), and the like.

[00109] Suitable LABAs include salmeterol, formoterol and isomers (e.g., arformoterol), clenbuterol, tulobuterol, vilanterol (Revolair™), indacaterol, carmoterol, isoproterenol, procaterol, bambuterol, milveterol, olodaterol, and the like.

[00110] Examples of salmeterol formulations include salmeterol xinafoate as Serevent® (GlaxoSmithKline Pic), salmeterol as Inaspir (Laboratories Almirall, S.A.), Advair® HFA (GlaxoSmithKline PLC), Advair Diskus® (GlaxoSmithKline PLC, Theravance Inc), Plusvent (Laboratorios Almirall, S.A.), VR315 (Novartis, Vectura Group PLC) and the like. Examples of formoterol and isomers (e.g., arformoterol) include Foster (Chiesi Farmaceutici S.p.A), Atimos (Chiesi Farmaceutici S.p.A, Nycomed Intemaional Management), Flutiform® (Abbott Laboratories, SkyePharma PLC), MFF258 (Novartis AG), Formoterol clickhaler (Vectura Group PLC), Formoterol HFA (SkyePharma PLC), Oxis® (Astrazeneca PLC), Oxis pMDI (Astrazeneca), Foradil® Aerolizer (Novartis, Schering-Plough Corp, Merck), Foradil® Certihaler (Novartis, SkyePharma PLC), Symbicort® (AstraZeneca), VR632 (Novartis AG, Sandoz International GmbH), MFF258 (Merck & Co Inc, Novartis AG), Alvesco® Combo (Nycomed International Management GmbH, Sanofi-Aventis, Sepracor Inc), Mometasone furoate (Schering-Plough Corp), and the like. Examples of clenbuterol include Ventipulmin® (Boehringer Ingelheim), and the like. Examples of tulobuterol include Hokunalin Tape (Abbott Japan Co., Ltd., Maruho Co., Ltd.), and the like. Examples of vilanterol include Revolair™ (GlaxoSmithKline PLC), GSK64244 (GlaxoSmithKline PLC), and the like. Examples of indacaterol include QAB149 (Novartis AG, SkyePharma PLC), QMF149 (Merck & Co Inc) and the like. Examples of carmoterol include CHF4226 (Chiese Farmaceutici S.p.A., Mitsubishi Tanabe Pharma Corporation), CHF5188 (Chiesi Farmaceutici S.p.A), and the like. Examples of isoproterenol sulfate include Aludrin (Boehringer Ingelheim GmbH) and the like. Examples of procaterol include Meptin -30- WO 2012/044736 PCT/US2011/053829 clickhaler (Vectura Group PLC), and the like. Examples of bambuterol include Bambec (AstraZeneca PLC), and the like. Examples of milveterol include GSK159797C (GlaxoSmithKline PLC), TD3327 (Theravance Inc), and the like. Examples of olodaterol include BI1744CL (Boehringer Ingelheim GmbH) and the like.

[00111] Examples of LAMAs include tiotroprium (Spiriva), trospium chloride, glycopyrrolate, aclidinium, ipratropium and the like.

[00112] Examples of tiotroprium formulations include Spiriva® (Boehringer-Ingleheim, Pfizer), and the like. Examples of glycopyrrolate include Robinul® (Wyeth-Ayerst), Robinul® Forte (Wyeth-Ay erst), NVA237 (Novartis), and the like. Examples of aclidinium include Eklira® (Forest Labaoratories, Almirall), and the like.

[00113] Examples of combinations of LABAs and LAMAs include indacaterol with glycopyrrolate, formoterol with glycopyrrolate, indacaterol with tiotropium, olodaterol and tiotropium, vilanterol with a LAMA, and the like. Examples of combinations of formoterol with glycopyrrolate include PT003 (Pearl Therapeutics) and the like. Examples of combinations of olodaterol with tiotropium include BI1744 with Spirva (Boehringer Ingelheim) and the like. Examples of combinations of vilanterol with a LAMA include GSK573719 with GSK642444 (GlaxoSmithKline PLC), and the like.

[00114] Examples of combinations of indacaterol with glycopyrrolate include QVA149A (Novartis), and the like.

[00115] Examples of methylxanthine include aminophylline, ephedrine, theophylline, oxtriphylline, and the like.

[00116] Examples of aminophylline formulations include Aminophylline BOEHRINGER (Boehringer Ingelheim GmbH) and the like. Examples of ephedrine include Bronkaid® (Bayer AG), Broncholate (Sanofi-Aventis), Primatene® (Wyeth), Tedral SA®, Marax (Pfizer Inc) and the like. Examples of theophylline include Euphyllin (Nycomed International Management GmbH), Theo-dur (Pfizer Inc, Teva Pharmacetuical Industries Ltd) and the like. Examples of oxtriphylline include Choledyl SA (Pfizer Inc) and the like. -31- WO 2012/044736 PCT/US2011/053829 [00117] Examples of short-acting anticholinergic agents include ipratropium bromide, and oxitropium bromide.

[00118] Examples of ipratropium bromide formulations include Atrovent'®/Apoveni/ Inpratropio (Boehringer Ingelheim GmbH), Ipramol (Teva Pharmaceutical Industries Ltd) and the like. Examples of oxitropium bromide include Oxivent (Boehringer Ingelheim GmbH), and the like.

[00119] Suitable anti-inflammatory agents include leukotriene inhibitors, phosphodiesterase 4 (PDE4) inhibitors, other anti-inflammatory agents, and the like.

[00120] Suitable leukotriene inhibitors include montelukast formulations (cystinyl leukotriene inhibitors), masilukast. zafirleukast (leukotriene D4 and E4 receptor inhibitors), pranlukast, zileuton (5-lipoxygenase inhibitors), and the like.

[00121] Examples of montelukast (cystinyl leukotriene inhibitor) include Singulair® (Merck & Co Inc), Loratadine, montelukast sodium SCHERING (Schering-Plough Corp), MK0476C (Merck & Co Inc), and the like. Examples of masilukast include MCC847 (AstraZeneca PLC), and the like. Examples of zafirlukast (leukotriene D4 and E4 receptor inhibitor) include Accolate® (AstraZeneca PLC), and the like. Examples of pranlukast include Azlaire (Schering-Plough Corp), Examples of zileuton (5-LO) include Zyflo® (Abbott Laboratories), Zyflo CR® (Abbott Laboratories, SkyePharma PLC), Zileuton ABBOTT LABS (Abbott Laboratories), and the like. Suitable PDE4 inhibitors include cilomilast, roflumilast, oglemilast, tofimilast, and the like.

[00122] Examples of cilomilast formulations include Ariflo (GlaxoSmithKline PLC), and the like. Examples of roflumilast include Daxas® (Nycomed International Management GmbH, Pfizer Inc), APTA2217 (Mitsubishi Tanabe Pharma Corporation), and the like. Examples of oglemilast include GRC3886 (Forest Laboratories Inc), and the like. Examples of tofimilast include Tofimilast PFIZER INC (Pfizer Inc), and the like.

[00123] Other anti-inflammatory agents include omalizumab (anti-IgE immunoglobulin Daiichi Sankyo Company, Limited), Zolair (anti-IgE immunoglobulin, Genentech Inc, -32- WO 2012/044736 PCT/US2011/053829

Novartis AG, Roche Holding Ltd), Solfa (LTD4 antagonist and phosphodiesterase inhibitor, Takeda Pharmaceutical Company Limited), IL-13 and IL-13 receptor inhibitors (such as AMG-317, MILR1444A, CAT-354, QAX576, IMA-638, Anrukinzumab, IMA-026, MK-6105,DOM-0910, and the like), IL-4 and IL-4 receptor inhibitors (such as Pitrakinra, AER-003,AIR-645, APG-201, DOM-0919, and the like), IL-1 inhibitors such as canakinumab, CRTh2 receptor antagonists such as AZD1981 (CRTh2 receptor antagonist, AstraZeneca), neutrophil elastase inhibitor such as AZD9668 (neutrophil elastase inhibitor, from AstraZeneca), GW856553X Losmapimod (P38 kinase inhibitor, GlaxoSmithKline PLC), Arofylline LAB ALMIRALL (PDE-4 inhibitor, Laboratories Almirall, S.A.), ABT761 (5-LO inhibitor, Abbott Laboratories), Zyflo® (5-LO inhibitor, Abbott Laboratories), BT061 (anti-CD4 mAb, Boehringer Ingelheim GmbH), Corus (inhaled lidocaine to decrease eosinophils, Gilead Sciences Inc), Prograi® (IL-2-mediated T-cell activation inhibitor, Astellas Pharma), Bimosiamose PFIZER INC (selectin inhibitor, Pfizer Inc), R411 (α4 β!/α4 β7 integrin antagonist, Roche Holdings Ltd), Tilade® (inflammatory mediator inhibitor, Sanofi-Aventis), Orenica® (T-cell co-stimulation inhibitor, Bristol-Myers Squibb Company), Soliris® (anti-C5, Alexion Pharmaceuticals Inc), Entorken® (Farmacija d.o.o.), Excellair® (Syk kinase siRNA, ZaBeCor Pharmaceuticals, Baxter International Inc), KB003 (anti-GMCSF mAb, KaloBios Pharmaceuticals), Cromolyn sodiums (inhibit release of mast cell mediators): Cromolyn sodium BOEHRINGER (Boehringer Ingelheim GmbH), Cromolyn sodium TEVA (Leva Pharmaceutical Industries Ltd), Intal (Sanofi-Aventis), BI1744CL (oldaterol (β2-adrenoceptor antagonist) and tiotropium, Boehringer Ingelheim GmbH), NFk-B inhibitors, CXR2 antagaonists, HLE inhibitors, HMG-CoA reductase inhibitors and the like.

[00124] Anti-inflammatory agents also include compounds that inhibit/decrease cell signaling by inflammatory molecules like cytokines (e.g., IL-1, IL-4, IL-5, IL-6, IL-9, IL-13, IL-18 IL-25, IFN-a, IFN-β, and others), CC chemokines CCL-1 - CCL28 (some of which are also known as, for example, MCP-1, CCL2, RANTES), CXC chemokines CXCL1 - CXCL17 (some of which are also know as, for example, IL-8, MIP-2), growth factors (e.g., GM-CSF, NGF, SCF, TGF-β, EGF, VEGF and others) and/or their respective receptors. -33- WO 2012/044736 FCT/US2011/053829 [00125] Some examples of the aforementioned anti-inflammatory antagonists/inhibitors include ABN912 (MCP-1/CCL2, Novartis AG), AMG761 (CCR4, Amgen Inc), Enbrel* (TNF, Amgen Inc, Wyeth), huMAb OX40L GENENTECH (TNF superfamily, Genentech

Inc, AstraZeneca PLC), R4930 (TNF superfamily, Roche Holding Ltd), SB683699/Firategrast (VLA4, GlaxoSmithKline PLC), CNT0148 (TNFa, Centocor, Inc, Johnson & Johnson, Schering-Plough Corp); Canakinumab (IL-Ιβ, Novartis); Israpafant MITSUBISHI (PAF/IL-5, Mitsubishi Tanabe Pharma Corporation); IL-4 and IL-4 receptor antagonists/inhibitors: AMG317 (Amgen Inc), BAY 169996 (Bayer AG), AER-003 (Aerovance), APG-201 (Apogenix); IL-5 and IL-5 receptor antagonists/inhibitors: MEDI563 (AstraZeneca PLC, Medlmmune, Inc), Bosatria® (GlaxoSmithKline PLC), Cinquil® (Ception Therapeutic), TMC120B (Mitsubishi Tanabe Pharma Corporation), Bosatria (GlaxoSmithKline PLC), Reslizumab SCHERING (Schering-Plough Corp); MEDI528 (IL-9, AstraZeneca, Medlmmune, Inc); IL-13 and IL-13 receptor antagonists/inhibitors: TNX650 GENENTECH (Genentech), CAT-354 (AstraZeneca PLC, Medlmmune), AMG-317 (Takeda Pharmaceutical Company Limited), MK6105 (Merck & Co Inc), IMA-026 (Wyeth), IMA-638 Anrukinzumab (Wyeth), MILRI444A/Lebrikizumab (Genentech), QAX576 (Novartis), CNTO-607 (Centocor), MK-6105 (Merck, CSL); Dual IL-4 and IL-13 inhibitors: AIR645/ISIS369645 (ISIS Altair), DOM-0910 (GlaxoSmithKline, Domantis), Pitrakinra /AEROOl/Aerovant™ (Aerovance Inc), AMG-317 (Amgen), and the like.

[00126] Suitable steroids include corticosteroids, combinations of corticosteroids and LABAs, combinations of corticosteroids and LAMAs, combinations of corticosteroids, LABAs and LAMAs, and the like.

[00127] Suitable corticosteroids include budesonide, fluticasone, flunisolide, triamcinolone, beclomethasone, mometasone, ciclesonide, dexamethasone, and the like.

[00128] Examples of budesonide formulations include Captisol-Enabled® Budesonide Solution for Nebulization (AstraZeneca PLC), Pulmicort® (AstraZeneca PLC), Pulmicort® Flexhaler (AstraZeneca Pic), Pulmicort® HFA-MDI (AstraZeneca PLC), Pulmicort Respules® (AstraZeneca PLC), Inflammide (Boehringer Ingelheim GmbH), Pulmicort® HFA-MDI (SkyePharma PLC), Unit Dose Budesonide ASTRAZENECA (AstraZeneca PLC), -34- WO 2012/044736 PCT/US2011/053829

Budesonide Modulite (Chiesi Farmaceutici S.p.A), CHF5188 (Chiesi Farmaceutici S.p.A), Budesonide ABBOTT LABS (Abbott Laboratories), Budesonide clickhaler (Vestura Group PLC), Miflonide (Novartis AG), Xavin (Teva Pharmaceutical Industries Ltd.), Budesonide TEVA (Teva Pharmaceutical Industries Ltd.), Symbicort® (AstraZeneca K.K., AstraZeneca PLC), VR632 (Novartis AG, Sandoz International GmbH), and the like.

[00129] Examples of fluticasone propionate formulations include Flixotide Evohaler (GlaxoSmithKline PLC), Flixotide Nebules (GlaxoSmithKline Pic), Flovent® (GlaxoSmithKline Pic), Flovent® Diskus (GlaxoSmithKline PLC), Flovent® HFA (GlaxoSmithKline PLC), Flovent® Rotadisk (GlaxoSmithKline PLC), Advair® HFA (GlaxoSmithKline PLC, Theravance Inc), Advair Diskus® (GlaxoSmithKline PLC, Theravance Inc.), VR315 (Novartis AG, Vectura Group PLC, Sandoz International GmbH), and the like. Other formulations of fluticasone include fluticasone as Flusonal (Laboratorios Almirall, S.A.), fluticasone furoate as GW685698 (GlaxoSmithKline PLC, Thervance Inc.), Plusvent (Laboratorios Almirall, S.A.), Flutiform® (Abbott Laboratories, SkyePharma PLC), and the like.

[00130] Examples of flunisolide formulations include Aerobid® (Forest Laboratories Inc), Aerospan® (Forest Laboratories Inc), and the like. Examples of triamcinolone include Triamcinolone ABBOTT LABS (Abbott Laboratories), Azmacort® (Abbott Laboratories, Sanofi-Aventis), and the like. Examples of beclomethasone dipropionate include Beclovent (GlaxoSmithKline PLC), QVAR® (Johnson & Johnson, Schering-Plough Corp, Teva Pharmacetucial Industries Ltd), Asmabec clickhaler (Vectura Group PLC), Beclomethasone TEVA (Teva Pharmaceutical Industries Ltd), Vanceril (Schering-Plough Corp), BDP Modulite (Chiesi Farmaceutici S.p.A.), Clenil (Chiesi Farmaceutici S.p.A), Beclomethasone dipropionate TEVA (Teva Pharmaceutical Industries Ltd), and the like. Examples of mometasone include QAB149 Mometasone furoate (Schering-Plough Corp), QMF149 (Novartis AG), Fomoterol fumarate, mometoasone furoate (Schering-Plough Corp), MFF258 (Novartis AG, Merck & Co Inc), Asmanex® Twisthaler (Schering-Plough Corp), and the like. Examples of cirlesonide include Alvesco® (Nycomed International Management GmbH, Sepracor, Sanofi-Aventis, Tejin Pharma Limited), Alvesco® Combo (Nycomed International -35- WO 2012/044736 PCT/US2011/053829

Management GmbH, Sanofi-Aventis), Alvesco® HFA (Nycomed Intenational Management GmbH, Sepracor Inc), and the like. Examples of dexamethasone include DexPak® (Merck), Decadron® (Merck), Adrenocot, CPC-Cort-D, Decaject-10, Solurex and the like. Other corticosteroids include Etiprednol dicloacetate TEVA (Teva Pharmaceutical Industries Ltd), and the like.

[00131] Combinations of corticosteroids and LABAs include salmeterol with fluticasone, formoterol with budesonide, formoterol with fluticasone, formoterol with mometasone, indacaterol with mometasone, and the like.

[00132] Examples of salmeterol with fluticasone include Plusvent (Laboratories Almirall, S.A.), Advair® HFA (GlaxoSmithKline PLC), Advair® Diskus (GlaxoSmithKline PLV, Theravance Inc), VR315 (Novartis AG, Vectura Group PLC, Sandoz International GmbH) and the like. Examples of formoterol with budesonide include Symbicort® (AstraZeneca PLC), VR632 (Novartis AG, Vectura Group PLC), and the like. Examples of vilanterol with fluticasone include GSK642444 with fluticasone and the like. Examples of formoterol with fluticasone include Flutiform® (Abbott Laboratories, SkyePharma PLC), and the like. Examples of formoterol with mometasone include Dulera®/MFF258 (Novartis AG, Merck & Co Inc), and the like. Examples of indacaterol with mometasone include QAB149 Mometasone furoate (Schering-Plough Corp), QMF149 (Novartis AG), and the like. Combinations of corticosteroids with LAMAs include fluticasone with tiotropium, budesonide with tiotropium, mometasone with tiotropium, salmeterol with tiotropium, formoterol with tiotropium, indacaterol with tiotropium, vilanterol with tiotropium, and the like. Combinations of corticosteroids with LAMAs and LABAs include, for example, fluticasone with salmeterol and tiotropium.

[00133] Other anti-asthma molecules include: ARD111421 (VIP agonist, AstraZeneca PLC), AVE0547 (anti-inflammatory, Sanofi-Aventis), AVE0675 (TLR agonist, Pfizer, Sanofi-Aventis), AVE0950 (Syk inhibitor, Sanofi-Aventis), AVE5883 (NK1/NK2 antagonist, Sanofi-Aventis), AVE8923 (tryptase beta inhibitor, Sanofi-Aventis), CGS21680 (adenosine A2A receptor agonist, Novartis AG), ATL844 (A2B receptor antagonist, Novartis AG), BAY443428 (tryptase inhibitor, Bayer AG), CHF5407 (M3 receptor inhibitor, Chiesi -36- WO 2012/044736 PCT/US2011/053829

Farmaceutici S.p.A.), CPLA2 Inhibitor WYETH (CPLA2 inhibitor, Wyeth), ΪΜΑ-638 (IL-13 antagonist, Wyeth), LAS100977 (LABA, Laboratorios Almirall, S.A.), MABA (M3 and β2 receptor antagonist, Chiesi Farmaceutici S.pA), R1671 (mAb, Roche Holding Ltd), CS003 (Neurokinin receptor antagonist, Daiichi Sankyo Company, Limited), DPC168 (CCR antagonist, Bristol-Myers Squibb), E26 (anti-IgE, Genentech Inc), HAE1 (Genentech), IgE inhibitor AMGEN (Amgen Inc), AMG853 (CRTH2 and D2 receptor antagonist, Amgen), IPL576092 (LSAID, Sanofi-Aventis), ΕΡΪ2010 (antisense adenosine 1, Chiesi Farmaceutici S.p.A,), CHF5480 (PDE-4 inhibitor, Chiesi Farmaceutici S.p.A.), KI04204 (corticosteroid, Abbott Laboratories), SVT47060 (Laboratorios Salvat, S.A.), VML530 (leukotriene synthesis inhibitor, Abbott Laboratories), LAS35201 (M3 receptor antagonist, Laboratorios Almirall, S.A.), MCC847 (D4 receptor antagonist, Mitsubishi Tanabe Pharma Corporation), MEM1414 (PDE-4 inhibitor, Roche), TA270 (5-LO inhibitor, Chugai Pharmaceutical Co Ltd), TAK66I (eosinophil chemotaxis inhibitor, Takeda Pharmaceutical Company Limited), TBC4746 (VLA-4 antagonist, Schering-Plough Corp), VR694 (Vectura Group PLC), PLD177 (steroid, Vectura Group PLC), KI03219 (corticosteroid + LABA, Abbott Laboratories), AMG009 (Amgen Inc), AMG853 (D2 receptor antagonist, Amgen Inc); [00134] AstraZeneca PLC: AZD1744 (CCR3/histamine-l receptor antagonist, AZD1419 (TLR9 agonist), Mast Cell inhibitor ASTRAZENECA, AZD3778 (CCR antagonist), DSP3025 (TLR7 agonist), AZD1981 (CRTh2 receptor antagonist), AZD5985 (CRTh2 antagonist), AZD8075 (CRTh2 antagonist), AZD1678, AZD2098, AZD2392, AZD3825 AZD8848, AZD9215, ZD2138 (5-LO inhibitor), AZD3199 (LABA); [00135] GlaxoSmithKline PLC: GW328267 (adenosine A2 receptor agonist), GW559090 (a4 integrin antagonist), GSK679586 (mAb), GSK597901 (adrenergic β2 agonist), AM103 (5-LO inhibitor), GSK256006 (PDE4 inhibitor), GW842470 (PDE-4 inhibitor), GSK870086 (glucocorticoid agonist), GSK159802 (LABA), GSK256066 (PDE- 4 inhibitor), GSK642444 (LABA, adrenergic β2 agonist), GSK64244 and Revolair (fluticasone/vilanterol), GSK799943 (corticosteroid), GSK573719 (mAchR antagonist), and GSK573719; -37- WO 2012/044736 PCT/US2011/053829 [00136] Pfizer Inc: PF3526299, PF3893787, PF4191834 (FLAP antagonist), PF610355 (adrenergic β2 agonist), CP664511 (a4pl/VCAM-l interaction inhibitor), CP609643 (inhibitor of ot4pl/VCAM-l interactions), CP690550 (JAK3 inhibitor), SAR21609 (TLR9 agonist), AVE7279 (Thl switching), TBC4746 (VLA-4 antagonist); R343 (IgE receptor signaling inhibitor), SEP42960 (adenosine A3 antagonist); [00137] Sanofi-Aventis: MLN6095 (CrTH2 inhibitor), SAR137272 (A3 antagonist), SAR21609 (TLR9 agonist), SAR389644 (DPI receptor antagonist), SAR398171 (CRTH2 antagonist), SSR161421 (adenosine A3 receptor antagonist); [00138] Merck & Co Inc: MK0633, MR0633, MK0591 (5-LO inhibitor), MK886 (leukotriene inhibitor), BIO 1211 (VLA-4 antagonist); Novartis AG: QAE397 (long-acting corticosteroid), QAK423, QAN747, QAP642 (CCR3 antagonist), QAX935 (TLR9 agonist), NVA237 (LAMA).

[00139] The pharmaceutically active agent can also be selected from the group consisting of transient receptor potential (TRP) channel agonists. In certain embodiments, the TRP agonist is a TRPC, TRPV, TRPM and/or TRPA1 subfamily agonist. In some embodiments, the TRP channel agonist is selected from the group consisting of TRPV2, TRPV3, TRPV4, TRPC6, TRPM6, and/or TRPA1 agonist. Suitable TRP channel agonists may be selected from the group consisting of allyl isothiocyanate (AITC), benyzl isothiocyanate (BITC), phenyl isothiocyanate, isopropyl isothiocyanate, methyl isothiocyanate, diallyl disulfide, acrolein (2-propenal), disiilfiram (Antabuse®), famesyl thiosalicylic acid (FTS), famesyl thioacetic acid (FT A), chlodantoin (Sporostacin®, topical fungicidal), (15-d-PGJ2), 5,8,11,14 eicosatetraynoic acid (ETYA), dibenzoazepine, mefenamic acid, fluribiprofen, keoprofen, diclofenac, indomethacin, SC alkyne (SCA), pentenal, mustard oil alkyne (MOA), iodoacetamine, iodoacetamide alkyne, (2-aminoethyl) methanethiosulphonate (MTSEA), 4-hydroxy-2-noneal (HNE), 4-hydroxy xexenal (HHE), 2-chlorobenzalmalononitrile, N-chloro tosylamide (chloramine-T), formaldehyde, isoflurane, isovelleral, hydrogen peroxide, URB597, thiosulfinate, Allicin (a specific thiosulfinale), flufenamic acid, niflumic acid, carvacrol, eugenol, menthol, gingerol, icilin, methyl salicylate, arachidonic acid, cinnemaldehyde, super sinnemaldehyde, tetrahydrocannabinol (THC or A9-THC), -38- WO 2012/044736 PCT/US2011/053829 cannabidiol (CBD), cannabichromene (CBC), cannabigerol (CBG), THC acid (THC-A), CBD acid (CBD-A), Compound 1 (AMG5445), 4-inethyl-'V-[2,2,2-1nchloro-l-(4- chlorophenylsulfanyl) ethyl]benzamide, V-[2,2,2-trichloro-l-(4-chlorophenylsulfanyl)ethyl] acetamid, AMG9090, AMG5445, 1 -oleoyl-2-acetyl-sn-glycerol (OAG), carbachol,

diacylglycerol (DAG), 1,2-Didecanoylglycerol, flufenamate/flufenamic acid, niflumate/niflumic acid, hyperforin, 2-aminoethoxydiphenyl borate (2-APB), diphenylborinic anhydride (DPBA), delta-9-tetrahydrocannabinol (A9-THC or THC), cannabiniol (CBN), 2-APB, 0-1821, 11-hydroxy- z\9-tetrahydrocannabinol, nabilone, CP55940, HU-210, HU-211/dexanabinol, HU-331, HU-308, JWH-015, WIN55,212-2, 2-Arachidonoylglycerol (2-AG), Arvil, PEA, AM404, 0-1918, JWH-133, incensole, incensole acetate, menthol, eugenol, dihydrocarveol, carveol, thymol, vanillin, ethyl vanillin, cinnemaldehyde, 2 aminoethoxy diphenyl borate (2-APB), diphenylamine (DPA), diphenylborinic anhydride (DPBA), camphor, (+)-bomeol, (-)-isopinocampheol, (-)-fenchone, (-)-trans-pinocarveol, isobomeol, (+)-camphorquinone, (-)-a-thujone, a-pinene oxide, 1,8-cineole/eucalyptol, 6-bulyl-m-cresol, carvacrol, p-sylenol, kreosol, propofol, p-cymene, (-)-isoppulegol, (-)-carvone, (+)-dihydrocarvone, (-)-menthone, (+)-linalool, geraniol, l-isopropyl-4-methylhicyclo[ 3.1.0]hexan-4-ol, 4aPDD, GSK1016790A, 5'6'Epoxyeicosatrienoic (5’6’-EET), 8’9’Epoxyeicosatrienoic (8'9’-EET), APP44-1, RN1747, Formulation lb W0200602909, Formulation lib W0200602909, Formulation He W0200602929, Formulation lid W0200602929, Formulation Illb W0200602929, Formulation IIIc W0200602929, arachidonic acid (AA), 12-O-Tetradecanoylphorbol-13-acetate (TPA)/phorbol 12-myristate 13-acetate (PMA), bisandrographalide (BAA), incensole, incensole acetate, Compound IX W02010015965, Compound X WO2010015965, Compound XI WO2010015965, Compound XII WO2010015965, W02009004071, W02006038070, W02008065666, Formula VII W02010015965, Formula IV WO2010015965, dibenzoazepine, dibenzooxazepine, Formula I W02009071631, N-{(1S)-l-(({(4R)~l-[(4-chlorophenyl)sulfonyl]-3-oxohexahydro-lHazepin- 4-yl}amino)carbonyl]-3-methylbutyl)-l-benzothiophen-2-carboxamide, N-{(1S)-1- [({(4R)-l-[(4- fluorophenyl)sulfonyl]-3-oxohexahydro-1 H-azepin-4-yl) amino)carbonyI]-3- methylbutyl} -l-benzothiophen-2-carboxamide, N- {(1 S)~l -[({(4R)~ 1-((2- cyanophenyl)sulfonyl]-3- -39- WO 2012/044736 PCT/US2011/053829 oxohexahydro-1 H-azepin-4-yl} amino)carbony 1]-3 -methylbuty 1} -1 - methyl-1 H-indole-2- carboxamide, and N- {(1S)-1 - [({(4R)- 1 -[(2- cyanophenyl)sulfonyl]hexahydro-1 H-azepin-4-yl} amino)carbonyl]-3-methylbutyl} -1-methyl-1 H-indole-2-carboxamide.

[00140] Suitable expectorants include guaifenesin, guaiacolculfonate, ammonium chloride, potassium iodide, tyloxapol, antimony peritasulfide and the like.

[00141] Suitable vaccines include nasally inhaled influenza vaccines and the like.

[00142] Suitable macromolecules include proteins and large peptides, polysaccharides and oligosaccharides, DNA and RNA nucleic acid molecules and their analogs having therapeutic, prophylactic or diagnostic activities. Proteins can include growth factors, hormones, cytokines (e.g., chemokines), and antibodies. As used herein, antibodies can include: all types of immunoglobulins, e.g. IgG, IgM, IgA, IgE, IgD, etc., from any source, e.g. human, rodent, rabbit, cow, sheep, pig, dog, other mammals, chicken, other avian, aquatic animal species etc., monoclonal and polyclonal antibodies, single chain antibodies (including IgNAR (single-chain antibodies derived from sharks)), chimeric antibodies, bifunctional/bispecific antibodies, humanized antibodies, human antibodies, and complementary determining region (CDR)- grafted antibodies, that are specific for the target protein or fragments thereof, and also include antibody fragments, including Fab, Fab’, F(ah')2, scFv, Fv, camelbodies, microantibodies, nanobodies, and small-modular immunopharmaceuticals (SMIPs). Nucleic acid molecules include DNA, e.g. encoding genes or gene fragments, or RNA, including mRNA, antisense molecules, such as antisense RNA, RNA molecules involved in RNA interference (RNAi), such as microRNA (miRNA), small interfering RNA (siRNA) and small hairpin RNA (shRNA), ribozymes or other molecules capable of inhibiting transcription and/or translation. Preferred macromolecules have a molecular weight of at least 800 Da, at least 3000 Da or at least 5000 Da.

[00143] In preferred embodiments, the respirable dry powder or respirable dry particle comprises a therapeutic antibody. In certain preferred embodiments, the antibody is a monoclonal antibody. In certain preferred embodiments, the antibody is a single chain antibody, a chimeric antibody, a bifunctional/bispecific antibody, a humanized antibody, or a -40- WO 2012/044736 PCT/US2011/053829 combination thereof. In preferred embodiments, the antibody is selected from the group consisting of: monoclonal antibodies, e.g. Abciximab (ReoPro®, chimeric), Adalimumab (Humira®, human), Alemtuzumab (Campalh®, humanized), Basiliximab (Si mu led®, chimeric), Belimumab (Benlysta®, human), Bevacizumab (Avastin®, humanized), Brentuximab vedotin (Adcetris®, chimeric), Canakinumab (Haris®, human), Cetuximab (Erbitux®, chimeric), Certolizumab pegol (Cimzia®, humanized), Daclizumab (Zenapax®, humanized), Denosumab (Prolia®, Xgeva®, human), Eculizumab (Soliris®, humanized), Efalizumah (Raptiva®, humanized), Gemtuzumab (Mylotarg®, humanized), Golimumab (Simponi®, human), Ibritumomab tiuxetan (Zevalin®, murin), Infliximab (Remicade®, chimeric), Ipilimumab (MDX-101) (Yervoy®, human), Muromonab-CDS (Orthoclone OKT3, murine), Natalizumab (Tysabri®, humanized), Ofatumumah (Arzerra®, human), Omalizumab (Xolair®, humanized), Palivizumab (Synagis®, humanized), Panitumumab (Vectibix®, human), Ranibizumab (Lucentis®, humanized), Rituximab (Rituxan®, Mabthera®, chimeric), Tocilizumab (or Atlizumab) (Actemra® and RoActemra®, humanized), Tositumomab (Bexxar®, murine), Trastuzumab (Herceptin®, humanized), and bispecific antibodies, e.g. catumaxomab (Removab®, rat-mouse hybrid monoclonal antibody).

[00144] Selected macromolecule active agents for systemic applications include, but are not limited to: Ventavis® (Iloprost), Calcitonin, Erythropoietin (EPO), Factor IX, Granulocyte Colony Stimulating Factor (G-CSF), Granulocyte Macrophage Colony, Stimulating Factor (GM-CSF), Growth Hormone, Insulin, TGF-heta, Interferon Alpha, Interferon Beta, Interferon Gamma, Luteinizing Hormone Releasing Hormone (LHRH), follicle stimulating hormone (FSH), Ciliary Neurotrophic Factor, Growth Hormone Releasing Factor (GRF), Insulin-Like Growth Factor, Insulinotropin, Interleukin-1 Receptor Antagonist, Interleukin-3, Interleukin-4, Interleukin-6, Macrophage Colony Stimulating Factor (M-CSF), Thymosin Alpha 1, Ilb/IIIa Inhibitor, Alpha-1 Antitrypsin, Anti-RSV Antibody, palivizumab, motavizumab, and ALN-RSV, Cystic Fibrosis Transmembrane Regulator (CFTR) Gene, Deoxyribonuclase (DNase), Heparin, Bactericidal/Permeability Increasing Protein (BPI), Anti- Cytomegalovirus (CMV) Antibody, Interleukin-1 Receptor Antagonist, and the like, alpha-defensins (e.g. human neutrophil proteins (HNPs): HNP1, 2, 3, and 4; human defensins 5 and 6 (HD5 and HD6)), beta-defensins (HBD1, 2, 3, and 4), or Θ-d efen sins/retrocy clins, -41 - WO 2012/044736 PCT/US2011/053829 GLP-1 analogs (liraglutide. exenatide, etc.), Domain antibodies (dAbs), Pramlintide acetate (Symlin), Leptin analogs, Synagis (palivizumab, Medlmmune) and cisplatin. In certain preferred embodiments, the respirable dry powder or respirable dry particle comprises a macromolecule involved in intra- or inter-cellular signaling, such as a growth factor, a cytokine, a chemokine or a hormone. In preferred embodiments, the respirable dry powder or respirable dry particle comprises a hormone. In certain preferred embodiments, the hormone is insulin.

[00145] Selected therapeutics helpful for chronic maintenance of CF include antibiotics/macrolide antibiotics, bronchodilators, inhaled LABAs, and agents to promote airway secretion clearance. Suitable examples of antibiotics/macrolide antibiotics include tobramycin, azithromycin, ciprofloxacin, colistin, aztreonam and the like. Another exemplary antihiotic/macrolide is levofloxacin. Suitable examples of bronchodilators include inhaled short-acting beta2 agonists such as albuterol, and the like. Suitable examples of inhaled LABAs include salmeterol, formoterol, and the like. Suitable examples of agents to promote airway secretion clearance include Pulmozyme (domase alfa, Genentech) hypertonic saline, DNase, heparin, and the like. Selected therapeutics helpful for the prevention and/or treatment of CF include VX-770 (Vertex Pharmaceuticals) and amiloride.

[00146] Selected therapeutics helpful for the treatment of idiopathic pulmonary fibrosis include Metelimumah (CAT-192) (TGF-βΙ mAb inhibitor, Genzyme), Aerovant™ (AER001, pitrakinra) (Dual IL-13, IL-4 protein antagonist, Aerovance), Aeroderm™ (PEGylated Aerovant, Aerovance), microRNA, RNAi, and the like.

[00147] In preferred embodiments, the respirable dry powder or respirable dry particle comprises an antibiotic, such as a macrolide (e.g., azithromycin, clarithromycin and erythromycin), a tetracycline (e.g., doxycycline, tigecycline), a fluoroquinolone (e.g,, gemifloxacin, levofloxacin, ciprofloxacin and mocifloxacin), a cephalosporin (e.g., ceftriaxone, defotaxime, ceftazidime, cefepime), a penicillin (e.g., amoxicillin, amoxicillin with clavulanate, ampicillin, piperacillin, and ticarcillin) optionally with a β-lactamase inhibitor (e.g., sulbactam, tazobactam and clavulanic acid), such as ampicillin-sulbactam, piperacillin-tazobactam and ticarcillin with clavulanate, an aminoglycoside (e.g., amikacin, -42- WO 2012/Θ44736 PCT/US2011/053829 arbekacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin, streptomycin, tobramycin, and apramycin), a penem or carbapenem (e.g. doripenem, ertapenem, imipenem and meropenem), a monobactam (e.g., aztreonam), an oxazolidinone (e.g., linezolid), vancomycin, gly copeptide antibiotics (e.g. telavancin), tuberculosis-mycobacterium antibiotics, tobramycin, azithromycin, ciprofloxacin, colistin, and the like. In a preferred embodiment, the respirable dry powder or respirable dry particle comprises levofloxacin. In another preferred embodiment, the respirable dry powder or respirable dry particle comprises aztreonam or a pharmaceutically acceptable salt thereof (i.e., Cays ton®). In a further preferred embodiment, the respirable dry powder or respirable dry particle does not comprise tobramycin. In another embodiment, the respirable dry powder or respirable dry particle does not comprise levofloxacin. In another embodiment, the respirable dry powder or respirable dry particle does not comprise Cayston®.

[00148] In preferred embodiments, the respirable dry powder or respirable dry particle comprises a LABA, such as salmeterol, formoterol and isomers (e.g., arformoterol), clenbuterol, tulobuterol, vilanterol (Revolair™), indacaterol, carmoterol, isoproterenol, procaterol, bambuterol, milveterol, and the like. In a further preferred embodiment, the respirable dry powder or respirable dry particle comprises formoterol. In a further preferred embodiment, the respirable dry powder or respirable dry particle comprises salmeterol. When the dry powders are intended for treatment of CF, preferred additional therapeutic agents are short-acting beta agonists (e.g., albuterol), antibiotics (e.g., levofloxacin), recombinant human deoxyribonuclease I (e.g., domase alfa, also known as DNAse), sodium channel blockers (e.g., amiloride), and combinations thereof.

[00149] In preferred embodiments, the respirable dry powder or respirable dry particle comprises a LAMA, such as tiotroprium, glycopyrrolate, aclidinium, ipratropium and the like. In a further preferred embodiment, the respirable dry powder or respirable dry particle comprises tiotropium.

[00150] In preferred embodiments, the respirable dry powder or respirable dry particle comprises a corticosteroid, such as hudesonide, fluticasone, flunisolide, triamcinolone, beclomethasone, mometasone, ciclesonide, dexamethasone, and the like. In a further -43- WO 2012/044736 PCT/US2011/053829 preferred embodiment, the respirable dry powder or respirable dry particle comprises fluticasone.

[0015111η preferred embodiments, the respirable dry powder or respirable dry particle comprises a combination of two or more of the following; a LABA, a LAMA, and a corticosteroid. In a further preferred embodiment, the respirable dry powder or respirable dry particle comprises fluticasone and salmeterol. In a further preferred embodiment, the respirable dry powder or respirable dry particle comprises fluticasone, salmeterol, and tiotropium.

[00152] When an additional therapeutic agent is administered to a patient with a dry powder or dry particles disclosed herein, the agent and the dry powder or dry particles are administered to provide overlap of the therapeutic effect of the additional therapeutic agent with the administration of the dry powder or dry particles. For example, a LABA such as formoterol, or a short-acting beta agonist such as albuterol can be administered to the patient before a dry powder or dry particle, as described herein, is administered.

[00153] In preferred embodiments, the respirable dry powder or respirable dry particle does not comprise a surfactant, such as L-alpha-phosphatidylcholine dipalmitoyl ("DPPC*'), diphosphatidyl glycerol (DPPG), l,2-Dipalmitoyl-sn-glycero-3-phospho-L-serine (DPPS), l,2-Dipalmitoyl-sn-glycero-3-phosphocholine (DSPC), l,2-Distearoyl-sn-glycero-3-phosphoethanolamine (DSPE), 1 -palmitoyl-2-oieoylphosphatidylcholine (POPC), fatty alcohols, polyoxyethylene-9-lauryl ether, surface active fatty, acids, sorbitan trioleate (Span 85), glycocholate, surfactin, poloxomers, sorbitan fatty acid esters, tyloxapol, phospholipids, or alkylated sugars.

Dry Powder and Dry Particle Properties [00154] The dry particles of the invention are preferably small and dispersible, and can be sodium cation (Na+) and/or potassium cation (K+) dense. Generally, the dry particles of the invention have a VMGD as measured by HELOS/RODOS at 1.0 bar of about 10 pm or less (e.g., about 0.1 pm to about 10 pm). Preferably, the dry particles of the invention have a -44- WO 2012/044736 PCT/US2011/053829 VMGD of about 9 pan or less (e.g., about 0.1 pm to about 9 pm), about 8 pm or less (e.g., about 0.1 pm to about 8 pm), about 7 pm or less (e.g., about 0.1 pm to about 7 pm), about 6 pm or less (e.g., about 0.1 pm to about 6 pm), about 5 pm or less (e.g., less than 5 pm, about 0.1 pm to about 5 pm), about 4 pm or less (e.g., 0.1 pm to about 4 pm), about 3 pm or less (e.g., 0.1 pm to about 3 pm), about 2 pm or less (e.g., 0,1 pm to about 2 pm), about 1 pm or less (e.g., 0.1 pm to about 1 pm), about 1 pm to about 6 pm, about 1 pm to about 5 pm, about 1 pm to about 4 pm, about 1 pm to about 3 pm, or about 1 pm to about 2 pm as measured by HELOS/RODOS at 1.0 bar.

[00155] The respirable dry powders of the invention can have poor flow properties, such as bulk flow properties, for example as assessed by Hausner Ratio, as described herein. Yet, surprisingly, the powders are highly dispersible. This is surprising because flow properties and dispersibility are both known to be negatively affected by particle agglomeration or aggregation. Thus, it was unexpected that particles that have poor flow characteristics, such as bulk flow characteristics, would be highly dispersible.

[00156] The respirable dry powders can have a Hausner Ratio that is at least 1.5, and can be at least 1.6, at least 1.7, at least 1.8, at least 1.9, at least 2.0, at least 2.1, at least 2.2, at least 2.3, at least 2.4, at least 2.5, at least 2.6 or at least 2.7.

[00157] Generally, the dry particles of the invention are dispersible, and have 1 bar/4 bar and/or 0.5 bar/4 bar and/or 0.2 bar/4 bar and/or 0.2 bar/2 bar of about 2.2 or less (e.g., about 1.0 to about 2.2) or about 2.0 or less (e.g., about 1.0 to about 2.0). Preferably, the dry particles of the invention have 1 bar/4 bar and/or 0.5 bar/4 bar of about 1.9 or less (e.g., about 1.0 to about 1.9), about 1.8 or less (e.g., about 1.0 to about 1.8), about 1.7 or less (e.g., about 1.0 to about 1.7), about 1,6 or less (e.g., about 1.0 to about 1.6), about 1.5 or less (e.g., about 1.0 to about 1,5), about 1.4 or less (e.g., about 1.0 to about 1.4), about 1.3 or less (e.g., less than 1,3, about 1.0 to about 1.3), about 1.2 or less (e.g., 1.0 to about 1.2), about 1.1 or less (e.g., 1.0 to about 1.1 pm) or the dry particles of the invention have 1 bar/4 bar and/or 0.5 bar/4 bar of about 1.0. Preferably 1 bar/4 bar and/or 0.5 bar/4 bar are measured by laser diffraction using a HELOS/RODOS system. -45- WO 2012/044736 PCT/US2011/053829 [00158] Alternatively or in addition, the respirable dry particles of the invention can have an MM AD of about 10 microns or less, such as an MM AD of about 0.5 micron to about 10 microns. Preferably, the dty particles of the invention have an MMAD of about 5 microns or less (e.g., about 0.5 micron to about 5 microns, preferably about 1 micron to about 5 microns), about 4 microns or less (e.g., about 1 micron to about 4 microns), about 3.8 microns or less (e.g., about 1 micron to about 3.8 microns), about 3.5 microns or less (e.g, about 1 micron to about 3.5 microns), about 3.2 microns or less (e.g., about 1 micron to about 3.2 microns), about 3 microns or less (e.g., about 1 micron to about 3.0 microns), about 2.8 microns or less (e.g., about 1 micron to about 2.8 microns), about 2.2 microns or less (e.g, about 1 micron to about 2.2 microns), about 2.0 microns or less (e.g., about 1 micron to about 2.0 microns) or about 1.8 microns or less (e.g., about 1 micron to about 1.8 microns).

[00159] Alternatively or in addition, the respirable dry powders and dry particles of the invention can have an FPF of less than about 5.6 microns (FPF<5.6 pm) of at least about 20%, at least about 30%, at least about 40%, preferably at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, or at least about 70%.

[00160] Alternatively or in addition, the dry powders and dry particles of the invention have a FPF of less than 5.0 microns (FPF_TD<5.0 pm) of at least about 20%, at least about 30%, at least about 45%, preferably at least about 40%, at least about 45%, at least about 50%, at least about 60%, at least about 65% or at least about 70%. Alternatively or in addition, the dry powders and dry particles of the invention have a FPF of less than 5.0 microns of the emitted dose (FPF_ED<5.0 pm) of at least about 45%, preferably at least about 50%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, or at least about 85%. Alternatively or in addition, the dry powders and dry particles of the invention can have an FPF of less than about 3.4 microns (FPF<3.4 pm) of at least about 20%, preferably at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, or at least about 55%.

[00161] Alternatively or in addition, the respirable dry powders and dry particles of the invention have a tap density of about 0.1 g/cm3 to about 1.0 g/cm3. For example, the small and dispersible dry particles have a tap density of about 0.1 g/cm3 to about 0.9 g/cm3, about -46- WO 2012/044736 PCT/US2011/053829 0.2 g/cm3 to about 0.9 g/cm3 , about 0.2 g/cm3 to about 0.9 g/cm3, about 0.3 g/cm3 to about 0.9 g/cm3, about 0.4 g/cm3 to about 0.9 g/cm3, about 0.5 g/cm3 to about 0.9 g/cm3, or about 0,5 g/cm3 to about 0.8 g/cm3, greater than about 0.4 g/cc, greater than about 0.5 g/cc, greater than about 0.6 g/cc, greater than about 0.7 g/cc, about 0.1 g/cm3 to about 0.8 g/cm3, about 0.1 g/cm3 to about 0.7 g/cm3, about 0.1 g/cm3 to about 0.6 g/cm3 , about 0.1 g/cm3 to about 0.5 g/cm3, about 0.1 g/cm3 to about 0.4 g/cm3, about 0.1 g/cm3 to about 0.3 g/cm3, less than 0.3 g/cm3. In a preferred embodiment, tap density is greater than about 0.4 g/cm3. In another preferred embodiment, tap density is greater than about 0.5 g/ cm3. Alternatively, tap density is less than about 0.4 g/cc.

[00162] Alternatively or in addition, the respirable dry powders and dry particles of the invention can have a water or solvent content of less than about 15% by weight of the respirable dry particle. For example, the respirable dry particles of the invention can have a water or solvent content of less than about 15% by weight, less than about 13% by weight, less than about 11.5% by weight, less than about 10% by weight, less than about 9% by weight, less than about 8% by weight, less than about 7% by weight, less than about 6% by weight, less than about 5% by weight, less than about 4% by weight, less than about 3% by weight, less than about 2% by weight, less than about 1% by weight or he anhydrous. The respirable dry particles of the invention can have a water or solvent content of less than about 6% and greater than about 1%, less than about 5.5% and greater than about 1.5%, less than about 5% and greater than about 2%, about 2%, about 2.5%, about 3%, about 3.5%, about 4%, about 4.5% about 5%.

[00163] The dissolution of the respirable dry powders and respirable dry particles upon deposition of the dry powder or particles in the lungs may be rapid or sustained. The period of sustained dissolution, in one aspect, is on the time scale of minutes, for example half of the calcium cation of the calcium lactate can be released from the particle in more than about 30 minutes or more than about 45 minutes. In another aspect, the period of sustained dissolution is over a time scale of hours, for example half of the calcium ion of the calcium lactate can be released in more than about 1 hour, more than 1.5 hours, more than about 2 hours, more than -47- WO 2012/044736 PCT/US2011/053829 about 4 hours, more than about 8 hours, or more than about 12 hours. In a further aspect, the period of sustained dissolution is over a period of one day or two days.

[00164] The respirable dry particles can be characterized by the crystalline and amorphous content of the particles. The respirable dry particles can comprise a mixture of amorphous and crystalline content, in which the monovalent metal cation salt, e.g., sodium salt and/or potassium salt, is substantially in the crystalline phase. As described herein, the respirable dry particles can further comprise an excipient, such as leucine, maltodextrin or mannitol, and/or a pharmaceutically active agent. The excipient and pharmaceutically active agent can independently be crystalline or amorphous or present in a combination of these forms. In some embodiments, the excipient is amorphous or predominately amorphous. In some embodiments, the respirable dry particles are substantially crystalline. (00165] This provides several advantages. For example, the crystalline phase (e.g., crystalline sodium chloride) can contribute to the stability of the dry particle in the dry state and to the dispersibility characteristics, whereas the amorphous phase (e.g., amorphous active agent and/or excipient) can facilitate rapid water uptake and dissolution of the particle upon deposition in the respiratory tract. It is particularly advantageous when salts with relatively high aqueous solubilities (such as sodium chloride) that are present in the dry particles are in a crystalline state and when salts with relatively low aqueous solubilities (such as calcium citrate) are present in the dry particles in an amorphous state.

[00166] The amorphous phase can be characterized by a high glass transition temperature (Tg), such as a Tg of at least 100°C, at least 110°C, 120°C, at least 125°C, at least 130°C, at least 135°C, at least 140°C, between 120°C and 200°C, between 125°C and 200°C, between 130°C and 200°C, between 120°C and 190°C, between 125°C and 190°C, between 130°C and 190°C, between 120°C and 180°C, between 125°C and 180°C, or between 130°C and 180°C. Alternatively, the amorphous phase can be characterized by a high Tg such as at least 80°C or at least 90°C.

[00167] In some embodiments, the respirable dry particles contain an excipient and/or active agent rich amorphous phase and a monovalent salt (sodium salt, potassium salt) crystalline -48- WO 2012/044736 PCT/US2011/053829 phase and the ratio of amorphous phase to crystalline phase (w:w) is about 5:95 to about 95:5, about 5:95 to about 10:90, about 10:90 to about 20:80, about 20:80 to about 30:70, about 30:70 to about 40:60, about 40:60 to about 50:50; about 50:50 to about 60:40, about 60:40 to about 70:30, about 70:30 to about 80:20, or about 90:10 to about 95:5. In other embodiments, the respirable dry particles contain an amorphous phase and a monovalent salt crystalline phase and the ratio of amorphous phase to particle by weight (w:w) is about 5:95 to about 95:5, about 5:95 to about 10:90, about 10:90 to about 20:80, about 20:80 to about 30:70, about 30:70 to about 40:60, about 40:60 to about 50:50; about 50:50 to about 60:40, about 60:40 to about 70:30, about 70:30 to about 80:20, or about 90:10 to about 95:5. In other embodiments, the respirable dry particles contain an amorphous phase and a monovalent salt crystalline phase and the ratio of crystalline phase to particle by weight (w:w) is about 5:95 to about 95:5, about 5:95 to about 10:90, about 10:90 to about 20:80, about 20:80 to about 30:70, about 30:70 to about 40:60, about 40:60 to about 50:50; about 50:50 to about 60:40, about 60:40 to about 70:30, about 70:30 to about 80:20, or about 90:10 to about 95:5.

[00168] In addition to any of the features and properties described herein, in any combination, the respirable dry particles can have a heat of solution that is not highly exothermic. Preferably, the heat of solution is determined using the ionic liquid of a simulated lung fluid (e.g., as described in Moss, O.R. 1979. Simulants of lung interstitial fluid. Health Phys. 36, 447-448; or in Sun, G. 2001. Oxidative interactions of synthetic lung epithelial lining fluid with metal-containing particulate matter. Am J Physiol Lung Cell Mol Physiol. 281, L807-L815) at pH 7.4 and 37°C in an isothermal calorimeter. For example, the respirable dry particles can have a heat of solution that is less exothermic than the heat of solution of calcium chloride dihydrate, e.g., have a heat of solution that is greater than about -10 kcal/mol, greater than about -9 kcal/mol, greater than about -8 kcal/mol, greater than about -7 kcal/mol, greater than about -6 kcal/mol, greater than about -5 kcal/mol, greater than about -4 kcal/mol, greater than about -3 kcal/mol, greater than about -2 kcal/mol, greater than about -1 kcal/mol or about -lOkcal/mol to about lOkcal/mol.

[00169] The respirable dry powders and dry particles are characterized by a high emitted dose (e.g., CEPM of at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least „49- WO 2012/044736 PCT/US2011/053829 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%) from a dry powder inhaler when a total inhalation energy of less than about 2 Joules or less than about 1 Joule, or less than about 0.8 Joule, or less than about 0.5 Joule, or less than about 0.3 Joule is applied to the dry powder inhaler. The dry powder can fill the unit dose container, or the unit dose container can be at least 10% full, at least 20% full, at least 30% full, at least 40% full, at least 50% full, at least 60% full, at least 70% full, at least 80% full, or at least 90% full. The unit dose container can be a capsule (e.g., size 000, 00, 0E, 0, 1, 2, 3, and 4, with respective volumetric capacities of 1.37ml, 950μ1, 770μ1, 680μ1, 480μ1, 360μ1, 270μ1, and 200μ1).

[00170] Healthy adult populations are predicted to be able to achieve inhalation energies ranging from 2.9 Joules for comfortable inhalations to 22 Joules for maximum inhalations by using values of peak inspiratory flow rate (PIER) measured by Clarke et al. (Journal of Aerosol Med, 6(2), p.99-110, 1993) for the flow rate Q from two inhaler resistances of 0.02 and 0.055 kPal/2/LPM, with a inhalation volume of 2L based on both FDA guidance documents for dry powder inhalers and on the work of Tiddens et al. (Journal of Aerosol Med, 19(4), p.456-465, 2006) who found adults averaging 2.2L inhaled volume through a variety of DPIs.

[00171] Mild, moderate and severe adult COPD patients are predicted to be able to achieve maximum inhalation energies of 5.1 to 21 Joules, 5.2 to 19 Joules, and 2.3 to 18 Joules respectively. This is again based on using measured P1FR values for the flow rate Q in the equation for inhalation energy. The P1FR achievable for each group is a function of the inhaler resistance that is being inhaled through. The work of Broeders et al. (Eur Respir J, 18, p.780-783, 2001) was used to predict maximum and minimum achievable PIFR through 2 dry powder inhalers of resistances 0.021 and 0.032 kPal/2/LPM for each.

[00172] Similarly, adult asthmatic patients are predicted to be able to achieve maximum inhalation energies of 7.4 to 21 Joules based on the same assumptions as the COPD population and PIFR data from Broeders et al. -50- WO 2012/044736 PCT/US2011/053829 [00173] Healthy adults and children, COPD patients, asthmatic patients ages 5 and above, and CF patients, for example, are capable of providing sufficient inhalation energy to empty and disperse the dry powder formulations of the invention, [00174] An advantage of aspects of the invention is the production of powders that disperse well across a wide range of flow rates and are relatively flow rate independent. In certain aspects, the dry particles and powders of the invention enable the use of a simple, passive DPI for a wide patient population.

[00175] In preferred aspects, the respirable dry powder comprises respirable dry particles that characterized by: 1. VMGD at 1 bar as measured using a HELOS/RODOS system between 0.5microns and 10 microns, preferably between 1 microns and 7 microns, between 1 microns and 5 microns, or between 1 microns and 3 microns; 2. 1 bar/4 bar of 1.6 or less, preferably less than 1.5, less than 1.4, less than 1.3, less than 1.2 or less thanl.l; and 3. tap density of about 0.4 g/cm3 to about 1.2 g/cm3 , 0.5 g/cm3 to about 1.0 g/cm3, preferably between about 0.6 g/cm3 and about 0.9 g/cm3.

[00176] In other preferred aspects, the respirable dry powder comprises respirable dry particles that are characterized by: 1. VMGD at 1 bar as measured using a HELOS/RODOS system between 0.5microns and 10 microns, preferably between 1 microns and 7 microns, between 1 microns and 5 microns, or between 1 microns and 3 microns; 2. 1 bar/4 bar of 1.6 or less, preferably less than 1.5, less than 1.4, less than 1.3, less than 1.2 or less than 1.1; and 3. MMAD between 0.5 and 6.0, between 1.0 and 5.0 or between 1.0 and 3,0. -51 - WO 2012/044736 PCT/US2011/053829 [00177] In other preferred aspects, the respirable dry powder comprises respirable dry particles that are characterized by: 1. VMGD at 1 bar as measured using a HELOS/RODOS system between 0.5 microns and 10 microns, preferably between 1 microns and 7 microns, between 1 microns and 5 microns, or between 1 microns and 3 microns; 2. 1 bar/4 bar of 1.6 or less, preferably less than 1.5, less than 1.4, less than 1.3, less than 1.2 or less than 1.1; and 3. FPFTD<5.0 pm of at least 30%, at least 40%, at least 50% or at least 60%.

[00178] In other preferred aspects, the respirable dry powder comprises respirable dry particles that are characterized by: 1. VMGD at 1 bar as measured using a HELOS/RODOS system; less than 10 microns, between 0.5 microns and 10 microns, between 1 microns and 7 microns, preferably between 1 microns and 5 microns, or between 1 microns and 3 microns; 2. 1 bar/4 bar of 1.6 or less, preferably less than 1.5, less than 1.4, less than 1.3, less than 1.2 or less thanl.l;and 3. Hausner Ratio greater than 1.5, greater than 1.8, or greater than 2.1.

[00179] In other preferred aspects, the respirable dry powder comprises respirable dry particles that are characterized by: 1. tap density of about 0.4 g/cm1 2 3 to about 1.2 g/cm3 , 0.5 g/cm3 to about 1.0 g/cm3, preferably between about 0.6 g/cm3 and about 0.9 g/cm3. 2. FPF_TD<5.0 pm of at least 30%, at least 40%, at least 50% or at least 60%. 3. Hausner Ratio greater than 1.5, greater than 1.8, or greater than 2.1. -52- WO 2012/044736 PCT/US2011/053829 [00180] For each of the preferred embodiments described, the respirable dry particles described herein contain a monovalent salt; such as a sodium salt and/or a potassium salt, e.g,, sodium chloride, sodium citrate, sodium lactate, sodium sulfate, potassium chloride, potassium citrate, or any combinations thereof, in an amount between about 1% and about 20%, between about 3% and about 20%, between about 20% and about 60%, or between about 60% and about 99%. The preferred embodiments may further contain: (a) an active agent, such as a LABA (e.g., formoterol, salmeterol), a short-acting beta agonist (e.g., albuterol), a corticosteroid (e.g., fluticasone), a LAMA (e.g., tiotropium), an antibiotic (e.g., levofloxacin, tobramycin), antibodies (e.g., therapeutic antibodies), hormones (e.g. insulin), cytokines, growth factors and combinations thereof. When the dry powders are intended for treatment of CF, preferred additional therapeutic agents are short-acting beta agonists (e.g., albuterol), antibiotics (e.g., levofloxacin), recombinant human deoxyribonuclease I (e.g., domase alfa, also known as DNase), sodium channel blockers (e.g., amiloride), and combinations thereof, in an amount between about 0.01% and about 10%, between about 10% and about 50%, or between about 50% and about 99.9, and further may contain, (b) an excipient, such as leucine, maltodextrin, mannitol or any combination thereof, or the like, can he present in an amount of about 80% or less or about 50% or less or about 20% or less by weight of the dry particle.

[00181] The respirable dry particles and dry powders described herein are suitable for inhalation therapies. The respirable dry particles may be fabricated with the appropriate material, surface roughness, diameter and density for localized delivery to selected regions of the respiratory system such as the deep lung or upper or central airways. For example, higher density or larger respirable dry particles may be used for upper airway delivery, or a mixture of varying size respirable dry particles in a sample, provided with the same or a different formulation, may be administered to target different regions of the lung in one administration. -53- WO 2012/044736 PCT/US2011/053829 [00182] Because the respirable dry powders and respirable dry particles described herein contain salts, they may be hygroscopic. Accordingly it is desirable to store or maintain the respirable dry powders and respirable dry particles under conditions to prevent hydration of the powders. For example, if it is desirable to prevent hydration, the relative humidity of the storage environment should be less than 75%, less than 60%, less than 50%, less than 40%, less than 35%, less than 30%, less than 25%, less than 20%, less than 15%, less than 10%, or less than 5% humidity. In other embodiments, the storage environment should be between 20% to 40%, between 25% to 35%, about 30%, between 10% to 20%, or about 15% humidity. The respirable dry powders and respirable dry particles can be packaged (e.g., in sealed capsules, blisters, vials) under these conditions.

[00183] In preferred embodiments, the respirable dry powders or respirable dry particles of the invention possess aerosol characteristics that permit effective delivery of the respirable dry particles to the respiratory system without the use of propellants.

[00184] The dry particles of the invention can be blended with an active ingredient or coformulated with an active ingredient to maintain the characteristic high dispersibility of the dry particles and dry powders of the invention.

Methods for Preparing Dry Powders and Dry Particles [00185] The respirable dry particles and dry powders can be prepared using any suitable method. Many suitable methods for preparing respirable dry powders and particles are conventional in the art, and include single and double emulsion solvent evaporation, spray drying, spray freeze diying, milling (e.g., jet milling), blending, solvent extraction, solvent evaporation, phase separation, simple and complex coacervation, interfacial polymerization, suitable methods that involve the use of supercritical carbon dioxide (CO2), sonocrystalliztion, nanoparticle aggregate formation and other suitable methods, including combinations thereof. Respirable dry particles can be made using methods for making microspheres or microcapsules known in the art. These methods can be employed under conditions that result in the formation of respirable dry particles with desired aerodynamic properties (e.g., aerodynamic diameter and geometric diameter). If desired, respirable dry -54- WO 2012/044736 PCT/US2011/053829 particles with desired properties, such as size and density, can be selected using suitable methods, such as sieving.

[00186] The respirable dry particles are preferably spray dried. Suitable spray drying techniques are described, for example, by K. Masters in “Spray Drying Handbook"’, John Wiley & Sons, New York (1984). Generally, during spray drying, heat from a hot gas such as heated air or nitrogen is used to evaporate a solvent from droplets formed by atomizing a continuous liquid feed. If desired, the spray drying or other instruments, e.g., jet milling instrument, used to prepare the dry particles can include an inline geometric particle sizer that determines a geometric diameter of the respirable dry particles as they are being produced, and/or an inline aerodynamic particle sizer that determines the aerodynamic diameter of the respirable dry particles as they are being produced, [00187] For spray drying, solutions, emulsions or suspensions that contain the components of the dry particles to he produced in a suitable solvent (e.g., aqueous solvent, organic solvent, aqueous-organic mixture or emulsion) are distributed to a drying vessel via an atomization device. For example, a nozzle or a rotary atomizer may be used to distribute the solution or suspension to the drying vessel. For example, a rotary atomizer having a 4- or 24-vaned wheel may he used. Examples of suitable spray dryers that can he outfitted with either a rotary atomizer or a nozzle, include, Mobile Minor Spray Dryer or the Model PSD-1, both manufactured by GEA Group (Niro, Denmark). Actual spray drying conditions will vary depending, in part, on the composition of the spray drying solution or suspension and material flow rates. The person of ordinary skill will be able to determine appropriate conditions based on the compositions of the solution, emulsion or suspension to be spray dried, the desired particle properties and other factors. In general, the inlet temperature to the spray dryer is about 90°C to about 300°C, and preferably is about 220°C to about 285°C. The spray dryer outlet temperature will vary depending upon such factors as the feed temperature and the properties of the materials being dried. Generally, the outlet temperature is about 50°C to about 150°C, preferably about 90°C to about 120°C, or about 98°C to about 108°C. If desired, the respirable dry particles that are produced can be fractionated by volumetric size, for example, using a sieve, or fractioned by aerodynamic size, for example, using a cyclone, -55- WO 2012/044736 PCT/US2011/053829 and/or further separated according to density using techniques known to those of skill in the art.

[00188] To prepare the respirable dry particles of the invention, generally, a solution, emulsion or suspension that contains the desired components of the dry powder (i.e., a feed stock) is prepared and spray dried under suitable conditions. Preferably, the dissolved or suspended solids concentration in the feed stock is at least about lg/L, at least about 2 g/L, at least about 5 g/L, at least about 10 g/L, at least about 15 g/L, at least about 20 g/L, at least about 30 g/L, at least about 40 g/L, at least about 50 g/L, at least about 60 g/L, at least about 70 g/L, at least about 80 g/L, at least about 90 g/L, or at least about 100 g/L. The feed stock can he provided by preparing a single solution or suspension by dissolving or suspending suitable components (e.g., salts, excipients, other active ingredients) in a suitable solvent. The solvent, emulsion or suspension can be prepared using any suitable methods, such as bulk mixing of dry and/or liquid components or static mixing of liquid components to form a combination. For example, a hydrophilic component (e.g., an aqueous solution) and a hydrophobic component (e.g., an organic solution) can be combined using a static mixer to form a combination. The combination can then be atomized to produce droplets, which are dried to form respirable dry particles. Preferably, the atomizing step is performed immediately after the components are combined in the static mixer.

[00189] The feed stock, or components of the feed stock, can be prepared using any suitable solvent, such as an organic solvent, an aqueous solvent or mixtures thereof. Suitable organic solvents that can he employed include but are not limited to alcohols such as, for example, ethanol, methanol, propanol, isopropanol, butanols, and others. Other organic solvents include but are not limited to perfluorocarbons, dichloromethane, chloroform, ether, ethyl acetate, methyl tert-butyl ether and others. Co-solvents that can be employed include an aqueous solvent and an organic solvent, such as, but not limited to, the organic solvents as described above. Aqueous solvents include water and buffered solutions.

[00190] The feed stock or components of the feed stock can have any desired pH, viscosity or other properties. If desired, a pH buffer can be added to the solvent or co-solvent or to the formed mixture. Generally, the pH of the mixture ranges from about 3 to about 8. -56- WO 2012/044736 PCT/US2011/053829 [00191] Respirable dry particles and dry powders can be fabricated and then separated, for example, by filtration or centrifugation by means of a cyclone, to provide a particle sample with a preselected size distribution. For example, greater than about 30%, greater than about 40%, greater than about 50%, greater than about 60%, greater than about 70%, greater than about 80%, or greater than about 90% of the respirable dry particles in a sample can have a diameter within a selected range. The selected range within which a certain percentage of the respirable dry particles fall can be, for example, any of the size ranges described herein, such as between about 0.1 to about 3 microns VMGD, or between 0.5 to about 5 micron VMGD.

[00192] The invention also relates to respirable dry powders or respirable dry particles produced by preparing a feedstock solution, emulsion or suspension and spray drying the feedstock according to the methods described herein, and to the methods described herein. The feedstock can be prepared, for example, using (a) monovalent salt, such as sodium chloride or potassium chloride, in an amount of about 1% to 100% by weight (e.g,, of total solutes used for preparing the feedstock), an excipient, such as leucine, in an amount of about 0% to 99% by weight (e.g., of total solutes used for preparing the feedstock), and optionally a pharmaceutically active agent in an amount of about 0.001% to 99% by weight (e.g., of total solutes used for preparing the feedstock), and one or more suitable solvents for dissolution of the solute and formation of the feedstock.

[00193] Any suitable method can be used for mixing the solutes and solvents to prepare feedstocks (e.g., static mixing, bulk mixing), if desired, additional components that cause or facilitate the mixing can be included in the feedstock. For example, carbon dioxide produces fizzing or effervescence and thus can serve to promote physical mixing of the solute and solvents. Various salts of carbonate or bicarbonate can promote the same effect that carbon dioxide produces and, therefore, can be used in preparation of the feedstocks of the invention.

[00194] In an embodiment, the respirable dry powders or respirable dry particles of the invention can be produced through an ion exchange reaction. In certain embodiments of the invention, two saturated or sub-saturated solutions are fed into a static mixer in order to obtain a saturated or supersaturated solution post-static mixing. Preferably, the post-mixed -57- WO 2012/044736 PCT/US2011/053829 solution is supersaturated. The post-mixed solution may be supersaturated in all components or supersaturated in one, two, or three of the components.

[00195] The two solutions may be aqueous or organic, but are preferably substantially aqueous. When the active agent is dissolved in an organic solvent, then one feed solution may be organic while the other one may be aqueous, or both feed solutions may be organic. The post-static mixing solution is then fed into the atomizing unit of a spray dryer. In a preferable embodiment, the post-static mixing solution is immediately fed into the atomizer unit. Some examples of an atomizer unit include a two-fluid nozzle, a rotary atomizer, or a pressure nozzle. Preferably, the atomizer unit is a two-fluid nozzle. In one embodiment, the two-fluid nozzle is an internally mixing nozzle, meaning that the gas impinges on the liquid feed before exiting to most outward orifice. In another embodiment, the two-fluid nozzle is an externally mixing nozzle, meaning that the gas impinges on the liquid feed after exiting the most outward orifice.

[00196] The diameter of the respirable dry particles, for example, their VMGD, can be measured using an electrical zone sensing instrument such as a Multisizer lie, (Coulter Electronic, Luton, Beds, England), or a laser diffraction instrument such as a HELOS system (Sympatec, Princeton, NJ) or a Mastersizer system (Malvern, Worcestershire, UK). Other instruments for measuring particle geometric diameter are well known in the art. The diameter of respirable dry particles in a sample will range depending upon factors such as particle composition and methods of synthesis. The distribution of size of respirable dry particles in a sample can he selected to permit optimal deposition within targeted sites within the respiratory system.

[00197] Experimentally, aerodynamic diameter can be determined using time of flight (TOF) measurements. For example, an instrument such as the Aerosol Particle Sizer (APS) Spectrometer (TSI Inc., Shoreview, MNcan he used to measure aerodynamic diameter. The APS measures the time taken for individual respirable dry particles to pass between two fixed laser beams. -58- WO 2012/044736 PCT/VS2011/0S3829 [00198] AeiOdynamic diameter also can be experimentally determined directly using conventional gravitational settling methods, in which the time required for a sample of respirable dry particles to settle a certain distance is measured. Indirect methods for measuring the mass median aerodynamic diameter include the Andersen Cascade Impactor (ACI) and the multi-stage liquid impinger (MSLI) methods. The methods and instruments for measuring particle aerodynamic diameter are well known in the art.

[00199] Tap density is a measure of the envelope mass density characterizing a particle. The envelope mass density of a particle of a statistically isotropic shape is defined as the mass of the particle divided by the minimum sphere envelope volume within which it can be enclosed. Features which can contribute to low tap density include irregular surface texture, high particle cohesiveness and porous structure. Tap density can be measured by using instruments known to those skilled in the art such as the Dual Platform Microprocessor Controlled Tap Density Tester (Vankel, NC), a GeoPyc™ instrument (Micrometries Instrument Corp. , Norcross, GA), or SOTAX Tap Density Tester model TD2 (SOTAX Corp., Horsham, PA). Tap density can be determined using the method of USP Bulk Density and Tapped Density, United States Pharmacopeia convention, Rockville, MD, 10th Supplement, 4950-4951,1999.

[00200] Fine particle fraction can be used as one way to characterize the aerosol performance of a dispersed powder. Fine particle fraction describes the size distribution of airborne respirable dry particles. Gravimetric analysis, using a Cascade Impactor, is one method of measuring the size distribution, or fine particle fraction, of airborne respirable dry particles. The ACI is an eight-stage Impactor that can separate aerosols into nine distinct fractions based on aerodynamic size. The size cutoffs of each stage are dependent upon the flow rate at which the ACI is operated. The ACI is made up of multiple stages consisting of a series of nozzles (i.e., a jet plate) and an impaction surface (i.e., an impaction disc). At each stage an aerosol stream passes through the nozzles and impinges upon the surface. Respirable dry particles in the aerosol stream with a large enough inertia will impact upon the plate. Smaller respirable dry particles that do not have enough inertia to impact on the plate will remain in the aerosol stream and be carried to the next stage. Each successive stage of the ACI has a -59- WO 2012/044736 PCT/US2011/053829 higher aerosol velocity in the nozzles so that smaller respirable dry particles can be collected at each successive stage.

[00201]If desired, a two-stage collapsed ACI can also be used to measure fine particle fraction. The two-stage collapsed ACI consists of only the top two stages 0 and 2 of the eight-stage ACI, as well as the final collection filter, and allows for the collection of two separate powder fractions. Specifically, a two-stage collapsed AC! is calibrated so that the fraction of powder that is collected on stage two is composed of respirable dry particles that have an aerodynamic diameter of less than 5.6 microns and greater than 3.4 microns. The fraction of powder passing stage two and depositing on the final collection filter is thus composed of respirable dry particles having an aerodynamic diameter of less than 3,4 microns. The airflow at such a calibration is approximately 60 L/min. The FPF(<5.6) has been demonstrated to correlate to the fraction of the powder that is able to reach the lungs of the patient, while the FPF(<3.4) has been demonstrated to correlate to the fraction of the powder that reaches the deep lung of a patient. These correlations provide a quantitative indicator that can be used for particle optimization.

[00202] The FPF(<5.6) has been demonstrated to correlate to the fraction of the powder that is able to make it into the lung of the patient, while the FPF(<3.4) has been demonstrated to correlate to the fraction of the powder that reaches the deep lung of a patient. These correlations provide a quantitative indicator that can be used for particle optimization.

[00203] An ACI can be used to approximate the emitted dose, which herein is called gravimetric recovered dose and analytical recovered dose. “Gravimetric recovered dose” is defined as the ratio of the powder weighed on all stage filters of the ACI to the nominal dose. “Analytical recovered dose” is defined as the ratio of the powder recovered from rinsing and analyzing all stages, all stage filters, and the induction port of the ACI to the nominal dose. The FPFTD(<5.0) is the ratio of the interpolated amount of powder depositing below 5.0 pm on the ACI to the nominal dose. The FPF_RD(<5.0) is the ratio of the interpolated amount of powder depositing below 5.0 pm on the ACI to either the gravimetric recovered dose or the analytical recovered dose. -60- WO 2012/044736 PCT/US2011/053829 [00204] Another way to approximate emitted dose is to determine how much powder leaves its container, e.g, capture or blister, upon actuation of a dry powder inhaler (DPI). This takes into account the percentage leaving the capsule, but does not take into account any powder depositing on the DPI. The emitted powder mass is the difference in the weight of the capsule with the dose before inhaler actuation and the weight of the capsule after inhaler actuation. This measurement can be called the capsule emitted powder mass (CEPM) or sometimes termed “shot-weight”.

[00205] A Multi-Stage Liquid Impinger (MSLI) is another device that can he used to measure fine particle fraction. The MSLI operates on the same principles as the ACI, although instead of eight stages, MSLI has five. Additionally, each MSLI stage consists of an ethanol-wetted glass frit instead of a solid plate. The wetted stage is used to prevent particle bounce and reentrainment, which can occur when using the ACL

[00206] The geometric particle size distribution can be measured for the respirable dry powder after being emitted from a dry powder inhaler (DPI) by use of a laser diffraction instrument such as the Malvern Spraytec. With the inhaler adapter in the close-bench configuration, an airtight seal is made to the DPI, causing the outlet aerosol to pass perpendicularly through the laser beam as an internal flow. In this way, known flow rates can be drawn through the DPI by vacuum pressure to empty the DPI. The resulting geometric particle size distribution of the aerosol is measured by the photodetectors with samples typically taken at 1000Hz for the duration of the inhalation and the DV50, GSD, FPF<5.0tnn measured and averaged over the duration of the inhalation, [00207] The invention also relates to a respirable dry powder or respirable dry particles produced using any of the methods described herein. (00208] The respirable dry particles of the invention can also be characterized by the physicochemical stability of the salts or the excipients that the respirable dry particles comprise. The physicochemical stability of the constituent salts can affect important characteristics of the respirable particles including shelf-life, proper storage conditions, acceptable environments for administration, biological compatibility, and effectiveness of the -61 - WO 2012/044736 PCT/US2O11/053829 salts. Chemical stability can be assessed using techniques well known in the art. One example of a technique that can he used to assess chemical stability is reverse phase high performance liquid chromatography (RP-HPLC). Respirable dry particles of the invention include salts that are generally stable over a long period time.

[00209] If desired, the respirable dry particles and dry powders described herein can be further processed to increase stability. An important characteristic of pharmaceutical dry powders is whether they are stable at different temperature and humidity conditions. Unstable powders will absorb moisture from the environment and agglomerate, thus altering particle size distribution of the powder, [00210] Excipients, such as maltodextrin, may be used to create more stable particles and powders. For example, maltodextrin may act as an amorphous phase stabilizer and inhibit the components from converting from an amorphous to crystalline state. Alternatively, a postprocessing step to help the particles through the crystallization process in a controlled way (e.g., on the product filter at elevated humidity) can be employed with the resultant powder potentially being further processed to restore their dispersibility if agglomerates formed during the crystallization process, such as by passing the particles through a cyclone to break apart the agglomerates. Another possible approach is to optimize around formulation or process conditions that lead to manufacturing particles that are more crystalline and therefore more stable. Another approach is to use different excipients, or different levels of current excipients to attempt to manufacture more stable forms of the salts.

Therapeutic Use and Methods [00211] The respirable dry powders and respirable dry particles of the present invention are for administration to the respiratory tract. Administration to the respiratory tract can be for local activity of the delivered pharmaceutically active agent or for systemic activity. For example, the respirable dry powders can be administered to the nasal cavity or upper airway to provide, for example, anti-inflammatory, anti-viral, or anti-bacterial activity to the nasal cavity or upper airway. The respirable dry powders can be administered to the deep lung to provide local activity in the lung or for absorption into the systemic circulation. Systemic -62- WO 2012/044736 PCT/US2011/053829 delivery of certain pharmaceutically active agents via the lung is particularly advantageous for agents that undergo substantial first pass metabolism (e.g., in the liver) following oral administration.

[00212] The respirable dry powders and respirable dry particles of the present invention may also be administered to the buccal cavity. Administration to the buccal cavity can be for local activity of the delivered pharmaceutically active agent or for systemic activity. For exaple, the respirable dry powders can be administered to the buccal cavity to provide, for example, anti-inflammatory, anti-viral, or anti-bacterial activity to the buccal cavity.

[00213] The dry powders and dry particles of the invention can be administered to a subject in need thereof for systemic delivery of a pharmaceutically active agent, such as to treat an infectious disease or metabolic disease.

[00214] The dry powders and dry particles of the invention can be administered to a subject in need thereof for the treatment of respiratory (e.g., pulmonary) diseases, such as respiratory syncytial virus infection, idiopathic fibrosis, alpha-1 antitrypsin deficiency, asthma, airway hyperresponsiveness, seasonal allergic allergy, brochiectasis, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, cystic fibrosis and the like, and for the treatment and/or prevention of acute exacerbations of these chronic diseases, such as exacerbations caused by viral infections (e.g, influenza virus, parainfluenza virus, respiratory syncytial virus, rhinovirus, adenovirus, metapneumo virus, coxsackie virus, echo virus, corona virus, herpes virus, cytomegalovirus, and the like), bacterial infections (e.g., Streptococcus pneumoniae, which is commonly referred to as pneumococcus, Staphylococcus aureus, Burkholderis ssp., Streptococcus agalactiae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Moraxella catarrhalis, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Serratia marcescens, Mycobacterium tuberculosis, Bordetella pertussis, and the like), fungal infections (e.g., Histoplasma capsulatum, Cryptococcus neoformans, Pneumocystis proved, Coccidioides immitis, and the like) or parasitic infections (e.g, Toxoplasma gondii, Strongyloides stercoralis, and the like), or environmental allergens and -63- WO 2012/044736 PCT/US2011/053829 irritants (e.g., aeroallergens, including pollen and cat dander, airborne particulates, and the like).

[00215] The dry powders and dry particles of the invention can be administered to a subject in need thereof for the treatment and/or prevention and/or reducing contagion of infectious diseases of the respiratory tract, such as pneumonia (including community-acquired pneumonia, nosocomial pneumonia (hospital-acquired pneumonia, HAP; health-care associated pneumonia, HCAP), ventilator-associated pneumonia (VAP)), ventilator-associated tracheobronchitis (VAT), bronchitis, croup (e.g., postintubation croup, and infectious croup), tuberculosis, influenza, common cold, and viral infections (e.g., influenza virus, parainfluenza virus, respiratory syncytial virus, rhinovirus, adenovirus, metapneumovirus, coxsackie virus, echo virus, corona virus, herpes virus, cytomegalovirus, and the like), bacterial infections (e.g., Streptococcus pneumoniae, which is commonly referred to as pneumococcus, Staphylococcus aureus, Streptococcus agalactiae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Moraxella catarrhalis, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Serratia marcescens, Mycobacterium tuberculosis, Pordetella pertussis, and the like), fungal infections (e.g., Histoplasma capsulatum, Cryptococcus neoformans, Pneumocystis jiroveci, Coccidioides immitis, and the like) or parasitic infections (e.g., Toxoplasma gondii, Strongyloides stercoralis, and the like), or environmental allergens and irritants (e.g., aeroallergens, airborne particulates, and the like).

[00216] In some aspects, the invention provides a method for treating a pulmonary diseases, such as asthma, airway hyperresponsiveness, seasonal allergic allergy, bronchiectasis, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, cystic fibrosis and the like, comprising administering to the respiratory tract of a subject in need thereof an effective amount of respirable dry particles or dry powder, as described herein.

[00217] In other aspects, the invention provides a method for the treatment or prevention of acute exacerbations of a chronic pulmonary disease, such as asthma, airway hyperresponsiveness, seasonal allergic allergy, bronchiectasis, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, cystic fibrosis and the like, comprising ~ 64 - WO 2012/044736 PCT/US2011/053829 administering to the respiratory tract of a subject in need thereof an effective amount of respirable dry particles or dry powder, as described herein.

[00218] In some aspects, the invention provides a method for the treatment or prevention of cardiovascular disease, auto-immune disorders, transplant rejections, autoimmune disorders, allergy-related asthma, infections, and cancer. For example, the invention provides a method for the treatment or prevention of postmenopausal osteoporosis, cryopyrin-associated periodic syndromes (CAPS), paroxysmal nocturnal hemoglobinuria, psoriasis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, multiple sclerosis, and macular degeneration. For example, dry powders or dry particles of the invention are co-formulated or blended with therapeutic antibodies as described herein. The co-formulated or blended dry powders may then be administered to a subject in need of therapy or prevention.

[00219] In certain aspects, the invention provides a method for the treatment or prevention of cancer such as acute myeloid leukemia, B cell leukemia, non-Hodgkin's lymphoma, breast cancer (e.g. with HER2/neu overexpression), glioma, squamous cell carcinomas, colorectal carcinoma, anaplastic large cell lymphoma (ALCL), Hodgkin lymphoma, head and neck cancer, acute myelogenous leukemia (AML), melanoma, and chronic lymphocytic leukemia (CLL). Alternatively or in addition, the invention provides a method for the treatment or prevention of cancer by anti-angiogenic cancer therapy. For example, dry powders or dry particles of the invention are co-formulated or blended with therapeutic antibodies as described herein. Therapeutic antibodies can be cancer-specific antibodies, such as a humanized monoclonal antibody, e.g. gemtuzumab, alemtuzumab, trastuzumab, nimotuzumab, bevacizumab, or a chimeric monoclonal antibody, e.g. rituximab and cetuximab. The co-formulated or blended dry powders may then be administered to a subject in need of therapy or prevention.

[00220] In certain aspects, the invention provides a method for the treatment or prevention of inflammation such as rheumatoid arthritis, Crohn's disease, ulcerative Colitis, acute rejection of kidney transplants, moderate-to-severe allergic asthma. For example, dry powders or dry particles of the invention are co-formulated or blended with therapeutic antibodies as described herein. Therapeutic antibodies can be inflammation-specific antibodies, such as -65- WO 2012/044736 PCT/US2011/053829 chimeric monoclonal antibodies, e.g. infliximab, basiliximab, humanized monoclonal antibodies, e.g. daclizumab, omalizumab, or human antibodies, e.g. adalimumab. The coformulated or blended dry powders may then be administered to a subject in need of therapy or prevention.

[00221] In certain aspects, the invention provides a method for the treatment or prevention of RSV infections in children. For example, dry powders or dry particles of the invention are coformulated or blended with therapeutic antibodies as described herein, Therapeutic antibodies can be RSV infection-specific antibodies, such as the humanized monoclonal antibody palivizumab which inhibits an RSV fusion (F) protein. The co-formulated or blended dry powders may then be administered to a subject in need of RSV infection therapy or prevention.

[00222] In certain aspects, the invention provides a method for the treatment or prevention of diabetes. For example, dry powders or dry particles of the invention are co-formulated or blended with insulin as described herein. The co-formulated or blended dry powders may then be administered to a subject in need of insulin therapy or prevention.

[00223] The respirable dry particles and dry powders can be administered to the respiratory tract of a subject in need thereof using any suitable method, such as instillation techniques, and/or an inhalation device, such as a dry powder inhaler (DPI) or metered dose inhaler (MDI). A number of DPIs are available, such as, the inhalers disclosed is U. S. Patent No. 4,995,385 and 4,069,819, Spinhaler® (Fisons, Loughborough, UK.), Rotahalers®, Diskhaler® and Diskus® (GlaxoSmithKline, Research Triangle Technology Park, North Carolina), FlowCapss® (Hovione, Loures, Portugal), Inhalators® (Boehringer-Ingelheim, Germany), Aerolizer® (Novartis, Switzerland), high-resistance and low-resistacne RS-01 (Plastiape, Italy), and others known to those skilled in the art.

[00224] Generally, inhalation devices (e.g., DPIs) are able to deliver a maximum amount of dry powder or dry particles in a single inhalation, which is related to the capacity of the blisters, capsules (e.g. size 000, 00,0E, 0, 1,2, 3, and 4, with respective volumetric capacities of 1.37ml, 950μ1, 770μ1, 680μ1, 480μ1, 360μ1, 270μ1, and 200μ1) or other means that contain -66- WO 2012/044736 PCT/US2011/053829 the dry particles or dry powders within the inhaler. Accordingly, delivery of a desired dose or effective amount may require two or more inhalations. Preferably, each dose that is administered to a subject in need thereof contains an effective amount of respirable dry particles or dry powder and is administered using no more than about 4 inhalations. For example, each dose of respirable dry particles or dry powder can be administered in a single inhalation or 2, 3, or 4 inhalations. The respirable dry particles and dry powders are preferably administered in a single, breath-activated step using a breath-activated DPI. When this type of device is used, the energy of the subject’s inhalation both disperses the respirable dry particles and draws them into the respiratory tract.

[00225] The respirable dry particles or dry powders can be delivered by inhalation to a desired area within the respiratory tract, as desired. It is well-known that particles with an aerodynamic diameter of about 1 micron to about 3 microns, can be delivered to the deep lung. Larger aerodynamic diameters, for example, from about 3 microns to about 5 microns can be delivered to the central and upper airways.

[00226] For dry powder inhalers, oral cavity deposition is dominated by inertial impaction and so characterized by the aerosol’s Stokes number (DeHaan et al. Journal of Aerosol Science, 35 (3), 309-331, 2003). For equivalent inhaler geometry, breathing pattern and oral cavity geometry, the Stokes number, and so the oral cavity deposition, is primarily affected by the aerodynamic size of the inhaled powder. Hence, factors which contribute to oral deposition of a powder include the size distribution of the individual particles and the dispersibility of the powder. If the MMAD of the individual particles is too large, e.g. above 5 um, then an increasing percentage of powder will deposit in the oral cavity. Likewise, if a powder has poor dispersibility, it is an indication that the particles will leave the dry powder inhaler and enter the oral cavity as agglomerates. Agglomerated powder will perform aerodynamically like an individual particle as large as the agglomerate , therefore even if the individual particles are small (e.g., MMAD of 5 microns or less), the size distribution of the inhaled powder may have an MMAD of greater than 5 um, leading to enhanced oral cavity deposition. -67- WO 2012/044736 PCT/US2011/053829 [00227] Therefore, it is desirable to have a powder in which the particles are small (e.g., MMAD of 5 microns or less, e.g. between 1 to 5 microns), and are highly dispersible (e.g. 1 bar/4 bar or alternatively, 0.5 bar/4 bar of 2.0, and preferably less than 1.5). More preferably, the respirable dry powder is comprised of respirable dry particles with an MMAD between 1 to 4 microns or 1 to 3 microns, and have a 1 bar/4 bar less than 1.4, or less than 1.3, and more preferably less than 1.2.

[00228] The absolute geometric diameter of the particles measured at 1 bar using the HELOS system is not critical provided that the particle’s envelope mass density is sufficient such that the MMAD is in one of the ranges listed above, wherein MMAD is VMGD times the square root of the envelope mass density (MMAD ~ VMGD*sqrt(envelope mass density)). If it is desired to deliver a high unit dose of pharmaceutically active agent using a fixed volume dosing container, then, particles of higher envelop density are desired. High envelope mass density allows for more mass of powder to be contained within the fixed volume dosing container. Preferable envelope mass densities are greater than 0.1 g/cc, greater than 0.25 g/cc, greater than 0.4 g/cc, greater than 0.5 g/cc, greater than 0.6 g/cc, greater than 0.7 g/cc, and greater than 0.8 g/cc.

[00229] The respirable dry powders and particles of the invention can be employed in compositions suitable for drug delivery via the respiratory system. For example, such compositions can include blends of the respirable dry particles of the invention and one or more other dry particles or powders, such as dry particles or powders that contain another active agent, or that consist of or consist essentially of one or more pharmaceutically acceptable excipients.

[00230] Respirable dry powders and dry particles suitable for use in the methods of the invention can travel through the upper airways (i.e., the oropharynx and larynx), the lower airways, which include the trachea followed by bifurcations into the bronchi and bronchioli, and through the terminal bronchioli which in turn divide into respiratory bronchioli leading then to the ultimate respiratory zone, the alveoli or the deep lung. In one embodiment of the invention, most of the mass of respirable dry powders or particles deposit in the deep lung. In -68- WO 2012/044736 PCT/US2011/053829 another embodiment of the invention, delivery is primarily to the central airways. In another embodiment, delivery is to the upper airways.

[00231] The respirable dry particles or dry powders of the invention can be delivered by inhalation at various parts of the breathing cycle (e.g., laminar flow at mid-breath). An advantage of the high dispersibility of the dry powders and dry particles of the invention is the ability to target deposition in the respiratory tract. For example, breath controlled delivery of nebulized solutions is a recent development in liquid aerosol delivery (Dalby et al. in Inhalation Aerosols, edited by Hickey 2007, p. 437). In this case, nebulized droplets are released only during certain portions of the breathing cycle. For deep lung delivery, droplets are released in the beginning of the inhalation cycle, while for central airway deposition, they are released later in the inhalation.

[00232] The highly dispersible powders of the invention can provide advantages for targeting the timing of drug delivery in the breathing cycle and also location in the human lung. Because the respirable dry powders of the invention can be dispersed rapidly, such as within a fraction of a typical inhalation maneuver, the timing of the powder dispersal can be controlled to deliver an aerosol at specific times within the inhalation.

[00233] With a highly dispersible powder, the complete dose of aerosol can be dispersed at the beginning portion of the inhalation. While the patient’s inhalation flow rate ramps up to the peak inspiratory flow rate, a highly dispersible powder will begin to disperse already at the beginning of the ramp up and could completely disperse a dose in the first portion of the inhalation. Since the air that is inhaled at the beginning of the inhalation will ventilate deepest into the lungs, dispersing the most aerosol into the first part of the inhalation is preferable for deep lung deposition. Similarly, for central deposition, dispersing the aerosol at a high concentration into the air which will ventilate the central airways can be achieved by rapid dispersion of the dose near the mid to end of the inhalation. This can be accomplished by a number of mechanical and other means such as a switch operated by time, pressure or flow rate which diverts the patient’s inhaled air to the powder to be dispersed only after the switch conditions are met. -69- WO 2012/044736 PCT/US2011/053829 [00234] Aerosol dosage, formulations and delivery systems may be selected for a particular therapeutic application, as described, for example, in Gonda, I. “Aerosols for delivery of therapeutic and diagnostic agents to the respiratory tract,” in Critical Reviews in Therapeutic Drug Carrier Systems, 6: 273-313 (1990); and in Moren, “Aerosol Dosage Forms and Formulations,” in Aerosols in Medicine, Principles, Diagnosis and Therapy, Moren, et al., Eds., Esevier, Amsterdam (1985).

[00235] Suitable dosing to provide the desired therapeutic effect can be determined by a clinician based on the severity of the condition (e.g., infection), overall well being of the subject and the subject's tolerance to respirable dry particles and dry powders and other considerations. Based on these and other considerations, a clinician can determine appropriate doses and intervals between doses. Generally, respirable dry particles and dry powders are administered once, twice or three times a day, as needed.

[00236] If desired or indicated, the respirable dry particles and dry powders described herein can be administered with one or more other therapeutic agents. The other therapeutic agents can be administered by any suitable route, such as orally, parenterally (e.g., intravenous, intraarterial, intramuscular, or subcutaneous injection), topically, by inhalation (e.g., intrabronchial, intranasal or oral inhalation, intranasal drops), rectally, vaginally, and the like. The respirable dry particles and dry powders can be administered before, substantially concurrently with, or subsequent to administration of the other therapeutic agent. Preferably, the respirable dry particles and dry powders and the other therapeutic agent are administered so as to provide substantial overlap of their pharmacologic activities.

[00237] Another advantage provided by the respirable dry powders and respirable dry particles described herein, is that dosing efficiency can be increased as a result of hygroscopic growth of particles inside the lungs, due to particle moisture growth. The propensity of the partially amorphous, high salt compositions of the invention to take up water at elevated humidities can also be advantageous with respect to their deposition profiles in vivo. Due to their rapid water uptake at high humidities, these powder formulations can undergo hygroscopic growth do the absorbance of water from the humid air in the respiratory tract as they transit into the lungs. This can result in an increase in their effective aerodynamic -70- WO 2012/044736 PCT/US2011/053829 diameters during transit into the lungs, which will further facilitate their deposition in the airways.

EXEMPLIFICATION

Methods: [00238] Geometric or Volume Diameter. Volume median diameter (VMD) (x50), which may also be referred to as volume median geometric diameter (VMGD) and Dv(50), was determined using a laser diffraction technique. The equipment consisted of a HELOS diffractometer and a RODOS dry powder disperser (Sympatec, Inc., Princeton, NJ). The RODOS disperser applies a shear force to a sample of particles, controlled by the regulator pressure (typically set at 1.0 bar with maximum orifice ring pressure) of the incoming compressed dry air. The pressure settings may be varied to vary the amount of energy used to disperse the powder. For example, the regulator pressure may be varied from 0.2 bar to 4.0 bar. Powder sample is dispensed from a microspatula into the RODOS funnel. The dispersed particles travel through a laser beam where the resulting diffracted light pattern produced is collected, typically using an Rl lens, by a series of detectors. The ensemble diffraction pattern is then translated into a volume-based particle size distribution using the Fraunhofer diffraction model, on the basis that smaller particles diffract light at larger angles. Using this method, geometric standard deviation (GSD) for the volume mean geometric diameter was also determined.

[00239] Fine Particle Fraction. The aerodynamic properties of the powders dispersed from an inhaler device were assessed with a Mk-II 1 ACFM Andersen Cascade Impactor (Copley Scientific Limited, Nottingham, UK). The instrument was run in controlled environmental conditions of 18 to 25°C and relative humidity (RH) between 25 and 35%. The instrument consists of eight stages that separate aerosol particles based on inertial impaction. At each stage, the aerosol stream passes through a set of nozzles and impinges on a corresponding impaction plate. Particles having small enough inertia will continue with the aerosol stream to the next stage, while the remaining particles will impact upon the plate. At each successive stage, the aerosol passes through nozzles at a higher velocity and aerodynamically smaller -71 - WO 2012/044736 PCT/US2011/053829 particles are collected on the plate. After the aerosol passes through the final stage, a filter collects the smallest particles that remain. Gravimetric or analytical analysis can then be performed to determine the particle size distribution.

[00240] The impaction technique utilized allowed for the collection of eight separate powder fractions. The capsules (Capsugel, Greenwood, SC) were filled with approximately 20,40 or 50 mg powder and placed in a hand-held, breath-activated dry powder inhaler (DPI) device, the high resistance RS-01 DPI (Plastiape, Osnago, Italy). The capsule was punctured and the powder was drawn through the cascade impactor operated at a flow rate of 60.0 L/min for 2.0 seconds. At this flow rate, the calibrated cut-off diameters for the eight stages are 8.6, 6.5, 4.4, 3.3, 2.0, 1.1, 0.5 and 0.3 microns. The fractions were collected by placing filters in the apparatus and determining the amount of powder that impinged on them by gravimetric and/or analytical measurements. The fine particle fraction of the total dose of powder (FPFTD) less than or equal to an effective cut-off aerodynamic diameter was calculated by dividing the powder mass recovered from the desired stages of the impactor by the total particle mass in the capsule. Results are reported as the fine particle fraction of less than 4.4 microns (FPF <4.4 microns), as well as mass median aerodynamic diameter (MMAD) and GSD calculated from the FPF trend across stages. The fine particle fraction can alternatively be calculated relative to the recovered or emitted dose of powder by dividing the powder mass recovered from the desired stages of the impactor by the total powder mass recovered.

[00241] If desired, a two-stage collapsed AC! can also be used to measure fine particle fraction. The two-stage collapsed ACI consists of only stages 0 and 2, and the collection filter, all from the eight-stage ACI, and allows for the collection of two separate powder fractions. Specifically, a two-stage collapsed ACI is calibrated so that the fraction of powder that is collected on stage two is composed of respirable dry particles that have an aerodynamic diameter of less than 5.6 microns and greater than 3.4 microns. The fraction of powder passing stage two and depositing on a collection filter (stage F) is thus composed of respirable diy particles having an aerodynamic diameter of less than 3.4 microns. The airflow at such a calibration is approximately 60 L/min. -72- WO 2012/044736 PCT/US2011/053829 [00242] Tap Density. Tap density was measured using a modified USP method requiring smaller powder quantities by following USP <616> with the substitution of a 1.5 cc microcentrifuge tube (Eppendorf AG, Hamburg, Germany) or a 0.3 cc section of a disposable serological polystyrene micropipette (Grenier Bio-One, Monroe, NC) with polyethylene caps (Kimble Chase, Vineland, NJ) to cap both ends and hold the powder within the pipette section. Instruments for measuring tap density, known to those skilled in the art, include hut are not limited to the Dual Platform Microprocessor Controlled Tap Density Tester (Vankel, Cary, NC) or a SOT AX Tap Density Tester model TD1 (Horsham, PA). Tap density is a standard measure of the envelope mass density. The envelope mass density of an isotropic particle is defined as the mass of the particle divided by the minimum spherical envelope volume within which it can be enclosed.

[00243] Bulk Density. Bulk density was estimated prior to tap density measurement by dividing the weight of the powder by the volume of the powder, as estimated using the volumetric measuring device.

[00244] Emitted Geometric or Volume Diameter. The volume median diameter (VMD) (Dv50) of the powder after it emitted from a dry powder inhaler, which may also be referred to as volume median geometric diameter (VMGD) and x50, was determined using a laser diffraction technique via the Spraytec diffractometer (Malvern, Inc., Westborough, MA). Powder was filled into size 3 capsules (V-Caps, Capsugel) and placed in a capsule based dry powder inhaler (RS01 Model 7 High resistance, Plastiape, Italy), or DPI, which was joined via an airtight connection to the inhaler adapter of the Spraytec. A steady airflow rate was drawn through the DPI typically at 60 L/min for a set duration, typically of 2 seconds controlled by a timer controlled solenoid (TPK2000, Copley, Scientific, UK). The outlet aerosol then passed perpendicularly through the laser beam as an internal flow. The resulting geometric particle size distribution of the aerosol was calculated from the software based on the measured scatter pattern on the photodetectors with samples typically taken at 1000Hz for the duration of the inhalation. The Dv50, GSD, and FPF<5.0 pm measured were then averaged over the duration of the inhalation. -73 - WO 2012/044736 PCT/US2011/053829 [00245] Fine Particle Dose. The fine particle dose is determined using the information obtained by the ACT The cumulative mass deposited on the filter, and stages 6, 5, 4, 3, and 2 for a single dose of powder actuated into the AC1 is equal to the fine particle dose less than 4.4 microns (FPD<4.4um).

[00246] Capsule Emitted Powder Mass. A measure of the emission properties of the powders was determined by using the information obtained from the ACI tests or emitted geometric diameter by Spraytec. The filled capsule weight was recorded at the beginning of the run and the final capsule weight was recorded after the completion of the run. The difference in weight represented the amount of powder emitted from the capsule (CEPM or capsule emitted powder mass). The CEPM was reported as a mass of powder or as a percent by dividing the amount of powder emitted from the capsule by the total initial particle mass in the capsule.

Example 1. Production and characterization of monovalent cation dry powders.

[00247] Several powders of the invention were produced by spray drying of homogenous particles. The dry powders produced are shown in Table 1.

Table 1. Composition of monovalent cation dry powders.

Form. Salt % Salt load (w/w) Excipient % Excipient load (w/w) Drug % Drug load (w/w) I Sodium chloride 65.4 Leucine 30 fluticasone propionate / salmeterol xinafoate (FP/SX) 4/0.58 II Sodium lactate 10 Mannitol 85.42 FP/SX 4/0.58 III Potassium chloride 60 Trehalose 30 budesonide 10 IV Sodium chloride 40 Mannitol 10 ciprofloxacin 50 -74- WO 2012/044736 PCT/US2011/053829 y Potassium citrate 5 Maltodextrin 45 tobramycin 50 VI Sodium chloride 40.9 Leucine 59.1 N/A N/A VII Sodium chloride 67.7 Leucine 30 FP/SX 2.0/0.29 VIII Sodium chloride 66.7 Leucine 30 FP/SX 2.9/0.42 N/A N/A Leucine 95.4 FP/SX 4/0.58 X Sodium chloride 65.4 Lactose 30 FP/SX 4/0.58 XI N/A N/A Lactose 95.4 FP/SX 4/0.58 [00248] The materials used to make the above powders and their sources are as follows. Potassium chloride, potassium citrate, sodium chloride, sodium lactate, L-leucine, lactose monohydrate, maltodextrin, mannitol, trehalose, budesonide, ciprofloxacin hydrochloride, fluticasone propionate (FP), salmeterol xinafoate (SX) and tobramycin were obtained from Sigma-Aldrich Co. (St. Louis, MO) or Spectrum Chemicals (Gardena, CA), except for sodium lactate (Chem Service, West Chester, PA), potassium chloride (Fisher Scientific, Pittsburgh, PA) and trehalose (Acros Organics, Morris Plane, NJ). Ultrapure water was from a water purification system (Millipore Corp., Billerica, MA). Ethyl alcohol (200 Proof, ACS/USP Grade) was from Pharmco-Aaper (Shelbyville, KY).

[00249] Spray drying homogenous particles requires that the ingredients of interest he solubilized in solution or suspended in a uniform and stable suspension. Most of the materials mentioned in the material section are sufficiently water-soluble to prepare suitable spray drying solutions. However, budesonide, flucticasone propionate and salmeterol xinafoate are practically insoluble in water. As a result of these low solubilities, formulation feedstock development work was necessary to prepare solutions or suspensions that could be spray dried. Budesonide, flucticasone propionate and salmeterol xinafoate are slightly soluble in ethanol, so these were fully solubilized in 99% ethanol prior to mixing with other components dissolved in water to obtain a 2-10 g/L solids concentration in 60% ethanol solution. -75- WO 2012/044736 PCT/US2011/053829 [00250J For the spray drying process, the salts, excipients and other drugs were dissolved or suspended in a solvent (e.g., water). The solid concentrations (w/v) were chosen dependent on the solubility of the different components (see Table 2). The ratios used for formulations were based on the molecular weight of the anhydrous salts (see Table 3).

Table 2. Salt solubilities

Salt Water solubility at 20-30 °C, 1 bar Potassium chloride 1 g/2.8 mL1 Potassium citrate Monohydrate, 1 g /0.65 mL1 Sodium ascorbate 62gZ100mL‘ Sodium bicarbonate Soluble in 10 parts1 Sodium carbonate Soluble in 3.5 parts1 Sodium chloride 1 g/2.8 mL1 Sodium citrate Dihydrate, soluble in 1.3 parts1 Sodium lactate Commercially available as 70-80% in water1 Dibasic sodium phosphate Soluble in -8 parts1 Sodium propionate 1 g/~l mL1 Sodium sulfate Soluble in 3.6 parts1 1 O'Neil, MaryadeleJ. The Merck Index: an Encyclopedia of Chemicals, Drugs, andBiologicals. 14th ed. Whitehouse Station, NX: Merck, 2006. -76- WO 2012/044736 PCT/US2011/053829

Table 3. Weight Percent K+ and Na+ in Salt Molecules

Salt Molecular Formula MW (g/mol) Weight % of cation in molecule Potassium chloride KC1 74.55 52.45 Potassium citrate C6H5K3O7 306.39 38.28 Sodium ascorbate C6H7NaO6 198.11 20.23 Sodium bicarbonate CHNaO3 84.01 47.71 Sodium carbonate CNa2O3 105.99 43.38 Sodium chloride NaCl 58.44 39.34 Sodium citrate ΟΛΝα,Ο, 258.07 26.73 Sodium lactate C3H5NaO3 112.06 20.52 Dibasic sodium phosphate HNa^CLP 141.96 28.23 Sodium propionate C3H3NaO2 96.06 41.72 Sodium sulfate Na2O4S 142.04 32.37 [00251] Dry powders were prepared by spray drying on a Biichi B-290 Mini Spray Dryer (BLfCHI Labortechnik AG, Flawil, Switzerland) with powder collection from a High Performance cyclone. The system used the Biichi B-296 dehumidifier to ensure stable temperature and humidity of the air used to spray dry. Furthermore, when the relative humidity in the room exceeded 30% RH, an external LG dehumidifier (model 49007903, LG Electronics, Englewood Cliffs, NJ) was run constantly. Atomization of the liquid feed utilized a Biichi two-fluid nozzle with a 1.5 mm diameter. Inlet temperature of the process gas can range from 100 °C to 220 °C and outlet temperature from 80 °C to 120 °C with a liquid feedstock flowrate of 3 mL/min to 10 mL/min. The two-fluid atomizing gas ranges from 25 mm to 45 mm (300 LPH to 530 LPH) and the aspirator rate from 70% to 100%. The feedstock was prepared as a batch by dissolving the specific salt in ultrapure water, then the excipient, and finally the drug component. For Formulations Ι-ΠΙ and VII-IX where budesonide, FP and SX are practically insoluble in water, but slightly soluble in ethanol, the drug components were fully dissolved in ethanol and mixed slowly with the aqueous solution (salt and excipient previously dissolved in water) to avoid precipitation. The solution was -77- WO 2012/044736 PCT/US2011/O53829 kept agitated throughout the process until the materials were completely dissolved in the water or ethanol solvent system at room temperature.

[00252] Formulation Ϊ dry powders were produced by spray drying on the Biichi B-290 Mini Spray Dryer (BFJCHI Labortechnik AG, Flawil, Switzerland) with powder collection in a 60 mL glass vessel from a High Performance cyclone. The system used the Biichi B-296 dehumidifier and an external LG dehumidifier (model 49007903, LG Electronics, Englewood Cliffs, NJ) was run constantly. Atomization of the liquid feed utilized a Biichi two-fluid nozzle with a 1.5 mm diameter. The two-fluid atomizing gas was set at 40 mm and the aspirator rate to 90%. Room air was used as the drying gas. Inlet temperature of the process gas was 180 °C and outlet temperature from 86 °C to 87 °C with a liquid feedstock flow rate of 8 mL/min to 9 mL/min. The solids concentration was 10 g/L in 60% ethanol.

[00253] Formulation II was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 83 °C to 85 °C with a liquid feedstock flow rate of 9 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[00254] Formulation III was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 92 °C to 94 °C with a liquid feedstock flow rate of 6 mL/min to 7 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[00255] Formulation IV was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 75 °C to 81 °C with a liquid feedstock flow rate of 6 mL/min. The solids concentration was 10 g/L in ultrapure water.

[00256] Formulation V was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 81 °C to 86 °C with a liquid feedstock flow rate of 6 mL/min to 7 mL/min. The solids concentration was 5 g/L in ultrapure water. -78- WO 2012/044736 PCT/US2011/053829 [00257] Formulation VI was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 61 °C to 87 °C with a liquid feedstock flow rate of 6 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[0Θ258] Formulation VII was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 88 °C to 89 °C with a liquid feedstock flow rate of 9 mL/min to 10 mL/min. The solids concentration was 10 g/L in 60% ethanol.

[00259] Formulation VIII was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 84 °C to 85 °C with a liquid feedstock flow rate of 9 mL/min to 10 mL/min. The solids concentration was 10 g/L in 60% ethanol.

[00260] Formulation IX was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 76 °C to 87 °C with a liquid feedstock flow rate of 9 mL/min to 10 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[00261] Formulation X was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 86 °C to 87 °C with a liquid feedstock flow rate of 9 mL/min to 10 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[00262] Formulation XI was produced using the same equipment and settings. Inlet temperature of the process gas was 180 °C and outlet temperature from 87 °C to 88 °C with a liquid feedstock flow rate of 9 mL/min to 10 mL/min. The solids concentration was 5 g/L in 60% ethanol.

[00263] Formulations I, Π and VII-XI comprise FP, SX and excipients. The drug loading for FP ranged from 2.0 to 4.0 wt%, while that of SX ranged from 0.29 to 0.58 wt%. The higher drug loads are comparable to the amount of drug contained within a single dosage unit of a commercial formulation of FP and SX. The lower drug loads take into account deposition -79- WO 2012/044736 FCT/US2011/053829 efficiency of the commercial formulation, as well as anticipated aerosol properties of the formulations produced here, to target a nominal drug mass that results in the desired drug dose.

[00264] The spray drying process yield was obtained by calculating the ratio of the weight of dry powder collected after the spray drying process was completed divided by the weight of the starting solid components placed into the spray drying liquid feed, [0O265]The FPF_TD (<5.6 microns) and FPF TD (<3.4 microns) were measured by characterizing the powders with a two stage ACI using stages 0, 2 and F. Powder formulations were filled into size 3 HPMC capsules by hand with the fill weight measured gravimetrically using an analytical balance. Fill weights of 20 mg were filled for Formulations Ι-ΠΙ and VI-XI, 40 mg for Formulation VII and 50 mg for Formulations IV and V. An RS-01 DPI was used to disperse the powder into the cascade impactor. One capsule was used for each measurement, with two actuations of 2L of air at 60 LPM drawn through the dry powder inhaler (DPI). The flow rate and inhaled volume were set using a timer controlled solenoid valve with flow control valve. Three replicate ACI measurements were performed for each formulation. The impactor stage plates were inverted and pre-weighed 81mm glass fiber filters were placed on them. After the inhalation maneuver, the impactor was disassembled and the glass fiber filters were weighed. Powder that is collected on stage two is composed of respirable dry particles that have an aerodynamic diameter of less than 5.6 microns and greater than 3.4 microns. The fraction of powder passing stage two and depositing on a collection filter on stage F is thus composed of respirable dry particles having an aerodynamic diameter of less than 3.4 microns. The results of the size characterization of the powders are shown in Table 4 below.

Table 4, Size characteristics of monovalent cation dry powders.

Formulation Spray Drying Yield (%) FPFTD <3.4 pm (%) FPFTD <5.6 pm (%) I NaCl:Leu:FP/SX 52.1% 59.1% 72.3% II NaLac:Mann:FP/SX 44.7% 2.6% 12.5% -80- WO 2012/044736 FCT/US2011/053829 in KCl:Tre:Budes 44.9% 42.2% 48.7% IV NaCkMann; Cipro 81.4% 27.1% 48.3% V KCit:Malt:Tobra 69.2% 35.9% 51.8% VI NaCkLeu 40.0% 66.9% 82.3% VH NaCl:Leu:FP/SX 54.7% 59.1% 76.4% VUI NaCl:Leu:FP/SX 58.7% 53.1% 74.9% IX Leu:FP/SX 43.5% 26.1% 40.0% X NaCkLact:FP/SX 50.0% 24.6% 44.9% XI Lact:FP/SX 44.7% 46.0% 70.2% [00266] The powders produced were further characterized with regard to density and dispersibility ratio.

[00267] Bulk and tapped densities were determined using a SOT AX Tap Density Tester model TD1 (Horsham, PA). For any given run, a sample was introduced to a tared 0.3 cc section of a disposable serological polystyrene micropipette (Grenier Bio-One, Monroe, NC) using a funnel made with weighing paper (VWR International, West Chester, PA) and the pipette section was plugged with polyethylene caps (Kimble Chase, Vineland, NJ) to hold the powder. The powder mass and initial volume (Vo) were recorded and the pipette was attached to the anvil and run according to the USP I method. For the first pass, the pipette was tapped using Tap Count 1 (500 taps) and the resulting volume Va was recorded. For the second pass, Tap Count 2 was used (750 taps) resulting in the new volume Vbi. If Vbi > 98% of Va, the test was complete, otherwise Tap Count 3 was used (1250 taps) iteratively until Vbn > 98% of Vbn-ι. Bulk density was estimated prior to tap density measurement by dividing the weight of the powder by the volume of the powder, as estimated using the volumetric measuring device. Calculations were made to determine the powder bulk density (da), tap density (dr), and Hausner Ratio (H), which is the tap density divided by the bulk density.

[Θ0268] Volume median diameter was determined using a HELOS laser diffractometer and a RODOS dry powder disperser (Sympatec, Inc., Princeton, NJ). A microspatula of material (approximately 5 milligrams) was introduced into the RODOS funnel, where a shear force is -81 - WO 2012/044736 PCT/US2011/053829 applied to a sample of particles as controlled by the regulator pressure of the incoming compressed dry air. The pressure settings were varied to use different amounts of energy to disperse the powder. The regulator pressure was set at 0.2 bar, 0.5 bar, 1.0 bar, 2,0 bar and 4.0 bar, with maximum orifice ring pressure at each pressure. The dispersed particles traveled through a laser beam where the resulting diffracted light pattern produced is collected, using an Rl or R3 lens, by a series of detectors. The ensemble diffraction pattern is then translated into a volume-based particle size distribution using the Fraunhofer diffraction model, on the basis that smaller particles diffract light at larger angles. 1 bar/4 bar, 0.5 bar/4 bar, 0.2 bar/4 bar ratios were obtained by dividing average volume median diameter values obtained at each of 0.2 bar, 0.5 bar and Ϊ .0 bar by the volume median diameter value obtained at 4.0 bar.

[002691 Results for the density tests for the formulations are shown in Table 5. The tap densities for Formulations I-X were relatively high (e.g., > 0.4 g/cc). The bulk densities were such that the Hausner ratio was also rather high for all formulations, particularly Formulations II and IX. All of the powders tested possessed Hausner Ratios that have been described in the art as being characteristic of powders with extremely poor flow properties (See, e.g., USP <1174>). USP <1174> notes that dry powders with a Hausner ratio greater than 1.35 are poor flowing powders. Flow properties and dispersibility are both negatively affected by particle agglomeration or aggregation. It is therefore unexpected that powders with Hausner Ratios of 1.9 to 3.3 would be highly dispersible and possess good aerosolization properties

Table 5. Characteristics of monovalent cation dry powders.

Formulation Density HELOS/RODOS VMGD Bulk Density (g/cc) Tap Density (g/cc) Hausner Ratio 1/4 bar 0.5/4 bar 0.2/4 bar at 1 bar (pm) I NaCkLeu: FP/SX 0.23±0.O1 O.48±0.11 2.09 1.19 1.36 1.42 1.58 II 11.00 -82- WO 2012/044736 PCT/US2011/053829

NaLac:Mann: 17P/CV Γ lr / Ο.Λ, 0.12±0.02 0.39±0.11 3.25 1.10 1.62 2.12 III KCLTre: Budes 0.29±0.03 0.59±0.00 2.03 1.18 1.39 1.83 1.27 IV NaCEMann: Cipro 0.32±0.13 0.60EQ.02 1.88 0.92 1.00 1.21 2.00 y KCitMalt: Tobra 0.29±0.01 0.56±0.00 1.93 1.10 1.16 1.40 1.55 VI NaCELeu 0.2H0.11 0.4H0.02 1.94 1.09 1.11 1.26 1.89 VII NaCELeu:FP/SX 0.24±0.01 0.49±0.00 2.04 1.11 1.16 1.25 1.76 VIII NaCl:Leu:FP/SX 0.24±0.03 0.47L0.03 1.96 1.13 1.30 1.41 1.56 IX Leu;FP/SX 0.22±0.02 0.45±0.02 2.07 1.25 1.40 2.46 1.88 X NaCELact:FP/S 0.37±0.01 0.76±0.08 2.05 1.07 1.32 1.93 1.44 XI Lact:FP/SX 0.10±0.00 0.19±0.00 1.86 1.05 1.17 1.36 1.89 [00270] Table 5 further shows that Formulations I-XI have a HELOS/RODOS dispersibility ratio at 1/4 bar between 0.92 andl.25, at 0.5/4 bar between 1.00 and 1.62, and at 0.2/4 bar between 1.21 and2.46. Values that are close to 1.0, as these values are, are considered indicative of powders that are highly dispersible. In particular, Formulation I, IV, V-VIII and XI displayed highly dispersible behavior, as all had dispersive pressure ratios less than about 1.4 [00271] Table 5 also shows the VMGD at 1 bar for Formulations I through XI. The VMGD for all the formulations except for Formulation II is between about 1.2 microns and about 2.0 microns. -83- WO 2012/044736 PCT/US2011/053829

Example 2. Dispersibility of monovalent cation powders.

[002723 This example demonstrates the dispersibility of dry powder formulations when delivered from a dry powder inhaler over a range of inhalation flow rate and volumes.

[00273] The dispersibility of various powder formulations was investigated by measuring the geometric particle size distribution and the percentage of powder emitted from capsules when inhaling on a dry powder inhaler with flow rates representative of patient use. The particle size distribution and weight change of the filled capsules were measured for multiple powder formulations as a function of flow rate and inhaled volume in a passive dry powder inhaler.

[00274] Powder formulations were filled into size 3 HPMC capsules (Capsugel V-Caps) by hand with the fill weight measured gravimetrically using an analytical balance (Mettler Toledo XS205). Fill weights of 20 mg were filled for Formulations I and III. A capsule-based passive dry powder inhaler (RS-01 Model 7, High Resistance, Plastiape S.p.A.) was used which had specific resistance of 0.036 kPaI/2LPM"1. Flow rate and inhaled volume were set using a timer controlled solenoid valve and flow control valve with an inline mass flow meter (TSI model 3063). Capsules were placed in the dry powder inhaler, punctured and the inhaler sealed inside a cylinder, exposing the air jet exiting from the DPI to the laser diffraction particle sizer (Spraytec, Malvern) in its open bench configuration. The steady air flow rate through the system was initiated using the solenoid valve and the particle size distribution was measured via the Spraytec at 1kHz for the duration of the single inhalation maneuver with a minimum of 2 seconds. Particle size distribution parameters calculated included the volume median diameter (Dv50) and the geometric standard deviation (GSD). At the completion of the inhalation duration, the dry powder inhaler was opened, the capsule removed and re-weighed to calculate the mass of powder that had been emitted from the capsule during the inhalation duration. Two inhalation conditions were used for each powder including 60 LPM and 2L for the high inhalation energy condition and 30LPM and IL for the low inhalation energy condition. At each inhalation condition, 5 replicate capsules were measured and the results of Dv50, GSD and capsule emitted powder mass (CEPM) were averaged. -84- WO 2012/044736 PCT/US2011/053829 [00275] In order to relate the dispersion of powder at different flow rates, volumes, and from inhalers of different resistances, the energy required to perform the inhalation maneuver was calculated. Inhalation energy was calculated as E=R2Q2V where E is the inhalation energy in Joules, R is the inhaler resistance in kPa!/2/LPM, Q is the steady flow rate in L/min and V is the inhaled air volume in L. In the example described here, the inhalation energy for the case of 60 LPM and 2 L was 9.2 Joules, while for the other case of 30 LPM and 1 L, the inhalation energy was 1.2 Joules.

[00276] Table 6 shows the dose emitted from a capsule (CEPM), and the particle size distribution parameters of the powder emitted (Dv50 and GSD) for Formulations I and III at a capsule fill weight of 20 mg using the high resistance RS-01 dry powder inhaler. For each powder, a 2L inhalation was used at the high flow rate condition of 60 LPM and a IL inhalation for the 30 LPM condition. For Formulation I, the CEPM decreased modestly from 62% to 44% while the volume median diameter increased only slightly from L60 to 1.77 gm with a drop of inhalation energy from 9.2 to 1.2 Joules. For Formulation III, while the CEPM did decrease from 90 to 55%, more than 50% of the filled powder weight was emptied from the capsule at the low energy condition. The Dv50 of the emitted powder was less than 5 micrometers for both inhalation conditions.

Table 6. Aerosol properties of monovalent powders.

Flow Rate: (LPM) 60 30 Formulation I NaCELeu: FP/SX Dv(50) (gm): 1.60L0.06 1.77±0.20 GSD (gm): 2.94±0.46 4.27±0.53 CEPM (%): 62% 44% Formulation HI KCl:Tre: Budes Dv(50) (gm): 1.63±0.05 3.43±0.74 GSD (gm): 4.87±0.83 7.09H.38 CEPM (%): 90% 55% -85- WO 2012/044736 PCT/US2011/053829 [00277] Table 7 shows the dose emitted from a capsule (CEPM) and the particle size distribution parameters of the powder emitted Dv(50) for Formulations VI through XI at the indicated capsule fill weight using the high resistance RS-01 dry powder inhaler across several flow rates. In this example, the inhaler resistance was 0.036 kPa ZLPM and the inhalation energy for 60 LPM and 2 L was 9.2 Joules, for 30 LPM and I L was 1.2 Joules, for 20 LPM and 1 L was 0.52 Joules and for 15 LPM and 1 L was 0.29 Joules.

Table 7. Aerosol properties of monovalent cation-based dry powder formulations of FP/SX.

Flow Rate: (LPM) 60 30 20 15 Formulation VI Dv(50) 2.4 N/A N/A N/A NaCLLeu (pm): CEPM N/A N/A N/A N/A Formulation VII-1 Dv(50) 1.37±0.15 2.29±0.06 3.5310.18 5.4310.42 NaCl:Leu:FP/SX (40 mg capsule fill) (pm): CEPM (%): 99.H0.1 69.5126.8 54.9126.9 36.H16.5 Formulation VII-2 Dv(50) (pm): CEPM (%): N/A N/A N/A 5.3310.13 NaCl:Leu:FP/SX N/A N/A N/A 90.712.8 Formulation VIII Dv(50) 1.6210.17 2.4810.67 3.6510.08 5.4210.16 NaCl:Leu:FP/SX (pm): CEPM (%): 97.910.4 94.1103.3 87.1116.1 92.514.4 Formulation IX Dv(50) 2.7910.25 3.8H0.12 6.2410.16 8.2310.51 Leu: FP/SX (gm): CEPM (%): 99. HOT 98.210.3 97.110.9 80.7111.4 Formulation X Dv(50) 1.9610.22 3L1H6.96 87.03122.43 96.81111.81 NaCl:Lact:FP/SX (pm): CEPM (%): 83.5H4.7 40.6±22.3 44.4119.9 43.5118.4 Formulation XI Dv(50) (pm): CEPM (%): 2.4710.16 7.9510.88 39.61111.08 61.1614.71 Lact:FP/SX 91,912.8 49.9H9.6 47.8121.8 32.5117.5 [00278] All powder formulations at 60 LPM and 2 L were well dispersed from the dry powder inhaler with all listed formulations having greater than 80% of the filled powder mass emptying from the capsules and median volumetric diameters of less than 5 micrometers. At -86- WO 2012/044736 PCT/US2011/053829 the 30 LPM and 1 L condition corresponding to 1.2 Joules, formulations VIII and IX maintained a CEPM greater than 80% and volume median diameter of less than 5 micrometers, with only modest increases in diameter measured for either formulation. At the lowest flow rate condition of 15 LPM and 1 L corresponding to 0.3 Joules of inhalation energy, Formulations VU-2, VIII, and IX all showed greater than 80% CEPM and volume median diameters below 10 micrometers which is very good dispersibility at such a low applied energy condition.

Example 3. Aerodynamic particle size of monovalent cation powders.

[00279] This example demonstrates that the aerodynamic size distribution of dry powder formulations comprised in part of monovalent cationic salts, when delivered from a dry powder inhaler, is in a range appropriate for deposition in the respiratory tract.

[00280] The aerodynamic particle size distributions of rive powder formulations were measured by characterizing the powders with an eight stage ACL Powder formulations were filled into size 3 HPMC capsules (V-Caps, Capsugel) by hand with the fill weight measured gravimetrically using an analytical balance (Mettler Toledo XS205). Fill weights of 20 mg were filled for Formulations I, II, and III, and a fill weights of 50mg were filled for Formulations IV and V. A reloadable, capsule-based passive dry powder inhaler (RS-01 Model 7, High Resistance, Plastiape, Osnago, Italy) was used to disperse the powder into the cascade impactor. One capsule was used for each measurement, with two actuations of 2L of air at 60 LPM drawn through the dry powder inhaler (DPI). The flow rate and inhaled volume were set using a timer controlled solenoid valve with flow control valve (TPK2000, Copley Scientific). Three replicate ACI measurements were performed for each formulation. The impactor stage plates were inverted and pre-weighed 81mm glass fiber filters (1820-6537, Whatman) were placed on them. After the inhalation maneuver, the impactor was disassembled and the glass fiber filters were weighed to determine the mass of powder deposited on each stage and on the final filter. The size distribution of the emitted powder was averaged across the replicates and the average mass of powder delivered to each of the stages (-1, -0, 1, 2, 3, 4, 5, 6, and F) are shown for each formulation in FIGs 1A to IE with error bars giving standard deviation of the 3 replicates. The mass median aerodynamic -87- WO 2012/044736 PCT/US2011/053829 diameter (MMAD), geometric standard deviation (GSD), and fine particle dose (FPD<4.4 pm) of the emitted powder were calculated and averaged across the replicates and are tabulated in TableS.

Table 8. Aerodynamic particle size of monovalent cation dry powder formulations. aPSD (ACI-8) Formulation MMAD (pm) GSD (pm) FPD < 4.4 pm (mg) I NaChLeu;FP/SX 3.01 ±0.16 1.81+0.04 11.2+ 0.8 II NaLac:Mann:FP/SX 8.56+0.40 1.62+0.06 0.73+ 0.04 III KCl:Tre:Budes 2.18+0.10 1.71±0.03 8.6+0.2 IV NaCl: Mann: Cipro 3.88+0.10 1.75+0.02 15.4+0.7 V KCit:Malt;Tobra 2.91+0.11 1.83+0.00 21.1 + 1.4 [00281] All five formulations were found to have repeatable size distributions as illustrated by the low standard deviations for all the stages and calculated values. All five formulations had respirable size distributions with Formulations I, III, IV and V having MMADs less than 5 micrometers and Formulation II having an MMAD less than 10 micrometers.

[00282] With a maximum GSD of 1.83 for the five formulations, the polydispersity of the size distributions was relatively small compared to typical dry powder formulations for inhalation. The fine particle dose shown in Table 8 for the five powder formulations demonstrated that a significant mass of the powder dose was contained in small diameter particles that would be expected to deposit in the lung.

Example 4. Production and optimization of monovalent cation dry powders. WO 2012/044736 PCT/US2011/053829 [00283] Several monovalent cation powders comprised of sodium sulfate and mannitol or maltodextrin were produced by spray drying of homogeneous particles. The powders produced are shown below in Table 9.

Table 9. Composition of monovalent cation dry powders.

Formulation Sait % Salt load (w/w) Excipient % Excipient load (w/w) XII Sodium sulfate 90 Mannitol 10 XIII Sodium sulfate 50 Mannitol 50 XIV Sodium sulfate 10 Mannitol 90 XV Sodium sulfate 90 Maltodextrin 10 XVI Sodium sulfate 50 Maltodextrin 50 xvn Sodium sulfate 10 Maltodextrin 90 [00284] The materials to make the above powders and their sources are as follows: sodium sulfate, mannitol and maltodextrin were purchased from Spectrum Chemicals (Gardena, CA). Ultrapure water was from a water purification system (Millipore Corp., Billerica, MA). (00285] Formulation XII-XVI1 dry powders were prepared by spray drying on a Buchi B-290 Mini Spray Dryer (BIJCHI Labortechnik AG, Flawil, Switzerland) with powder collection from a High Performance cyclone. The system used the Buchi B-296 dehumidifier to ensure stable temperature and humidity of the air used to spray dry. Atomization of the liquid feed utilized a Buchi two-fluid nozzle with a 1.5 mm diameter. Inlet temperature of the process gas was 100 °C and outlet temperature ranged from 51 °C to 58 °C with a liquid feedstock flowrate of 2.6 mL/min. The two-fluid atomizing gas was set to 40 mm (473 LPH) and the aspirator rate to 80% (33 m3/h). Room air was used as the drying gas. The feedstock was prepared as a batch by dissolving the specific salt in ultrapure water, then the excipient, and finally the drug component. The solution was kept agitated throughout the process until the -89- WO 2012/044736 PCT/US2011/053829 materials were completely dissolved in the water solution at room temperature. The solids concentration was 10 g/L in 60% ultrapure water.

[00286] As shown in Table 10, all the powders had acceptable yields (dry powder output collected divided by the total solids added to the solution) from the spray drying process. The powders produced were then characterized with regard to size (FPFTD <3.4 pm and <5.6 pm) using a two-stage ACI as described in Example 1. The large percentage of particles with a FPF TD less than 5.6 pm and less than 3.4 pm indicated that the powder particles were respirable and of the appropriate size for deposition in the lung.

Table 10. Size characteristics of monovalent cation dry powders.

Formulation Spray Drying Yield (%) FIT ID <3.4 pm (%) FPFTD <5.6 pm (%) XII 81 27 49 XIII 79 26 49 XIV 77 32 54 XV 83 39 59 XVI 82 33 51 XVII 75 30 48 [00287] Bulk and tapped densities of the powders were determined using a TD1 as described in Example 1. Results for the density tests for formulations XI1-XVI1 are shown in Table 11.

Table 11. Characterization of monovalent cation dry powders.

Formulation Density HELOS/RODOS VMGD Bulk Density (g/cc) Tap Density (g/cc) Hausner Ratio 1/4 bar 0.5/4 bar 0.2/4 bar at 1 bar (pm) XII N/A N/A N/A 1.18 0.68 0.94 5.34 XIII 0.42 ± 0.03 0.88 ± 0.00 2.11 1.04 1.12 1.31 1.80 XIV 0.38 ± 0.03 0.83 ±0.05 2.19 1.04 1.06 1.17 1.97 XV 0.34 ± 0.06 0.79 ± 0.28 2.31 1.20 1.07 1.13 2.34 XVI 0.41 ±0.02 0.88 ± 0.01 2.15 0.97 1.01 1.05 1.76 XVII 0.29 ± 0.03 0.57 ±0.06 1.93 1.01 0.98 1.20 2.12 -90- WO 2012/044736 PCT/US2011/053829 [00288] The tap densities of Formulations ΧΠΙ-XVII were high (e.g., > than 0.4 g/cc) and their Hausner ratios were well above 1.35, a ratio typically indicative of powders with poor flowability and dispersibility. However, measurement of the dispersibility properties of the powders indicated that the formulations were surprisingly dispersible, in spite of having high Hausner ratios, [00289] Table 11 also shows the VMGD for Formulations XII through XVII at 1 bar. The VMGD at 1 bar for Formulations XHI through XVII is between about 1.7 microns to about 2.4 microns.

[O0290]The dispersibility of the dry powder formulations was assessed by measuring geometric particle size distribution Dv(50) and percentage of powder emitted from capsules (CEPM) at different flow rates representative of patient use. The Dv(50) and CEPM of Formulations XII-XVII were measured as described in Example 2, and the results are shown in Table 12.

Table 12. Aerosol properties of monovalent cation dry powders.

Formulation Flow Rate: (LPM) 60 30 20 15 XII Dv(50) (pm): 2.29±0.02 2.33±0.03 2.58±0.08 3.10E0.10 CEPM (%): 91.2±1.7 73.2E12.5 47.2±21.0 39.5±15.6 XIII Dv(50) (pm): 2.19±0.05 2.34±0.03 2.70±0.05 3.35±0.04 CEPM (%): 98.4±0.8 97.2±0.5 93.7±2.6 92.8±4.0 XIV Dv(50) (pm): 2.16±0.07 2,30±0.O2 2.70±0.05 3.26±0.09 CEPM (%): 94.6±0.8 88.8±2.2 78.2±10.9 78.8±4.3 XV Dv(50) (pm): 1.98±O.01 2.03±0.02 2.17±0.04 2.70±0.11 CEPM (%): 92.9±2.0 76.5±5.9 71.0±9.9 54.5±24.8 XVI Dv(50) (pm): 1.88±0.02 1.93±0.01 2.34±0.06 3.10±0.17 CEPM (%): 85.9±2.9 64,3±2.9 53.4±13.5 64.0±4.4 XVII Dv(50) (pm): 2.39±0.03 2.58±0.08 3.37±0.15 5.16±1.49 CEPM (%): 90.2±3.3 36,5±13.0 31.7±21.8 30.H15.6 -91 - WO 2012/044736 PCT/US2011/053829 [00291] All powder formulations at 60 LPM and 2 L were well dispersed from the dry powder inhaler with all listed formulations having greater than 80% of the filled powder mass emptying from the capsules and median volumetric diameters of less than 5 micrometers. At the 30 LPM and 1 L condition corresponding to 1.2 Joules, all formulations still had volume median diameters of less than 5 micrometers and all except formulation XVII had greater than 60% of the powder mass emitted from the capsule. At the lowest flow rate condition of 15 LPM and 1 L corresponding to 0.3 Joules of inhalation energy, all the formulations showed little agglomeration with volume median diameters of less than 5 micrometers and formulations XIII, XIV and XVI having greater than 60% of the powder mass emitted from the capsule, a very good dispersibility a such a low applied energy condition.

Example 5. Sodium salt-containing dry powders, optionally combined with active pharmaceutical agents A. Powder Preparation.

[00292] Feedstock solutions were prepared in order to manufacture dry powders comprised of dry particles containing a sodium salt, optionally a non-salt excipient, and at least one pharmaceutical active agent. Table 13 lists the components of the feedstock formulations used in preparation of the dry powders comprised of dry particles. Weight percentages are given on a dry basis.

Table 13. Feedstock compositions of sodium-salt with other pharmaceutically active agents

Formulation Salt % Salt load (w/w) Excipient % Excipient load (w/w) Drug % Drug load (w/w) xvin Sodium chloride 40.9 Leucine 59.1 N/A 0 XIX Sodium Chloride 34.5 Leucine 50.0 fluticasone propionate / salmeterol xinafoate (FP/SX) 13.5/2.0 vr'vr ΛΑ Sodium Chloride 65.42 Leucine 34.47 Tiotropium Bromide (TioB) 0.113 XXI Sodium 53 Leucine 27 Levofloxacin 20 92 WO 2012/044736 PCT/IJS2011/053829

Chloride (Levo) XXII Sodium Chloride 85.31 Leucine 10.0 FP/SX/TioB 4.0/0.58 /0.113 Sodium Chloride 65.42 Leucine 29.89 FP/SX/TioB 4.0/0.58 /0.113 XXIV Sodium sulfate 50.0 Mannitol 40.0 Insulin 10.0 XXV Sodium sulfate 50.0 Mannitol 47.5 Immunoglobulin G (IgG) 2.5 XXVI Sodium citrate 45.42 Leucine 50.0 r?T> /C'V' ΓΓ/ΟΛ 4.0/0.58 XXVII Sodium sulfate 45.42 Leucine 50.0 FP/SX 4.0/0.58 XXVIII Sodium sulfate 55.0 Mannitol 40.0 Insulin 5.0 ΑΛ1Λ Potassium chloride 50.0 Mannitol 50.0 N/A N/A ΛΑΛ Potassium chloride 10.0 Mannitol 90.0 N/A N/A ΆΑΛ1 Potassium citrate 10.0 Mannitol 90.0 N/A N/A ΛλαΙΙ Sodium lactate 10.0 Leucine/ Maltodextrin 50.0/ 39.9 TioB 0.113 VVV1TT ΛΛΛ111 Sodium chloride 65.4 Leucine 30.0 FP/SX 4.0/0.58 N/A - not applicable [00293] The feedstock solutions were made according to the parameters in Table 14.

Table 14. Formulation Conditions

Formulation: XVIII XIX XX 'Vr'VrT ΛΑ1 XXII Total solids (g) 10 7.5 3 5 10 Total volume water (L) 2 2.25 0.3 0.5 0.4 Total solids concentration (g/L) 5 3,3 10 10 10 Amount of NaCl in 1 L (g) 2.05 1.15 6.542 5.3 8.531 Amount leucine in 1 L (g) 2.96 1.67 3.447 2.7 1.0 Amount FP in 1 L (g) 0 0.45 0 2.0 0.4 Amount SX in 1 L (g) 0 0.07 0 0 0.058 Amount TioB in 1 L (g) 0 0 0.0113 0 0.0113 -93- WO 2012/044736 PCT/US2011/053829

Formulation: XXIII XXIV XXV XXVI XXVII Total solids (g) 4 5 5 2 2 Total volume water (L) 0.4 0.5 0.5 1 1 Total solids concentration (g/L) 10 10 10 2 2 Amount of NaCI in 1 L (g) 6.542 0 0 0 0 Amount of NaSulf in 1 L (g) 0 5.0 5.0 0 4.542 Amount of NaCit in 1 L (g) 0 0 0 4.542 0 Amount leucine in 1 L (g) 2.989 0 0 5.0 5.0 Amount mannitol in 1 L (g) 0 5.0 5.0 0 0 Amount FP in 1 L (g) 0.4 0 0 0.4 0.4 Amount SX in 1 L (g) 0.058 0 0 0.58 0.58 Amount TioB in 1 L (g) 0.0113 0 0 0 0 Amount Insulin in 1 L (g) 0 1 0 0 0 Amount IgG in 1 L (g) 0 0 0.25 0 0 Formulation: xxvin ΑΛχΑ XXX γγγττ ΛΛΛΙΙ Total solids (g) 10 3 3 3 3 Total volume water (L) 0.667 0,3 0.3 0.3 0.3 Total solids concentration (g/L) 15 10 10 10 10 Amount of NaCI in 1 L (g) 0 0 0 0 0 Amount of NaSulf in 1 L (g) 5.5 0 0 0 0 Amount of NaLact in 1 L (g) 0 0 0 0 1.0 Amount of KC1 in 1 L (g) 0 5.0 1.0 0 0 Amount of KCit in 1 L (g) 0 0 0 1.0 0 Amount leucine in 1 L (g) 0 0 0 0 5.0 Amount mannitol in 1 L (g) 4.0 5.0 9.0 9.0 0 Amount maltodextrin in 1 L(g) 0 0 0 0 3.897 Amount TioB in 1 L (g) 0 0 0 0 0.113 Amount Insulin in 1 L (g) 0.5 0 0 0 0

For all formulations, the liquid feedstock was batch mixed -94- WO 2012/044736 PCT/US2011/053829 [00294] The formulation conditions for Formulation XXXIII were: Total solids were 3 grams (g), total volume was 0.3 liters, total solids concentration was 10 grams per liter, amount of NaCl, leucine, FP, and SX in one liter was 6.542 g, 3.0 g, 0.4 g, and 0.058 g, respectively.

[00295] Formulation XVIII through XXXIII dry powders were produced by spray drying on the Biichi B-290 Mini Spray Dryer (BtJCHI Labortechnik AG, Flawil, Switzerland) with powder collection from a High Performance cyclone in a 60 mL glass vessel. The system used the Biichi B-296 dehumidifier and an external LG dehumidifier (model 49007903, LG Electronics, Englewood Cliffs, NJ) was run constantly, except for Formulation XXXII. Atomization of the liquid feed utilized a Biichi two-fluid nozzle with a 1,5 mm diameter except for Formulation XXXII, which used a two-fluid nozzle with a 1.4 mm diameter. The two-fluid atomizing gas was set at 40 mm (667 LPH). The aspirator rate was set to 90% (35 nr/h) for Formulations XVIII, XIX and XXI; to 80% (32 m3/h) for Formulations XX, XXIV, XXV, VVIIII, XXIX, XXX, XXXI and XXXIII; 70% for Formulations XXII, XXIII, XXVI, XXVII. Formulation XXXII had an aspirator rate of 100%, but nitrogen flow limited rate to approximately 31 kg/h or 26 m3/h. Air was used as the drying gas and the atomization gas, except for Formulation XXXII, where nitrogen was used. Table 15 below includes details about the spray drying conditions.

[0Θ296] Formulation XXXIII was essentially the same formulation as Formulation I. The solution preparation was the same as for Formulation I. The spray drying process conditions were the same when going from Formulation I to Formualtion XXXIII except that the inlet temperature was decreased from 180 °C to 100 °C, the aspirator rate was changed from 90% to 80% (35 cubic meters per hour to 32 cubic meters per hour) and the feed rate was increased from 8.6 to 10.2 mL/min, respectively.

Table 15. Spray Drying Process Conditions

Formulation Process Parameters xvni XX XXII Liquid feedstock solids concentration 5 3.3 10 10 10 Process gas inlet temperature (°C) 180 180 115 180 180 Process gas outlet temperature (°C) 61-87 77-92 67-68 89-92 74-75 -95- WO 2012/044736 PCT/US2011/053829

Process gas flowrate (liter/hr, LPH) 667 667 667 667 667 Atomization gas flowrate (meters3/hr) 35 35 32 35 29 Liquid feedstock flowrate (mL/min) 6.2 6.2 2.5 5.9 10 Formulation Process Parameters XXIII XXIV XXV XXVII Liquid feedstock solids concentration (sN) 10 10 10 2 2 Process gas inlet temperature (°C) 180 100 100 180 180 Process gas outlet temperature (°C) 71-74 55-57 57- 59 74- 78 77-80 Process gas flowrate (liter/hr, LPH) 667 667 667 667 667 Atomization gas flowrate (meters3/hr) 29 32 32 29 29 Liquid feedstock flowrate (mL/min) 12,1 2.9 2.8 10.2 10.5 Formulation Process Parameters xxvni XXIX XXX XXXII Liquid feedstock solids concentration (g/L) 15 10 10 10 10 Process gas inlet temperature (°C) 100 115 115 115 100 Process gas outlet temperature (°C) 54-56 65-66 64- 67 65- 66 65-66 Process gas flowrate (liter/hr, LPH) 667 667 667 667 667 Atomization gas flowrate (meters3/hr) 32 32 32 32 32 Liquid feedstock flowrate (mL/min) 3.2 2.8 2.7 2.7 2.7 [00297] The spray drying process conditions for Formulation ΧΧΧΠΪ was: Liquid feedstock solids concentration was 10g/L. Process gas inlet temperature was 100 °C, Process gas outlet temperature was 42-43 °C, Process gas flowrate was 667 liters per hour, Atomization gas flowrate (meters3/hr) was 32 cubic meters per hour, and Liquid feedstock flowrate was 10.2 mL/min. B. Powder Characterization.

[00298] Powder physical and aerosol properties are summarized in Tables 16 to 20 below. Values with ± indicate standard deviation of the value reported. Two-stage ACI-2 results are reported in Table 16 for FPFtd < 3.4 pm and FPFtd < 5.6 pm. All formulations had a FPFtd <3.4 pm greater than 20%, and all but Formulations XXV, XXX and XXXI had a -96- WO 2012/044736 PCT/US2011/053829 FPFtd < 3.4 pm greater than 30%. Formulations XVIII, XIX, XX, XXI, XXIV, XXVIII, and XXXII each had a FPFtd < 3,4 pm greater than 45%. ΑΠ formulations had a FPFtd < 5.6 pm greater than 40%. Formulations XVIII through XXIV, XXVII, XXVIII, XXXII, and XXXIII each had a FPFtd <5.6 pm of greater than 60%.

Table 16. Aerodynamic properties

Formulation ACI-2 FPFtd < 3.4 pm FPFtd <5.6 pm % % XVIII 66.90% ± 0.52% 82.35% ± 3.70% XIX 47.49% 4.65% 67.70% ± 1.20% 53.96% ± 1.44% 73.00% ± 1.80% XXI 48.24% 0.49% 68.78% i 1.81% XXII 40.29% ± 0.28% 65.33% ± 0.41% XXIII 37.80% 2.97% 62.74% ± 2.47% XXIV 53.92% ± 2.25% 69.47% ± 0.21% XXV 29.03% 0.12% 57.84% + 0.52% XXVI 39.26% ± 1.35% 59.61% i 0.90% XXVII 43.06% ± 5.09% 65.48% ± 6.09% xxvin 56.37% i 1.45% 71.90% ± 0.57% XXIX 33.70% i 0.68% 50.43% ± 4.14% γγγ ΛΛΑ 22.46% + 0.73% 45.76% ± 1.25% XXXI 24.40% 3.68% 41.84% ± 4.50% XXXII 60.19% 1.59% 78.87% ± 0.66% XXXIII 38.73% 2.10% 64.87% ± 1.59% [00299] Data for Formulations XVIII and XIX is not available for the data presented in Tables 16 to 20, except for RODOS data reported for Formulation XVIII in Table 20.

[00300] All formulations had a tapped density greater than 0.35 g/cc, and all but Formulations XXIII and XXIV had a tapped density greater than 0.40 g/cc. Formulations XX, XXI, XXII, XXV, XXVI, XXVIII, XXX, XXXI, and XXXII each had a tapped density greater than 0.50 g/cc. Formulation XXI had a tapped density of 0.80 g/cc. All formulations -97- WO 2012/044736 PCT/US2011/053829 had a Hausner Ratio greater than or equal to 1.5. Formulations XXII, XXIII, XXIV, XXVI, XXVII, XXVIII, XXX, XXXI, and XXXIII each had a Hausner Ratios greater than 2.0. Formulation XXII had a Hausner Ratio of 3.07, Density measurements for Formulation XXIX was unavailable.

Table 17. Density properties

Formulation Density Bulk Tapped Hausner Ratio g/cc.................................... g/cc ΛΑ 0.34 ± 0.01 0.52 ± 0.05 1.54 XXI 0.46 ± 0.1 0.80 ± 0.17 1.75 XXII 0.17 ± 0 0.52 ± 0.04 3.07 XXIII 0.18 ± 0.01 0,37 ± 0.06 2.09 XXIV 0.16 ± 0.02 0.37 zb 0.01 2.28 XXV 0.52 ± 0.01 0,77 db 0.10 1.50 XXVI 0.23 ± 0.00 0.51 ± 0.04 2.21 XXVII 0.15 i 0.02 0.42 zb 0.01 2.73 XXVIII 0.22 zb 0.07 0.53 ± 0.06 2.40 XXX 0.27 ± 0.02 0.70 ± 0.05 2.56 γγγτ ΛΛΛ1 0.31 ± 0.03 0.65 ± 0.05 2.09 γγγττ ΛΛΛ11 0.37 ± 0.02 0.67 zb 0.02 L81 XXXIII 0,22 ± 0.01 0.49 zb 0.01 2.26 [00301] Table 18 shows that all formulations had geometric diameters (Dv50) of less than 3.0 um when emitted from a dry powder inhaler at a flowrate of 60 LPM. Formulations XX, XXI, XXII, XXIII, XXIV, XXIX, and XXXII had Dv50 of less than 2.0 um at 60 LPM. All formulations, except XXXI, had a Dv50 of less than 6.0 um at 15 LPM. Formulations XXI, XXII, XXV, XXVII, XXVIII, XXIX, XXX, XXXII, and XXXIII each had a Dv50 of less than 5.0 um at 15 LPM.

Table 18. Geometric Diameters

Formulation Dispersibility - Spraytec @ 60 LPM @ 15 LPM Dv50 (pm) GSD Dv50 (pm) GSD -98- WO 2012/044736 PCT/US2011/053829 XX 1.28 ± 0.08 5.59 ± 0.18 5.85 ± 0.18 4.04 ± 0.10 XXI 1.33 ± 0.18 5.15 ± 0.13 2.89 ± 0.06 2.78 ± 0.52 XXII 1.55 ± 0.07 5.02 ± 0.34 4.23 ± 0.10 3.20 ± 0.25 XXIII 1.70 ± 0.07 4.47 ± 0.25 5.09 ± 0.20 3.27 db 0.11 XXIV 1.89 ± 0.15 5.51 ± 0.15 5.65 ± 0.08 2.97 ± 0.05 XXV 2.44 ± 0.14 4.87 ± 0.28 4.04 ± 0.55 3.36 ± 0.13 XXVI 2.08 ± 0.04 4.85 ± 0.22 5.38 ± 0.09 3.43 ± 0.08 XXVII 2.09 ± 0.15 4.51 ± 0.35 4.73 ± 0.13 3.16 ± 0.16 XXVIII 2.25 ± 0.12 5.17 ± 0.50 4.56 ± 0.16 3.00 ± 0.13 XXIX 1.72 ± 0.02 4.04 ± 0.29 3.55 ± 0.21 5.96 ± 0.46 ΛΛΛ 2.77 ± 0.03 3.84 ± 0.24 4.32 ± 0.18 4.31 ± 0.11 XXXI 2.33 ± 0.05 4.45 ± 0.27 10.12 ± 0.52 5.53 i 0.40 XXXII 0.99 ± 0.12 5.40 ± 0.17 2.80 ± 0.10 3.29 ± 0.13 ΧΧΧΠΙ 2.52 ± 0.16 4,9 ± 0.4 4.85 ± 0.08 3.07 ± 0.09 [00302] Table 19 shows that all formulations had a capsule emitted particle mass (CEPM) of greater than 94% at 60 LPM, and all formulations except for XXV had a CEPM of greater than 96% at 60 LPM. All formulations except for XXI and XXX had a CEPM of greater than 80% at 15 LPM. Formulations XX. XXII, XXIII, XXIV, XXV, XXVII, XXVIII, XXXII, and XXXIII each had a CEPM of greater than 90% at 15 LPM.

Table 19, Pispersibilty properties

Formulation Dispersibility - CEPM @60 LPM @ 15 LPM CEPk a EPM XX 99.33% ± 0.40% 96.92% zb 0.81% XXI 99.96% ± 0.00% 79.46% zb 0.11% XXII 97.46% db 0.14% 95.94% db 0.55% XXIII 99.47% ± 0.14% 97.92% zb 0.41% XXIV 98.96% zb 0.06% 91.28% zb 8.01% XXV 94.58% ± 0.66% 94.12% ± 0.83% XXVI 97.79% dz 0.28% 83.17% dz 9.74% XXVII 98.63% db 0.61% 95.15% zb 0.88% XXVIII 98.66% ± 0.25% 95.23% db 0.40% XXIX 96.46% db 0.46% 85.83% db 5.73% -99- WO 2012/044736 PCT/US2011/053829 ΛΛΑ 96.07% ± 0.47% 74.60% ± 11.85% XXXI 98.63% ± 0.19% 62.70% ± 9.68% ΛΛΑΙΙ 98.21% i 0.10% 95.53% i 0.62% XXXIII 100.07% ± 2.01% 95.72% 0.99% [00303] Table 20 shows that all measured formulations except XXIX had a Dv50 of less than 3.0 gm when using the RODOS at a 1.0 bar setting; and all measured formulations except XXIV, XXVIII, XXIX, and XXX had a Dv50 of less than 2.0 gm. All measured formulations had a RODOS Ratio for 0.5 bar/4 bar of less than 1.4, and all measured formulations except for XXII had a RODOS Ratio for 0.5 bar/4 bar of less than 1.3. All measured formulations had a RODOS Ratio for 1 bar/4 bar of less than or equal to about 1.1.

Table 20. Dispersibilty properties (Geometric diameter using RODOS)

Form. RODOS 0.5 bar 1.0 bar 4.0 bar 0.5/4 bar 1/4 bar Dv50 (gm) GSD Dv50 (gm) GSD Dv50 (μπύ GSD XVIII 1.93 1.68 1.89 1.76 1.74 1.71 1.11 1.09 XX 1.66 2.16 1.46 2.06 1.36 1.92 1.22 1.07 XXI 1.91 2.13 1.83 2.24 1.99 2.19 0.96 1.08 XXII 1.87 1.95 1.48 1.78 1.37 1.78 1.36 1.08 XXIII 1.95 1.96 1.74 1.93 1.6 1.91 1.22 1.09 XXIV 2.33 2.28 2.10 2.19 1.91 2.12 1.22 1.10 XXV 1.90 2.10 1.64 1.99 1.68 2.22 1.13 0.98 XXVI 2.09 1.86 1.83 1.84 1.68 1.80 1.24 1.09 XXVII 2.15 1.84 1.97 1.83 1.78 1.76 1.21 1.11 XXVIII 2.56 2.35 2.25 2.30 2.18 2.26 1.17 1.03 γγτγ ΛΑ1Λ 2.51 2.41 3.67 2.48 3.36 2.16 0.75 1.09 yyy ΛΛΛ 2.62 2.35 2.55 2.34 2.42 2.27 1.08 1.05 XXXI 1.96 2.24 1.82 2.18 1.78 2.20 1.10 1.02 XXXII 1.61 2.23 1.46 2.20 1.41 2.15 1.14 1.04 XXXIII 2.15 2.07 1.90 2.05 1.73 2.06 1.24 1.10

Example 6. Efficacy of dry powders in an ovalbumin mouse model of allergic asthma. - 100- WO 2012/044736 PCT/US2011/053829 [00304] Dry powder formulations comprised of leucine, sodium chloride, fluticasone propionate (FP) and salmeterol xinafoate (SX) were tested for activity in a mouse model of allergic asthma. A mouse model of allergic asthma was established using ovalbumin (OVA). In this model, mice are sensitized to OVA over a period of two weeks and subsequently challenged via aerosol with OVA, as shown in Schematic 1. This challenge induces airway inflammation and causes changes in pulmonary function. The principle change in inflammation is an increase in the number of eosinophils in the lungs. Similar changes in lung inflammation and pulmonary function are observed in humans with asthma.

Schematic 1. OVA process of sensitization, challenge, treatment and testing. OVA chaiL (neb) i j?........4« -+ day e 4-1-//. 7 14

FP/SX t

BAL

Balb/c mice were sensitized and challenged to OVA on the days described above. Sensitizations were performed by intraperotineal injection of OVA plus Alum. Challenges were performed by whole body exposure to nebulized 1% OVA solution for 20 minutes. Mice were treated with the formulations listed in Table 9 1 hour before OVA challenge, on days 27 through 29 and once on day 30. -101- WO 2012/044736 PCT/US2011/053829

Table 21, Dry powders tested in an OVA mouse mode of allergic asthma. Form ulation Group Dry Powder Composition (% w/w) Capsules Delivered (quantity, till weight, size) Placebo-A Control 100% Leucine 3, 30 mg, size 00 XVIII Control 59.1% leucine, 40.9% sodium chloride 1,90 mg, size 00 XIX Active 50.0% leucine, 34.5% sodium chloride, 13.5% FP, 2.0% SX 1, 90 mg, size 00 XIX Active 50.0% leucine, 34.5% sodium chloride, 13.5% FP, 2.0% SX 3, 90 mg, size 00 [00305] Mice were sensitized and challenged with OVA as described and illustrated in Schematic 1, and treated once a day (QD) with a formulation comprised of leucine (50.0%), NaCl (34.5%), FP (13.5%) and SX (2.0%) (Formulation XIX; see Table 21). Treatments were made in a whole body exposure chamber using a capsule based dry powder inhaler system. Dose was varied by changing the number of capsules used for each exposure. Doses reported are the exposed dose each mouse inhaled as calculated based on the measured aerosol concentration sampled from the exposure chamber, the fraction of FP in the powder, the time of exposure, and the mouse’s mass and minute volume. Mouse minute volume was calculated using a standard equation (Bide et al. (2000) “Allometric respiration/body mass data for animals to be used for estimates of inhalation toxicity to young adult humans”, J. Appl. Toxicol. 20:273-290). On the final day of the study (day 31), mice were euthanized and bronchoalveolar lavages (BAL) were performed. The total number of cells per BAL was determined. In addition, the percentage and total number of macrophages, polymorphonuclear cells (neutrophils), lymphocytes, and eosinophils were determined by differential staining. Data depicted the mean ± SEM of 5 mice per group and are representative of two independent experiments. Data were analyzed by one way ANOVA and Tukey’s multiple comparison test, and asterisk presented in FIGs 2A and 2B represent a p-value of p<0.01. - 102- WO 2012/044736 PCT/US2011/053829 [00306]The data shown in FIGS 2A and 2B demonstrated that mice treated with dry powder formulations comprised of FP and SX exhibited a significant reduction in total inflammatory cell counts (FIG. 2A) and in eosinophil counts (FIG. 2B) as compared to both the leucine control (Placebo-A) and a control powder comprised of leucine and sodium chloride (Formulation XVIII). Because FP is a steroid with known anti-inflammatory properties, the effect observed was attributed to the action of FP in the airway. It is for this reason that the dose in the figures on the x-axis was stated in terms of mg of FP/kg of body weight. The data suggested that dry powder formulations of FP and SX could be made that are small, dense and dispersible, and in which the activity of the active ingredient was not altered during the spray drying process.

Example 7. Effect of dry powders on inflammation and airway hyperreactivity in an ovalbumin mouse model of allergic asthma.

[00307] A mouse model of allergic asthma was established using ovalbumin (OVA). Balb/c mice were sensitized to ovalbumin (OVA) over a period of two weeks and subsequently challenged via aerosol with OVA as indicated in Schematic 2 below.

Schematic 2. OVA process of sensitization, challenge, treatment and testing.

OVA sensitization (LpJ OVA chalk (neb] PFT

-J- I ri-1—I-1-l· day 0 27 28 29 30 31 t I.........t f f FP/SX FP/SX SAL (BP QDJ (BP BIB) [00308] Mice were sensitized to and challenged with OVA on the days depicted in Schematic 2 above. Sensitizations were performed by Intraperotineal injection of OVA plus Alum. Challenges were performed by whole body exposure to nebulized 1% OVA solution for 20 minutes. Mice were treated with a dry powder comprised of 50.0% Leucine 34.5% sodium chloride, 13.5% FP and 2.0% SX (Formulation XVIII) or placebo dry powder (100% -103- WO 2012/044736 FCT/US2011/053829

Leucine, i.e. Placebo-A) dry powders (DP) 1 hour before OVA challenge on days 27-29 and twice on day 30. Treatments were made in a whole body exposure chamber using a capsule based dry powder inhaler system. On the final day of the study (day 31), mice were euthanized and bronchoalveolar lavages (BAL) were performed. The total number of cells per BAL was determined. In addition, the percentage and total number of macrophages, polymorphonuclear cells (neutrophils), lymphocytes and eosinophils were determined by differential staining. Data depict the mean ± SEM of 5 mice per group and are representative of two independent experiments. Data were analyzed by Student’s t-test, and asterisk presented in FIGs 3A and 3B represent a p-value of p<0.05.

[00309] As seen previously (FIGS 2A and 2B), mice treated with the EP/SX dry powder exhibited a decline in total inflammatory cell counts and a significant decrease in eosinophil counts compared to those mice treated with the leucine dry powder control (FIGS 3A and 3B).

[00310] In addition to changes in inflammation, mice sensitized to and challenged with OVA exhibit increased airway hyperreactivity. It was known from the literature that salmeterol xinafoate (SX) enhances pulmonary function, resulting in lower sRaw values, for animals and human beings challenged with methacholine chloride (MCh) in 0.9% sodium chloride for inhalation. (Schutz, N. (2004), “Prevention of hronchoconstriction in sensitized guinea pigs: efficacy of common prophylactic drugs”, Respir Physiol Neurobiol 141(2): 167-178).

[00311] Therefore, specific airway resistance (sRaw) was measured in the mice.

These measurements were performed on day 30. Baseline sRaw measurements were taken for 5 minutes before treatment, after which the animals received the appropriate DP treatment. Immediately following DP treatments, the animals were returned to the plethysmograph and post-treatment sRaw measurements were then taken. The mice subsequently underwent methacholine (MCh) challenge with escalating concentrations of MCh delivered via nebulization in a head chamber. Data is presented as the average sRaw over the 5 minutes following MCh administration. Naive mice which were not sensitized to and challenged by OVA also underwent PFT and MCh challenge for the sake of comparison. -104- WO 2012/044736 PCT/US2011/053829 [00312] As shown in FIG. 3C, the FP/SX dry powder reduced sRaw values to near those measured in naive mice after each concentration of MCh challenge. This observation was due to the combined influence of both the reduced airway hyperreactivity as a result of airway inflammation and the influence of the long-acting bronchodilator, SX, The data indicated that not only can dry powder formulations be made that are small, dense and dispersible, but also that the activity of the spray dried active ingredients was maintained.

Example 8. Effect of a monovalent cation-based dry powder of FP/SX (Formulation X) on inflammation and airway hyperreactivity in an ovalbumin mouse model of allergic asthma A. Inflammation [00313] Formulation X (30% leucine, 65.4% NaCl, 4.0% fluticasone propionate and 0.58% salmeterol xinafoate, w/w on a dry basis) was evaluated in a mouse model of allergic asthma using ovalbumin (OVA) as an allergen. The model has been described and shown schematically in Examples 6 and 7.

[00314] In this model, mice were sensitized to OVA over a period of two weeks and subsequently challenged, via a liquid aerosol, with OVA (Example 6). This challenge induced lung inflammation and increased airway hyperreactivity in response to an airway challenge. The principle change in inflammation was an increase in the number of eosinophils in the lungs. Similar changes in lung inflammation and pulmonary function have been observed in humans with asthma, [00315] Balb/c mice were sensitized and challenged to OVA, as per the sensitization protocol described in Example 6. Mice were treated with Placeho-B dry powder (98% leucine, 2% NaCl, w/w on a dry basis) and Formulation X. Treatments were made in a whole body exposure chamber using a capsule based dry powder inhaler system. As in Example 7, on the final day of the study (day 31), mice were euthanized and bronchoalveolar lavages (BAL) were performed. The total number of cells per BAL was determined. In addition, the percentage and total number of eosinophils was determined by differential staining.

[00316] The effect of Formulation X on inflammation was assessed. Fluticasone propionate (FP) is known to reduce eosinophilic cells and total cellularity in the mouse OVA model. (Riesenfeld, E. P. (2010), “Inhaled salmeterol and/or fluticasone alters -105- WO 2012/044736 PCT/US2011/053829 structure/function in a murine model of allergic airways disease”, Respiratory Research, 11:22). However, the effect of co-formulating FP with a sodium salt into a dry powder were unknown in the art. Therefore, Formulation X was tested. The results for Formulation X are presented in Table 22. These data show that Formulation X significantly reduced eosinophilic cells and total cellularity in comparison to Placebo-B (p<0.01 for both eosinophils and total cells).

Table 22. Formulation X reduces eosinophilic and total cellular inflammation in a murine mode of allergic asthma Placebo-B Formulation X cells* 106/ml StdDev cells*106/ml Std Dev Eosinophils 0.55 0.27 0.11 0.10 Total cells (Cellularity) 1.38 .50 0.49 0.20 B, Airway Hyperreactivity [00317] The sensitization of mice with OVA and subsequent challenging of mice with OVA was achieved, as described and shown schematically in Examples 6 and 7. In addition to changes in inflammation, mice sensitized to and challenged with OVA exhibit increased airway hyperreactivity, as mentioned in Example 7, which can be measured as change in airway resistance following broncho-provocation. Pulmonary function testing was conducted one hour following treatment on day 30. This involved measuring the specific airway resistance (sRaw) in the mice. sRaw was a means for assessing pulmonary function. Baseline sRaw measurements were taken for 5 minutes. The mice subsequently underwent a methacholine (MCh) challenge for assessing pulmonary function with escalating concentrations of MCh delivered via nehulization in a head chamber using doses of MCh of 0 mg/ml, 50 mg/ml or 100 mg/ml.

[00318] The mice were challenged to test their pulmonary function according to the methods and schematic described in Example 7. It was known from the literature that salmeterol xinafoate (SX) enhances pulmonary function, resulting in lower sRaw values, for -106- WO 2012/044736 PCT/US2011/053829 animals and human beings challenged with methacholine chloride (MCh) in 0.9% sodium chloride for inhalation. (Schutz, N. (2004), “Prevention of bronchoconstriction in sensitized guinea pigs: efficacy of common prophylactic drugs”, Respir Physiol Neurobiol 141(2): 167-178), [003191 While the effects of SX on sRaw were known from the literature, the effect of coformulating SX formulations with a sodium salt were unknown. Formulation X (30% leucine, 65.4% NaCl, 4.0% fluticasone propionate and 0.58% salmeterol xinafoate, w/w on a dry basis) was tested, and compared to Placebo-B dry powder (98% leucine, 2% NaCl, w/w on a dry basis). Results from pulmonary function testing are shown in FIG 4. These data show that Formulation X significantly reduced sRaw during MCh challenge compared to Placebo-B (p<0.05).

Example 9. Effect of a monovalent cation-based dry powder of Tiotropium Bromide (Formulation XX) on airway hyperreactivity in an ovalbumin mouse model of allergic asthma [00320] A similar ovalbumin mouse model of allergic asthma as was used in Examples 6 to 8. The protocol of Examples 6 and 7 of sensitization and subsequent challenging with OVA was followed. Pulmonary function testing was conducted as per Example 8.

[00321] It was known from the literature that tiotropium bromide (TioB) enhances pulmonary function, resulting in lower sRaw values, for animals and human beings challenged with methacholine chloride (MCh) in 0.9% sodium chloride for inhalation. (Ohta, S. et al. (2010), “Effect of tiotropium bromide on airway inflammation and remodeling in a mouse model of asthma”, Clinical and Experimental Allergy 40:1266-1275).

[00322] While the effects of TioB on sRaw were known from the literature, the effect of co-formulating the TioB formulation with a sodium salt was unknown. Formulations XX (34.47% leucine, 65.42% NaCl and 0.113% tiotropium bromide, w/w on a dry basis) was tested, and compared to Placebo-B dry powder (98% leucine, 2% NaCl, w/w on a dry basis). Results from pulmonary function testing are shown in FIG 5. These data show that Formulation XX significantly reduced sRaw during MCh challenge compared to Placebo-B (p<0.00001). -107- WO 2012/044736 PCT/US2011/053829

Example 10. Efficacy of monovalent cation-based dry powders containing FP/SX in a mouse house dust mite model of allergic asthma.

[00323] Dry powder (DP) formulations comprised of leucine, sodium chloride, fluticasone propionate (FP) and salmeterol xinafoate (SX) were further tested for an ability to reduce inflammation and airway hyperreactivity in a mouse house dust mite (HDM) model of allergic asthma. A mouse model of allergic asthma was established by intranasal administration of 25 u,g of freeze-dried Dermatophagoides pteronyssinus HDM on days 0, 7 and 14 over a two week period as shown in the Schematic 3 below. Exposure of HDM to mice has been shown to cause an increase in total inflammatory cells, primarily eosinophils, in their lungs and, with chronic exposure, airway hyperreactivity. These similar changes in lung inflammation and pulmonary function have been observed in human asthma.

Schematic 3. HDM process of sensitization, challenge, treatment and testing.

HDM Sensitization PFT/BAL ; j -I-1-1—I—I—h day 0 7 14 15 16 17

FP/SX

[00324] Balb/c mice were treated with a dry powder comprised of 50.0% Leucine, 34.5% sodium chloride, 13.5% FP and 2.0% SX (Formulation XIX) or a placebo dry powder of 100% Leucine, on a dry basis (Placebo~A) once per day (QD), starting with the final day of HDM sensitization (day 14) until day 17, Treatments were made in a whole body exposure chamber using a capsule-based dry powder inhaler system. Immediately following treatment on day 17, the animals underwent pulmonary function testing (PFT) by dual chamber plethysmography. Specific airway resistance (sRaw) measurements were taken at baseline and following methacholine (MCh) challenge. Immediately following dry powder treatment, 5 minutes of baseline sRaw measurements were taken. sRaw measurements were then taken following escalating doses of MCh delivered via nebulization to the head -108- WO 2012/044736 PCT/US2011/053829 chamber. Data is presented as the average sRaw over the 5 minutes following MCh administration.

[0032SJ Mice were then euthanized and bronchoalveolar lavages (BAL) were performed. The total number of cells per BAL was determined, and the percentage and total number of macrophages, polymorphonuclear cells (neutrophils), lymphocytes, and eosinophils were determined by differential staining. A group of naive, non-sensitized, untreated mice also underwent PFT and BAL for comparison. Data depict the mean ± SEM and were analyzed by one way ANOVA and Tukey’s multiple comparison test (* p<0.5) (**p<0.01).

[00326] The FP/SX dry powder significantly reduced total inflammatory cell counts to near that of naive mice in comparison to leucine placebo treatment (FIG 6A). In addition, eosinophil counts were significantly reduced by nearly 60% (FIG 6B). The reduction in inflammatory and eosinophil counts indicated that the anti-inflammatory properties of the FP steroid were maintained in the dry powder.

[00327] Furthermore, the FP/SX dry powder reduced sRaw values below those measured in both HDM sensitized mice that received placebo dry powder treatment (FIG 6C). The fact that mice treated with the FP/SX dry powder demonstrated less of a bronchoconstrictive response to MCh than naive mice, while exhibiting increased eosinophilia suggested that the reduced hyperreactivity in mice treated with the FP/SX dry powder was due primarily to the influence of the long-acting bronchodilator SX. Thus, the data indicated that activity of each active ingredient in a small, dense and dispersible dry powder formulation described herein was retained.

Example 11. Efficacy of monovalent cation-based dry powders containing FP/SX in an LPS mouse model of acute lung injury.

[00328] In this study, a mouse model of acute lung injury was used to study the effects of FP/SX co-formulated with a sodium salt on pulmonary inflammation. Mice were exposed to aerosolized lipopolysaccharide (LPS) isolated from Pseudomonas aeruginosa. This challenge resulted in lung inflammation and caused changes in pulmonary function. The -109- WO 2012/044736 PCT/US2011/053829 principle change in inflammation was an increase in the number of neutrophils in the lungs. Similar changes in lung inflammation and pulmonary function have been observed in humans suffering from acute lung injury.

[0Θ329] Mice were exposed to whole body exposure with nebulized LPS, 1.12 mg/ml, for 30 minutes. Treatment with dry powder Formulation X (30% leucine, 65.4% NaCl, 4.0% fluticasone propionate and 0.58% salmeterol xinafoate, w/w on a dry basis) was performed 1 hour following LPS exposure using a whole body exposure chamber using a capsule based dry powder inhaler system. Animals were treated with two, 90 mg capsules. A separate group of animals was treated with two, 30 mg capsules of Placebo-B dry powder (98% leucine, 2% NaCl, w/w on a dry basis). Three hours following dry powder treatment, all mice were euthanized and underwent whole lung lavage for determination of total and differential cell counts.

[00330] As shown in Table 23, treatment of mice with Formulation X significantly reduced total cell counts (p<0.01) and neutrophils (p<0.01) in the BAL fluid when compared with animals exposed to Placebo-B. Thus, treatment of mice with Formulation X significantly reduced lung inflammation in an LPS model of acute lung injury.

Table 23. Formulation X reduces inflammation in a rodent model of acute lung injury.

Placebo-B Formulation X cells* 106/ml StdDev cells* 106/ml Std Dev Neutrophils 0.81 0.23 0.36 0.12 Total cells (Cellularity) 0.98 0.19 0.55 0.15

Example 12. Efficacy of monovalent cation-based dry powder containing ciprofloxacin in a mouse model of bacterial pneumonia.

[00331]A neutropenic mouse model of Pseudomonas aeruginosa was used to evaluate the efficacy of Formulation IV (10.0% mannitol, 40% sodium chloride, 50% ciprofloxacin hydrochloride, w/w on a dry basis). Mice (C57BL6; -20g) were given two doses of cyclophosphamide monohydrate (Sigma Aldrich; St Louis, MO) dissolved in sterile water for -110- WO 2012/044736 PCT/US2011/053829 injection on day -4 (200 mg/kg) and day -1 (100 mg/kg) relative to the day of infection (day 0). Cyclophosphamide was given by intraperotineal injection and acts to deplete neutrophils.

[00332] P. aeruginosa (PAO1) was prepared by growing a culture in 2.0 mL of Luria Bertani (LB) broth overnight at 37°C with shaker speed of 430 rpm. Cultures were diluted 1:100 the following day and grown to an OD6oo~0.3. Once the OD60o reached ~ 0.3, three washes were performed in sterile PBS and the resulting suspension was subsequently diluted 1:2000 in sterile PBS [~1.3xl05 Colony forming units (CFU)/mL], Mice were infected with 50 pL of bacterial suspension (~6xl03 CFU/mouse) by intranasal instillation while under injectable anesthesia.

[00333] Mice were exposed to Formulation IV or a control powder comprised of 100% leucine on a dry basis (Placebo-A) as a control in a whole-body exposure system using a capsule based system and a flow control unit connected to a pie chamber cage that individually holds up to 11 animals. Treatments were performed 4 hours after infection with P. aeruginosa. Exposure times were dependent on the number of capsules to be emitted. Doses reported are the exposed dose each mouse inhaled as calculated based on the measured aerosol concentration sampled from the exposure chamber, the fraction of ciprofloxacin in the powder, the time of exposure, and the mouse’s mass and minute volume. Mouse minute volume was calculated using a standard equation (Bide et al. (2000) “Allometric respiration/body mass data for animals to be used for estimates of inhalation toxicity to young adult humans”, J. Appl. Toxicol. 20:273-290). Twenty-four hours after infection, mice were euthanized by pentobarbital injection and lungs were collected and homogenized in sterile PBS. Lung homogenate samples were serially diluted in sterile PBS and plated on TSA blood agar plates. CFU were enumerated on the following day .As shown in FIG 7, compared to control animals exposed to Placebo-A, Formulation IV-treated animals exhibited greatly reduced bacterial titers 24 hours after infection. This data suggested that spray-dried ciprofloxacin was active against P. aeruginosa at doses of less than 7.5 mg/kg and that spray-dried DP formulations of ciprofloxacin could be made small, dense and dispersible.

Example 13. Efficacy of monovalent cation-based dry powder containing levofloxacin in a mouse model of bacterial pneumonia - Ill - WO 2012/044736 PCT/US2011/053829 [00334] A mouse model of bacterial infection was used to evaluate the efficacy of Formulation XXI in vivo. Neutropenia was induced by injection of cyclophosphamide (100 mg/kg) on days -4 and ~L Bacteria (Pseudomonas aeruginosa) were grown overnight in 2 ml of Luria Bertani broth at 37°C and approximately 5xl03 CFU were delivered per mouse via intranasal administration in 50 μΐ of PBS. Four hours following infection the animals were treated with Formulation XXI (27% leucine, 53% NaCI and 20% levofloxacin, w/w on a dry basis) and with Placebo-B dry powder (98% leucine, 2% NaCI) using a whole body exposure chamber and a capsule based dry powder inhaler system. The next day, animals were euthanized and the lungs and the spleen were harvested and homogenized to determine lung bacterial load and systemic bacterial load, respectively. Homogenates were serially diluted on tryptin-soyagar plates and allowed to incubate overnight at 37°C. The following day, colony forming units (CFU) were counted and CFU/ml for each the lung and the spleen was calculated.

[00335] Levofloxacin, being a potent antibiotic would be expected to significantly reduce CFU count in the spleen when administered through the gastro-intestinal tract. What was unknown were the following: (i) would co-formulating levofloxacin with a sodium salt have any effect on the efficacy of levofloxacin when administered to the lungs, and (ii) would these co-formulation of levofloxacin, when administered to the lungs, cause a reduction of CFU count in the spleen. The results are shown in Table 24. It was seen that Formulation XXI significantly reduced bacterial burden in the lung by more than 4 logio CFU and in the spleen by almost 100-fold compared to Placebo-B treated animals. Thus, treatment of mice with Formulation XXI significantly reduced lung and systemic bacterial burden (CFU count) during Pseudomonas aeruginosa infection, proving that levofloxacin could be (i) coformulated with a sodium salt and still have efficacy when administered to the lungs, and (ii) administered to the lungs as a co-formulation to reduce CFU count in the spleen.

[00336] It was observed from these data that the presence of sodium in levofloxacin dry powder formulations did not have a deleterious effect on the efficacy of levofloxacin. This is a surprising result given the literature which says that various salt formulations deleteriously affect the bioavailability of levofloxacin taken through the gastrointestinal tract. (Flor, S. et al. (1990), “Effects of Magnesium-Aluminum Hydroxide and Calcium Carbonate Antacids -112- WO 2012/044736 PCT/US2011/053829 on Bioavailability of Ofloxacin”, Antimicrobial Agents and Chemotherapy 34(12): 2436-2438), and (Pai, MP. et al. (2006), “Altered steady state pharmacokinetics of levofloxacin in adult cystic fibrosis patients receiving calcium carbonate”, J. Cyst. Fibres., Aug;5(3):153-7). (Ofloxacin is a racemic mixture, which consists of 50% levofloxacin, which is known to be biologically active, and 50% of its enantiomer.)

Table 24. Formulation XXI reduces bacterial burden during Pseudomonas aeruginosa infection

Placebo-B Formulation XXI CFU/ml StdDev CFU/ml Std Dev Lung 2.85x10s 2.88x10s 2.08 xlO4 3.87 xlO4 Spleen 1.57x10s 1.78x10s 2.16xl03 6.81xl02

Example 14. Efficacy of monovalent cation-based dry powders containing insulin in reducing blood glucose levels in a mouse model.

[00337] In this study, Formulations XXIV and XXVIII (Table 25) containing recombinant human insulin (Sigma-Aldrich, St. Louis, MO, approx. 27.5 U/mg, dry powder) were used to determine if monovalent cation-based dry powder formulations could be used to deliver proteins to the lung and if this dry powder could he used to deliver proteins systemically.

Table 25. Insulin containing dry powder formulations

Form. Salt % Salt load (w/w) Excipient % Excipient load (w/w) Drug % Drug load (w/w) % 1 load (w/w) XXIV Sodium sulfate 49.0 Mannitol 39.0 Insulin 8.0 4.0 XXVIII Sodium sulfate 54.0 Mannitol 39.0 Insulin 5.0 2.0 -113- WO 2012/044736 PCT/US20U/O53829 [00338j The sodium sulfate/mannitol solution was adjusted with hydrochloric acid (HCI) to obtain a low pH solution in which the insulin was soluble. The resulting DP contained 8% insulin (Formulation XXIV) and 5% insulin (Formulation XXVIII).

[O0339J In this study, mice (n=5) were treated with 6 capsules of either Formulation XXIV or XXVIII, with another group of animals that were treated with 6 capsules of Placebo-B control powder (98% leucine, 2% NaCl), using a whole body exposure chamber with a capsule based dry powder inhaler system. Whole blood was drawn from the mice by tail snip. Blood glucose levels were measured at 0 minutes (immediately before DP treatment), 30 minutes, 1 hour and 2 hours following DP treatment using a LIFESCAN OneTouch Ultra 2 blood glucose monitoring system (Johnson & Johnson, New Brunswick, NJ).

[00340] The results are shown in Figure 8 (Formulation XXIV, 8% insulin) and Figure 9 (Formulation XXVIII, 5% insulin). The placebo treated animals, Placebo-B, showed a small increase in glucose levels, likely as a stress (“fight or flight”) response to the powder administration and/or tail snip for the blood measurement. Glucose levels rapidly and significantly dropped in insulin-treated animals with levels reaching the lower detection limit of the glucose sensor (20mg/dL) at 2 hours after DP treatment. This demonstrated that monovalent cation-containing dry powders can be utilized to deliver proteins. Hormones, such as insulin, delivered in an animal model by DP can have fast-acting, systemic physiological, pharmacological effects in vivo.

Example 15. Sodium formulation of an immunoglobulin protein provides for delivery of the protein both locally in the lungs and systemically [00341] In this study, Formulation XXV (50.0% sodium sulfate, 47.5% mannitol, 2.5% bovine immunoglobulin G (IgG), w/w on a dry basis) was used to determine if monovalent cation salt-based dry powder formulations could be used to deliver proteins to the lungs and/or systemically by way of the lungs.

[00342] In this study, mice were treated with Formulation XXV using a whole body exposure chamber using a capsule-based dry powder inhaler system. Animals were then treated with 3 or 6 capsules of Formulation XXV with another group of animals that were _ U4 - WO 2012/044736 PCT/US2011/053829 treated with 6 capsules of placebo control powder (98% leucine, 2% NaCl; Placebo-B). The placebo controls were run to ensure that there was no cross reactivity with the bovine IgG assay and native mouse proteins in either the serum or the broncho-alveolar lavage (BAL). Immediately following DP treatment the animals were euthanized, underwent BAL and serum was collected. Lavage fluid and serum were then assayed for bovine IgG using a commercially available ELISA kit.

[00343] The data for lung detection of the IgG are shown in FIG 10-A and for serum detection of the IgG are shown in FIG 10-B. Placebo-B (n = 3 animals) was below the detectable range of the assay, which was indicative that there was no cross reactivity between the bovine IgG and the native mouse protein in either the serum or the BAL. It could be seen that detectable IgG delivered to the lung, and systemically by way of the lungs, increased stepwise with increasing number of capsules delivered to the animals. This demonstrated that monovalent cation-containing dry powders can be utilized to deliver proteins. Even large proteins such as immunoglobulins, such as IgG, and antibodies delivered in an animal model by DP could have fast acting, systemic physiological, pharmacological effects in vivo.

Example 16. Optimization of a dry powder sodium-based formulation of fluticasone propionate and salmeterol xinafoate [00344] Two sodium salt-based fluticasone propionate / salmeterol xinafoate (FP/SX) formulations were processed, Formulations I and ΧΧΧΙΠ. (See Table 26) Formulation I diy powder was produced by spray drying on the Biichi B-290 Mini Spray Dryer (ΒΪΟΠ Labortechnik AG, Flawil, Switzerland) with powder collection in a 60 mL glass vessel from a High Performance cyclone. The system used the Biichi B-296 dehumidifier and an external LG dehumidifier (model 49007903, LG Electronics, Englewood Cliffs, NJ) was run constantly. Atomization of the liquid feed utilized a Biichi two-fluid nozzle with a 1.5 mm diameter. The two-fluid atomizing gas was set at 40 mm and the aspirator rate to 90% (35 m3/h). Room air was used as the drying gas. Inlet temperature of the process gas was 180 °C and outlet temperature from 86 °C to 87 °C with a liquid feedstock flow rate of 8 mL/min to 9 mL/min. The solids concentration was 10 g/L in 60% ethanol and 40% water. -115- WO 2012/044736 PCT/US2011/053829 [00345] Formulation XXXIII shared the same chemical components and composition as Formulation I, as listed in Table 26. The solution preparation was the same as for Formulation I, namely that the solids concentration was 10 g/L in 60% ethanol and 40% water. The spray drying process conditions of Formulation XXXIII were the same as for Formulation I, except that for Formulation ΧΧΧΪΙΙ, the inlet temperature was decreased from 180 °C to 100 °C, the aspirator rate was changed from 90% to 80% (35 cubic meters per hour to 32 cubic meters per hour), and the feed rate was increased from 8.6 to 10.2 mL/min.

Table 26. Sodium chloride-based formulations of FP/SX

Formulation Salt % Salt load (w/w) Excipient % Excipient load (w/w) Drug % Drug load (w/w) Ϊ Sodium chloride 65.4 Leucine 30.0 FP/QV JT Jr/ DA 4.0/0.58 XXXIII Sodium chloride 65.4 Leucine 30.0 pp/CY J? Jr / ΟΛ 4.0/0.58 [00346] The modified processing conditions used to generate Formulation XXXIII were determined through process optimization. Formulation XXXIII had a significantly higher capsule emitted powder mass (CEPM), both at a higher flow rate of 60 LPM and at a lower flow rate of 15 LPM that Formulation I had at 60 LPM and 30 LPM. It should be noted that Formulation I was only run at a lower flow rate of 30 LPM, which provides more dispersion energy than at 15 LPM, yet Formulation XXXIII had a significantly higher CEPM than Formulation I at the lower flow rates. CEPM is relevant when it comes to determining the dose of the formulation and therefore the active agent a patient would receive from the inhaler. Formulation XXXIII also has an improved ratio of CEPM high flow rate / CEPM low flow rate that Formulation I. Results from the CEPM characterization can be seen in 77 [00347] This example showed how a monovalent salt formulation which contained an active agent could be optimized to produce particles and powders with improved properties. -116- WO 2012/044736 PCT/US2011/053829

Table 27. CEPM Disp&rsibilty Properties

Formulation Dispersibility - CEPM @6( )LPM Formulation I @ 30 LPM Formulation II @ 15 LPM I 62% ± n/a 44% ± n/a XXXIII 100.1% ± 2.0% 95.7% ± 1.0% n/a ™ not available

Example 17 A monovalent metal cation DP containing Tiotropium bromide is effective to enhance pulmonary function in mice challenged with methacholine chloride (MCh) in a mouse model of rhinovirus infection [00348] A mouse model of Rhinovirus infection with Rhinovirus minor IB strain was used (REF). Female inbred Balb/c mice (body weights on initial day of use; 16.8 - 24.3g) were obtained from Charles River Laboratories. Mice (n=4) were infected intranasally with 5x106 TCID50 of Rhinovirus-1B. Mice were exposed to dry powder Formulation XXXII using a custom designed whole body exposure system 18 hours after virus infection. Pulmonary function testing was conducted at approximately 1 hour following dry powder treatment. Baseline specific airway resistance (sRaw) measurements were taken for 5 minutes before treatment and the mice subsequently underwent methacholine (MCh) challenge with escalating concentrations of MCh (0-100 mg/ml) delivered via nebulization into the head chamber. Data in Table 28 is presented as the average sRaw over the 5 minutes following MCh administration.

Table 28. MCh Concentration (mg/ml) Placebo-B Formulation XXXII sRaw (cmH2O*s) Std Dev sRaw (cmEhO^s) Std Dev 0 3.30 0.22 2.71 (n.s.) 0.96 50 8.55 3.92 2.68 (p<0.05) 1.04 - 117- WO 2012/044736 PCT/US2011/053829 100 15.26 4.81 3.4Ί (p<0.01) 0.50 [00349] The data show that Formulation XXXII significantly reduced sRaw during MCh challenge compared to Placebo (p<0.05) at 50 and 100 mg/ml MCh.

[00350] The content of each of the patents, patent applications, patent publications and published articles cited in this specification are herein incoiporated by reference in their entirety. -118-