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The third is duration and safety : short controlled studies in animals say almost nothing about what months or years of exposure would do in a human, which is precisely why the cycling section defaults to scheduled off periods rather than open-ended use

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Although epithelial-based and macrophage-based barriers operate later, MCC acts earlier and impacts all formulations, making it the primary barrier to effective inhaled drug delivery 120,121,122

43.Lamperti M, Romero CS, Guarracino F, Cammarota G, Vetrugno L, Tufegdzic B et al (2025) Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care