LAUSR

BACKGROUND Technoshere insulin (TI), Afrezza, is a form of short-acting human insulin taken by oral inhalation with meals. METHODS literature search (English, French, Spanish) of all human studies and pertinent animal and in-vitro studies related to technosphere insulin until September 2016 with special emphasis on its safety. RESULTS Compared to subcutaneous insulin aspart, TI is slightly less effective, the difference in hemoglobin A1c (HbA1c) reduction being 0.19%. Use of TI is associated with lower risk of hypoglycemia and weight gain compared with insulin aspart. Apart from hypoglycemia, cough is the most common adverse effect of TI reported by 24-33% of patients. Cough induced by TI is mostly dry, occurs within 10 minutes after inhalation and usually subsides after few weeks of use. TI is contraindicated in patients with asthma and chronic obstructive lung disease in whom it causes acute bronchospasm. TI is also not recommended in smokers. All patients starting TI need to check their pulmonary function at baseline then after 6 months, and annually thereafter. CONCLUSIONS Overall, while TI is an attractive form of prandial insulin, its use is limited by high incidence of cough, requirement of frequent monitoring of respiratory function, and lack of long-term safety data.