Zhang, Z.; Yi, H.; Kolanjiyil, A. V.; Liu, C.; Feng, Y.

Small airways are the primary sites of airflow obstruction in chronic obstructive pulmonary disease. Effective delivery of aerosolized drug particles to these regions is crucial to maximize treatment efficacy while minimizing side effects. However, conventional inhalation therapy approaches (i.e., full-mouth particle release and inhalation (FMD)) typically result in insufficient drug deposition in the small airways and an uneven distribution across the five lung lobes. To address such deficiencies, the goals of this study are triple folds: (1) to develop a fast and accurate framework to secure target drug delivery (TDD) nozzle diameter and location based on the conventional computational fluid particle dynamics (CFPD)-FMD simulations, (2) to develop a CFPD-informed machine learning (ML) inverse-design framework that predicts optimal inhaler nozzle parameters based on patient-specific breathing patterns and drug properties, and (3) to demonstrate the feasibility of embedding this framework into a user-centered smart inhaler prototype to improve uniform TTD to the small airways across all five lung lobes. Specifically, a subject-specific mouth-to-generation-10 human respiratory system was employed, and 108 high-fidelity CFPD-FMD simulations were performed under varied physiological and design parameters, including tidal volume, particle diameter, release location, and release timing. Particle release maps generated from those CFPD-FMD simulations via backtracking identified optimal nozzle diameters and locations that promote uniform multi-lobe drug delivery while limiting off-target deposition. Accordingly, a dataset was compiled with inputs (i.e., flow rate, particle size, release z-coordinate, release time) and targets (i.e., nozzle center x- and y-coordinates, nozzle diameter). These inputs and targets form the CFPD-TDD dataset, on which 16 ML models were trained to learn inverse mapping from patient- and drug-specific inputs to optimal nozzle design parameters. Performance was evaluated using mean squared error (MSE) and mean absolute error (MAE) overall and per target feature. Parametric analysis using CFPD-FMD simulations was conducted to determine how patient-specific and drug-specific factors affect pulmonary air-particle transport dynamics and to explain why achieving CFPD-TDD in small airways with CFPD-FMD strategies remains challenging. Furthermore, the ML evaluation in this feasibility study demonstrated robust learning of the inverse mapping from patient-specific inputs to optimal nozzle parameters. Four top-performing models showed consistently low MSE/MAE across cases, and an ensemble (i.e., mixed model (MixModel)) combining their strengths was formulated. Independent CFPD-TDD simulations beyond the training and testing datasets were used as the ground truth to validate ML-predicted nozzle configurations. Compared with conventional CFPD-FMD strategies, ML-guided nozzle designs significantly improved inter-lobar deposition uniformity and reduced off-target deposition in the upper airways, demonstrating the feasibility of ML-enabled TDD to the small airways. Overall, this study establishes a CFPD-informed ML inverse-design framework as a viable algorithmic foundation for user-centered smart inhalers, enabling adaptive, patient-specific TDD to the small airways with improved deposition uniformity across all five lung lobes. By integrating first-principle-based CFPD with ML, this work provides a methodological pathway toward next-generation smart inhalers for more effective treatment of small airway diseases.