WO2023177366A1 - Use of active ingredient used against viral diseases with pressurized metered dose inhaler in the treatment of covid-19 and other viral lung diseases - Google Patents

Abstract

The present invention relates to a pharmaceutical composition that comprises aerosol formulation for direct delivery of at least one active substance used against viral diseases, for example favipiravir and/or umifenovir and/or molnupiravir and/or ritonavir and/or pimodivir and/or hydroxychloroquine and/or remdesivir and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof to the lungs with pressurized metered dose inhalers (pMDIs) in the treatment of COVID-19 or other viral lung diseases; wherein active substances used against viral diseases can be in water-soluble form, water-soluble salt form, solution form or suspension form. In one embodiment, the present invention discloses the use of favipiravir alone or in combination with hypertonic saline solution and/or mannitol for treating of COVID-19 and other viral lung diseases.

Description

USE OF ACTIVE INGREDIENT USED AGAINST VIRAL DISEASES WITH PRESSURIZED METERED DOSE INHALER IN THE TREATMENT OF COVID-19 AND OTHER VIRAL LUNG DISEASES

Technical Field of the Invention

The present invention relates to a pharmaceutical composition comprising at least one active substance used against viral diseases, for example favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine, remdesivir and other active substances used against viral diseases, salt forms thereof, cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, and direct delivery of this pharmaceutical composition to the lungs with pressurized metered dose inhalers (pMDIs) in the treatment of COVID-19 or other viral lung diseases; wherein active substances used against viral diseases can be in water- soluble form, solution form or suspension form. In one embodiment, the present invention discloses the use of favipiravir alone or in combination with hypertonic saline solution and/or mannitol for treating of COVID-19 and other viral diseases.

State of the Art

Coronaviruses (CoV) are a large family of viruses that cause diseases ranging from the common cold to more serious diseases such as Middle East Respiratory Syndrome (MERS- CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronaviruses can be detected in humans, domestic and wild animals. SARS-CoV-2 is an infectious and extremely pathogenic coronavirus that causes pneumonia in humans, an epidemic of severe respiratory tract infection. The viral respiratory disease caused by the SARS-CoV-2 virus and the most common symptoms thereof, which manifest themselves as high fever, cough, and respiratory distress (dyspnea, difficulty in breathing), has been defined as COVID-19. At present, a drug capable of completely treating COVID-19 clinically is not available. The drugs currently used are antivirals, cytokine inhibitors, and antibody administration methods, which are used in the palliative treatments of previous viruses.

It is known that COVID-19 primarily affects the lungs. In severe cases, patients usually die due to respiratory failure. Therefore, the effective drug dose must be delivered to the lungs for treatment. However, existing oral use of favipiravir does not directly target the lungs and causes systemic effects. This situation reduces the effectiveness of the treatment and increases the side effects during the treatment. By Bocan et al., in a biodistribution study of [¹⁸F] Favipiravir on mice, it was shown that the active substance was retained lowest in the lungs and the most in the kidney, liver and stomach.¹

Pathogens such as viruses reach and settle the lungs through inhalation route and cause severe infections in this region. Administration alternatives that are formulated in conventional dosage form and that have systemic effects are generally used in the treatment of these microbial and viral-based diseases that demonstrate high retention in the lung and that cause severe lung infections. The main disadvantages of the conventional dosage forms (tablets, parenteral drugs etc.) that are commercially available for use against the relevant symptoms in the treatment of acute diseases (COVID-19, pneumonia, etc.) or chronic diseases (COPD, asthma, etc.) in the lungs can be summarized as follows:

1 ) It has been proven that the accumulation of drugs administered in both tablet dosage form and parenteral form in the lung bronchoalveolar lavage fluid and lung tissue is low with respect to the lack of accumulation of the active substance in the lung tissue.

2) There is a possibility that the active substances used may have toxic effects on the whole body due to the systemic administration.

3) Since swallowing tablet forms is not possible for intubated patients and may be difficult for pediatric patients due to the tablet size, the common practice in hospitals, based on medical treatment guidelines is administering drugs in tablet form by crushing them. However, although it is practical, this method of administration causes antivirals to become unstable and their bioavailability to decrease by up to 50% due to especially crystal structures thereof.

4) Compliance with conventional dosage forms in pediatric patients is low due to the reasons such as bad taste of active substances and difficulty in swallowing.

5) Correct dose adjustment cannot be performed by dividing or crushing for the administration due to the fact that tablet forms are mostly film coated.

The choice of a drug that is used in the treatment of lung diseases (as in any organ or tissue) is primarily for the local treatment of said organ or tissue. Local treatment ensures the drugs to be used are effective only in the determined organ or tissue, and other parts of the body are not exposed to the drug systemically. The administration results in more effective although the active substances are applied in lower amounts and the side effects thereof are reduced by means of the local administration of the drug. Clinicians and researchers have turned to options of local application as an alternative to conventional dosage forms in the applications of lung diseases due to the disadvantages mentioned above. COVID-19 pandemic necessitates dosage forms that can be formulated very quickly and technologies thereof. Inhalation devices used in the treatment of lung diseases are metered dose inhaler (MDI), dry powder inhaler (DPI), nebulizers (Jet, ultrasonic, new type nebulizer (e.g., VMT and electronic)), and soft mist inhalers. Choosing the right administration route and the right device is extremely important in the treatment of viral lung diseases including COVID- 19. Considering the guidelines, classical nebulizers are contraindicated in COVID-19 due to the risk of contamination. Apart from this, the guidelines recommend drug administration with pMDIs in COVID-19 patients (COVID-19 Guidelines).

Pressurized metered dose inhalers (pMDI) are a type of MDIs that works based on the pressurized propellant in the aerosol chamber. pMDIs are well known, the most efficient and best-accepted devices for inhalational delivery of pharmaceutical products in small doses to the respiratory tract. pMDIs are widely used for treatment of asthma, chronic obstructive pulmonary diseases (COPD) and other respiratory tract disorders. pMDIs are either suspension or solution-based drug formulations delivered with the help of propellants. The propellants are used to expel droplets containing the pharmaceutical product as an aerosol. The traditional chlorofluorocarbon (CFC) propellants, which have previously been used in pMDIs for decades, were banned by the Montreal Protocol (1989) due to their ozone depletion effect. The hydrofluoroalkanes (HFA134a and HFA 227) were selected as alternative propellants. This propellant transition for pMDIs is almost complete in western countries (practical, regulatory and clinical considerations for development of inhalation drug products.)

It is known that pMDIs are available in several types. Most frequently, they comprise a pressure resistant container (canister) typically filled with a product such as a drug dissolved in a liquified propellant, or micronized particles suspended in a liquified propellant. The container is fitted with a metering valve. The valve is movable from an inner (charging) position to an outer (discharging) position. A spring bias holds the valve in the charging position until forced to the discharging position. Actuation of the metering valve allows a metered portion of the container content to be released, whereby the pressure of the liquified propellant carries the dissolved or micronized drug particles out of the container and to the patient. A valve actuator also functions to direct the aerosol as a spray into the patient's oropharynx. Surfactants are usually dissolved in the aerosol formulation and can serve the dual functions of lubricating the valve and reducing aggregation of micronized particles.

Delivery of active substance particles into the lungs of patients using a pMDI has to meet some sensitive criteria. The patient should be able to intake the active substance into his lungs in a safe and effective amount in a reproducible dose. That is, the active substance particles should be stable and possess an acceptable distribution. The active substance particles administered by inhalation should have an aerodynamic diameter of 1 to 10 microns, preferably 1 to 5 microns.

Favipiravir has a crystalline structure and has a molecular weight of 157.104 g/mol. Its solubility in water is ~4 mg/mL and it is a light sensitive molecule. Favipiravir was used against SARS- CoV-2 for the first time in Wuhan, at the very epicenter of the pandemic. Then, as the pandemic spread to Europe, this drug received approval for emergency use in many countries. Favipiravir is a synthetic prodrug, first discovered while assessing the antiviral activity of chemical agents active against the influenza virus. It is known that favipiravir inhibits many types of influenza viruses and ebola virus. In addition, favipiravir has been found to have therapeutic efficacy in cell culture and mouse models of arenavirus, bunyavirus, filovirus, West Nile virus, yellow fever virus, foot-and-mouth-disease virus, and Lassa virus including agents causing viral hemorrhagic fevers and encephalitis.

Favipiravir is used orally in the treatment of COVID-19 with a systemic effect, as a loading dose of 2 x 1600 mg on the first day and as a maintenance dose of 2 x 600 mg for the following 4 days. In fact, it was first approved in Japan for the treatment of influenza, a viral disease. It is a nucleoside analog that targets the RNA-dependent viral RNA polymerase enzyme. Since it shows its antiviral activity against RNA viruses, it is also used in the treatment of COVID-19, which is a disease caused by SARS-CoV-2, a RNA virus.

In the prior art, patent application numbered CN11 1297838A discloses an inhalation spray of antivirus medicines. The inhalation spray comprises the following components in percentage by mass of 0%-30% of antivirus activity agents, 0%-30% of auxiliary agents, 0%-30% of taste masking agents and the balance solvents, wherein the content of the antivirus activity agents and the content of the auxiliary agents are not 0% at the same time. However, this application only uses the term of inhalation spray which is a general term and do not indicate any particular formulation properties such as suspension, emulsion, foam etc., it just explains a spray formulation in general. Said drug spray is loaded into an atomizing device, and the atomized particle diameter formed by atomization is 5-10 pm. However, the particle diameter explained in CN11 1297838A is not in the range of prefered aerodynamic diameter of 1 to 5 microns.

In the patent application numbered CN1 11557939A relates the use of favipiravir and favipiravir's pharmaceutically acceptable salts, solvates, hydrates for treating coronavirus infection. The pharmaceutical composition disclosed here is in the form of solid preparation, injection, external preparation, spray, liquid preparation or compound preparation. This application is not clear concerning the drug administration route. It touches a wide range but stays within the general forms (e.g., solid preparation, injection, external preparation, spray, liquid preparation or compound preparation).

There are many active substances used against viral diseases that are used in COVID-19 outbreak. One of these active substances used against viral diseases is Remdesivir. Remdesivir an antiviral drug that is an RNA polymerase inhibitor adenosine nucleotide analogue, was developed for treatment of Ebola virus, and was tried intravenously to treat the first COVID-19 case in the USA. In a study on compassionate-use of Remdesivir, 53 COVID- 19 patients were treated with the drug for 10 days. Although data on viral load were not collected to confirm antiviral effects of Remdesivir, authors state to have observed an improvement in the oxygen-support status of 68% of patients.² A study from 1062 patients (541 assigned to Remdesivir and 521 to placebo) indicate that those who received Remdesivir had a median recovery time of 10 days, compared with 15 days in the placebo group. All-cause mortality was 11.4% in the Remdesivir group and 15.2% in the placebo. The study supports use of Remdesivir for COVID-19 patients as it may have prevented the progression to more severe respiratory status and provided a lower incidence of new oxygen use among patients 3

Another active substance used against viral diseases is lopinavir-ritonavir, which was proposed as a treatment option for COVID-19 on the basis of in vitro activity, preclinical studies, and observational studies. Lopinavir is a HIV type 1 aspartate protease inhibitor. Ritonavir is combined with Lopinavir as it increases the plasma’s half-life of Lopinavir via cytochrome P450 inhibition⁴.

Another active substance used against viral diseases is umifenovir (Arbidol), which is a small indole derivative molecule licensed for the prophylaxis and treatment of influenza and other respiratory viral infections in Russia and China ⁵⁶. It is a broad-spectrum antiviral agent against a number of enveloped and non-enveloped viruses, such as Ebola, Hepatitis B and C. For the influenza virus, Umifenovir was shown to increase the stability of the hemagglutinin glycoprotein (HA) and prevent HA from transitioning to a low pH-induced fusogenic state, which inhibits the virus from entering the cell ⁶. In a clinical pilot study of COVID-19 patients in Wuhan, the Umifenovir treatment was shown to reduce viral load and mortality compared with the control group ⁷. The antiviral effects and safety of Umifenovir and Lopinavir-ritonavir in COVID-19 patients were compared in a study, where fifty patients were divided into a Lopinavir-ritonavir group (34 cases) and a Umifenovir group (16 cases). On the 14^th day, no viral load was detected in the Umifenovir group, but the viral load was found in 15 patients (44.1 %) treated with Lopinavir-ritonavir. Patients in the Umifenovir group had a shorter duration of positive RNA test compared with those in the Lopinavir-ritonavir group. No apparent side effects were found in both groups. The authors concluded that Umifenovir therapy may be superior to Lopinavir-ritonavir in treating COVID-19 ⁸.

One of the other active substances used against viral diseases is Chloroquine (CQ), which belongs to the 4-aminoquinolines group of compounds, has long been used to treat malaria and amebiasis. However, Plasmodium falciparum developed widespread resistance to the drug, and with the development of new antimalarials, it has become a choice for the prophylaxis of malaria ⁹ . Besides its antimalarial activity, by accumulating in the acidic organelles, CQ exerts both direct antiviral effects on enveloped viruses and decreases activation of several cell types involved in the immune response ¹¹. The antiviral mechanism is achieved by increasing endosomal pH, which disrupts virus-cell fusion. The glycosylation of cellular receptors of SARS-CoV is also disturbed ^12-14. A study demonstrated that CQ functioned at both entry, and at post entry stages of SARS-CoV-2 in Vero E6 cells ¹⁵.

After a number of subsequent clinical trials in China, it was observed that CQ phosphate were superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, and promoting a virus negative conversion, hence shortening the disease course. An Expert Consensus in China recommended CQ phosphate tablets, 500 mg twice per day for 10 days for patients diagnosed with mild, moderate and severe cases of novel coronavirus pneumonia, if without contraindications to CQ ^{16 17}. In a randomized clinical trial of high and low dose CQ in COVID-19 patients, the high-dosage group (i.e., 600 mg CQ twice daily for 10 days) presented greater QTc interval and higher mortality rates (39.0% versus 15.0%) than the low-dosage group (i.e., 450 mg twice daily on day 1 and once daily for 4 days). The higher CQ dosage is not recommended for critically ill patients with COVID-19, particularly when taken concurrently with Azithromycin or/and Oseltamivir due to potentially synergistic cardiac toxic effects ¹⁸.

Hydroxychloroquine (HCQ), a derivative of CQ, was first synthesized in 1946 by introducing a hydroxyl group into CQ and was demonstrated to be 2 to 3 times less toxic than CQ in animals ¹⁹. HCQ is still widely available to treat autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis ⁹. Theoretically both agents are similar in their antiviral activity, but there is more clinical data available on the anti-coronaviral activity of CQ than that of HCQ. Of note, CQ is not as widely available as HCQ in some countries ²⁰. HCQ (EC₅o=O.72 pM) was found to be more potent than CQ (EC5o=5.47 pM) in vitro and it is recommended orally in a loading dose of 400 mg twice daily of HCQ sulphate, followed by a maintenance dose of 200 mg given twice daily for 4 days as a recommendation for SARS-CoV-2 infection ²¹. In a randomized clinical trial, after 5 days of HCQ treatment, the symptoms of COVID-19 patients were significantly relieved, the recovery time from cough and fever have shortened ²². Another known active substance used against viral diseases is molnupiravir, which is a prodrug that is metabolized into active antiviral ribonucleoside analogue p-D-N4-hydroxycytidine (NHC). It has activity against a number of RNA viruses, including SARS-CoV-2, SARS-CoV, MERS-CoV, and seasonal and pandemic influenza viruses. NHC shows its effect on RNA- dependent RNA-Polymerase enzyme, which plays a role in viral genome transcription and replication ²³. In a ferret model, Molnupiravir treatment completely blocked transmission to untreated animals. If ferret-based inhibition data of SARS-CoV-2 transmission are predictive for humans, patients with COVID-19 could become non-infectious within 24-36 h after the onset of an oral treatment ²⁴. Molnupiravir’s antiviral activity was evaluated in a SARS-CoV-2 hamster infection model combined with Favipiravir. The results indicate that the combined treatment is effective on virus and reduces the transmission to the uninfected contacts. These findings may form the basis for clinical trial design for combined therapies ²⁵. In an analysis of the results from Phase I, Phase II and Phase III clinical trials, Molnupiravir was found to be safe, and caused no major adverse reactions ²⁶. According to an interim analysis of a randomized, double-blind, placebo-controlled phase 2/3 study, 7.3% of patients, who received Molnupiravir were hospitalized through Day 29, compared with 14.1 % of placebo-treated patients, who were hospitalized or died ²⁷²⁸.

In the prior art there are many studies that explain details of the use of active substances used against viral diseases such as favipiravir, umifenovir, molnupiravir, ritonavir, hydroxychloroquine in COVID-19, dosage, contraindications and interactions with other medications. However, they are generally focusing on oral drug delivery routes in the form of an oral tablet. As a result of this route, a high dose treatment guide is necessary and according to present studies, it is found that oral delivery route is an insufficient treatment route for favipiravir.

The prior art contains problems such as insufficient treatment in viral lung diseases, especially in COVID-19 with active substances used against viral diseases such as favipiravir, umifenovir, molnupiravir etc. by oral route, the necessity of using high doses of these antivirals in oral tablets and therefore numerous side effects of these antivirals, inadequate aerodynamic particle diameter of solutions that contain these antivirals and low efficacy of them in medicaments. Due to these problems in prior art, developments in the usage, delivery and administration of these active substances for the effective treatment of viral lung diseases, especially for COVID-19 is needed in this technical field.

Brief Description and Objects of the Invention

The present invention discloses a pharmaceutical composition comprising at least one active substance used against viral diseases, for example favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine, remdesivir, and other active substances used against viral diseases, salt forms thereof, cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, and direct delivery of this pharmaceutical composition to the lungs with pressurized metered dose inhalers (pMDIs) in the treatment of COVID-19 or other viral lung diseases; wherein active substance used against viral diseases can be in water- soluble form, solution form or suspension form. The pharmaceutical composition can be in the form of sterile aqueous solution or dispersion ; and it can also be formulated in a microemulsion, liposome, or other ordered structure suitable to high drug concentration.

The present invention provides administration of at least one active substance used against viral diseases such as favipiravir alone or in combination with hypertonic saline solution and/or mannitol in the deep lung region through inhalation devices. The invention is a pharmaceutical ingredient in a pressurized metered dose inhaler-in which the drug is in the form of droplets found in solutions or suspensions which is then carried to the deep lung region by an inert gas expanded rapidly in air using a pressurized canister. The present invention covers a wider range of viral lung disease treatment options beside COVID-19.

The most important object of the present invention is to provide effective treatment of viral lung diseases, especially COVID-19. The present invention allows administration of the active substance used against viral diseases locally and directly to the lung in the treatment of viral lung diseases. Since the present invention provides a targeted delivery of favipiravir with inhalation, it has many advantages compared to other administration routes (oral, parenteral, etc.), thereby, it provides more effective treatment. In the present invention, since the active substance used against viral diseases will be targeted directly to the lungs in a form of particularly inhalable solutions and suspenssions, more effective treatment is provided compared to prior art.

Another object of the present invention is to have a fast onset of action for the treatment of viral lung diseases. In the present invention, delivery of the active substance used against viral diseases through pulmonary route increases the bioavailability since the effect of liver first pass is eliminated. This is because the pulmonary route is an optimal route of administration for drugs that are poorly absorbed or quickly metabolized through the oral route.

Another object of the present invention is to ensure that the active substance used against viral diseases used in the treatment of viral lung diseases, especially COVID-19 are used effectively in lower doses with higher efficacy. In the present invention, the drug efficacy increases, and side effects of the drug, which may occur systemically are reduced by means of its local administration compared to the oral and parenteral routes. In the present invention, the desired effect is achieved with lower doses compared to previous oral systemic use. Systemic side effects are either completely disappear or be greatly reduced due to lower doses and pulmonary administration route. In the prior art, due to usage of oral drugs, high dose treatments were necessary since favipiravir is not sufficiently delivered to the lungs in the oral drug delivery route. The present invention overcomes the insufficient oral drug delivery route of favipiravir and further decreases the required dosage treatment thus reducing unwanted side effects. Improved patient compliance is expected with the present invention since the required dosage amount is decreased greatly when compared to oral route of administration.

Another object of the present invention is to provide an applicable method for patients who have difficulty swallowing tablets. The present invention contains an inhaled route of favipiravir delivery, therefore the patients having difficulty in swallowing tablets can easily get the treatment by inhalation. While an oral tablet undergoes gastrointestinal system degradation, an inhaled form directlys targets the lungs. The side effects seen with oral favipiravir (diarrhea, gastrointestinal side effects, increase in serum uric acid levels, increase in AST/ALT/ALP serum transaminase levels, increase in total bilirubin levels, decrease in neutrophil levels and psychiatric symptoms) is decreased with the present invention.

Another object of the present invention is to treat the damage caused by the COVID-19 in the lungs. The present invention provides the treatment of viral lung diseases, especially COVID- 19 caused by the SARS-CoV-2 virus by means of the administration of favipiravir and/or other active substances used against viral diseases through pulmonary route with high efficiency.

The present invention overcomes the problems present in the prior art by making developments in the usage, delivery and administration of active substances used against viral diseases for the effective treatment of viral lung diseases, especially COVID-19. The present invention provides an effective treatment of viral lung diseases, especially COVID-19 with inhalation route, a fast onset of action compared to prior art, an effective use in lower doses with higher efficacy, lower side effects of active substances used against viral diseases for example favipiravir, easy application method for patients who have difficulty swallowing tablets and treatment of the damage caused by the COVID-19 in the lungs more effectively than prior art.

Description of the Figures

FIGURE 1 Favipiravir concentration and stability vs time according to different pH of solutions. Detailed Description of the Invention

The present invention relates to a pharmaceutical composition and direct delivery of this pharmaceutical composition comprising at least one active substance used against viral diseases, at least one excipient and at least one propellant, to the lungs with pressurized metered dose inhalers (pMDIs) in the treatment of COVID-19 and other viral lung diseases. The pharmaceutical composition can be in the form of sterile aqueous solution or dispersion ; and it can also be formulated in a microemulsion, liposome, or other ordered structure suitable to high drug concentration.

The present invention provides a pharmaceutical composition comprising aerosol formulation that comprises at least one excipient, at least one propellant, at least one active substance used against viral diseases and a carrier solution that displays solvent properties for said active substance to locally administer it to the lungs for use in the treatment of viral lung diseases including COVID-19 caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS- CoV-2) by means of pressurized metered dose inhaler through inhalation.

Said excipient is selected from suspending agent, solvents, co-solvents, surfactants, preservatives, solubilization enhancer, flavouring agents and low volatility compounds. Co- solvent is preferably selected from ethanol, isopropyl alcohol, polyethylene glycol, propylene glycol, glycerol, butanol, p-pentanol and glycerol.

Said propellant is selected from hydrofluorocarbon (HFC), hydrofluoroalkane (HFA), tetrafluoroethane, 1 ,1 ,1 ,2-Tetrafluoroethane (HFA 134a), 1 ,1 ,1 ,2,3,3, 3-Heptafluoropropane (HFC227), HFO-1234yf (2,3,3,3-tetra- fluoropropene) and HFO-1234ze (1 , 3,3,3- tetrafluoropropene) heptafluoropropane and 1 ,1 -difluoroethane (HFA 152a).

Said active substance used against viral diseases is selected from favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine, remdesivir, salt forms thereof, cyclodextrin complexes thereof, pharmaceutically acceptable derivatives thereof and water- soluble forms thereof obtained by water-solubility increasing methods, wherein the active substance used against viral diseases can be 1 -200 mg. For remdesivir 20-100 mg dose; for hydroxychloroquine 5-100 mg dose; for favipiravir 5-200 mg dose; for umifenovir, molnupiravir, ritonavir, or pimodivir 10-200 mg, more specifically 10-100 mg can be used. In the composition, PBS (main solvent) and active substance used against viral diseases (for example favipiravir) alone can be used; or PBS, active substance used against viral diseases (for example favipiravir) alone and hypertonic saline solution and/or mannitol can be used.

In the context of the embodiments of the invention the term "active substance used against viral diseases" refers, without limitation, to an agent that kills a virus or that suppresses its ability to replicate and, hence, inhibits its capability to multiply and/or reproduce, or an agent that helps to reduce cytokine storm or harmful inflammatory responses. It can be interchangeably referred as anti-viral drug or anti-viral substance or anti-viral compound. According to some embodiments of the above method, in addition to the active susbtances listed above, the non- limiting list of agents having anti-viral activity includes acyclovir, gancyclovir, valganciclovir, valacyclovir, famciclovir, penciclovir, vidarabine, cidofovir, ribavirin, adefovir, entecavir, brincidofovir, Idoxuridine, trifluridine, tipiracil, edoxudine, brivudine, FV- 100, sorivudine, cytarabine, lamivudine, lobucavir, telbivudine, clevudine, tenofovir disoproxil, tenofovir alafenamide, zidovudine, oseltamivir, zanamivir, peramivir, ribavirin, amantadine/rimantadine, interferon alpha, interferon beta, chloroquine, favilavir, lopinavir/ritonavir, triazavirin, efavirenz, atazanavir, baricitinib, tocilizumab, acalabrutinib, saquinavir, dolutegravir, asunaprevir, simeprevir, grazoprevir, daclatasvir, etravirine, entecavir, abacavir, penciclovir, danoprevir, telaprevir, darunavir, nelfinavir, indinavir, boceprevir, lomibuvir, raltegravir, amphotericin B, intraconazole, flucytosine, fluconazolem rifampin, rifabutin, isoniazid, prazinamide, ethambutol, pirfenidone, nintedanib, streptomycin, tocilizumab or a combination thereof.

Further examples of active agents according to the present invention include, but are not limited to 4-(4-guanidinobenzoyloxy) phenylacetate, abacavir, acyclovir, adefovir, albuvirtide, amantadine, amprenavir, apricitabine, atazanavir, atovaquone, AT-527, ATR-002, azithromycin, balavir, baloxavir, baricitinib, bemcentinib, bicalutamide, bictegravir, BMS- 955176, bequinar, brilacidin, bromhexine, cabotegravir, cenicriviroc, censavudine, cidofovir, clevudine, cobicistat, CS-8958, daclastavir, dalcetrapib, darunavir, decitabine, delaviridine, defibrotide, didanosine, docosanol, dolutegravir, doravirine, edoxudine, EDP1815, elvitegravir, emtricitabine, enfuvirtide, famiclovir, fosamprenavir, foscarnet, fosfonet, fostemsavir, FT 516, GS-9883, ibacitabine, ibalizumab, laninamivir, ibrutinib, idoxuridine, indinavir, ivermectin, lamivudine, letermovir, leflunomide, loviride, maraviroc, methisazone, moroxidine, N-(2- aminoethly)-1 -aziridine ethane amine, N4-hydroxycytidine (EIDD-1931 ), nitazoxanide, oseltamivir, penciclovir, peramivir, piconivir, PCT299, PRO 140, raltegravir, rilprivirine, rimantidine, ruxolitinib, saquinavir, silmatasertib, simeprevir, sofosbuvir, stavudine, telaprevir, telbivudine, tenovir, tenovir alafenamide, tenovir alafenamide fumarate, tenovir disoproxil, teriflunomide, tofacitinib, tipranavir, trifluridine, tromantadine, TXA127, tranexamic acid, ulinastatin, valaciclovir, VERU-11 1 , viciviroc, vidarabine, viramidine, zalcatibine, and zidovudine. In some of the embodiments favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine and/or remdesivir and/or their water-soluble salt forms, and/or their water-soluble cyclodextrin complexes, and/or their water-soluble forms and/or suspensions. The carrier solution acts as both carrier and solvent and is selected among water for injection, water for inhalation, physiological saline (0.9% NaCI), or half physiological saline (0.45% NaCI) and phosphate buffer (pH 7.4). The carrier solution in the composition is used up to the required volume (ml) in order to obtain the solution containing favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine and/or remdesivir, and/or water-soluble salt thereof, and/or water-soluble cyclodextrin complexes thereof, and/or water-soluble forms thereof, and/or pharmaceutically acceptable derivatives thereof which are in dissolved/dispersed form in the carrier solution. Carrier solution can include not only solution but also suspension type formulation. The concentration and the pH of phosphate buffer used in the carrier solution affects the stability of the composition. The volume of the canister for the pharmaceutical composition is varies between 10-25 mL preferably 10ml, 14ml, 17ml, 19ml and 22 ml. The treatment of viral lung diseases including COVID-19 is provided effectively when the local inhalation is applied with said active substance concentrations. The amount of drug that is administered is low and the side effects thereof is less since the localization ratio of said active substances in the lungs is much higher than the conventional dosage forms.

The pressured metered dose inhaler (pMDI) comprises a metal can contain an aerosol formulation, at least one propellant, a dose metering valve and a valve stem. Said aerosol formulation comprising the active substance used against viral diseases in water-soluble form, water-soluble salt form, solution form or suspension form. During use, the patient presses on the valve stem to dispense a metered dose of the formulation and at that time inhale this dose into his lungs. Favipiravir is used as active pharmaceutical ingredient, pMDI is used as administration device and HFA is used as propellant in the present invention.

The formulations diclosed in the invention is stored in pMDI with internal surfaces made of partially or fully anodized aluminum, stainless steel or lined with an inert organic coating. Examples of preferred coatings are epoxyphenol resins perfluoroalkoxyalkane, perfluoroalkoxyalkylene with perflooacylene, eg polytetrafluoroethylene, fluorinated-ethylene- propylene, polyether sulfone and copolymer fluorinated-ethylene-propylene polyether sulfone. Other suitable coatings can be polyamide, polyimide, polyamidimide, polyphenylene sulfur or combinations thereof.

The formulation is operated with a metering valve that can take between 1 -100 pl volume. Broadly, the pMDI manufacturing process involves combining the formulations components in bulk (i.e., batching), followed by dispensing (i.e., filling) that material into a container. During batching, it is especially critical to dispense the material accurately and properly as this ratio will determine the concentrations of the active pharmaceutical ingredient(s) (API) and excipient(s) in the finished product. This process is complicated by the inclusion of a volatile propellant, in one embodiment, either 1 ,1 ,1 ,2-tetrafluoroethane (HFA-134a, also called norflurane) or 1 ,1 ,1 ,2,3,3, 3-heptafluoropropane (HFA227ea, also called apaflurane). Under normal working pressures, these propellants are liquefied gases and maintain a constant vapor pressure at a given temperature regardless of container volume, eliminating the effectiveness of traditional means of determining vessel fill level or leakage by pressure change. Weighing of the batching vessel and product is the standard for determining leakage and fill level during production.

The present invention includes inhalation routes administration via lungs as a suspension, or solution (depending on the formulation). The pressurized metered dose inhaler is made up of a few main components that contributes to the success of the whole device. These components are propellants, container, metering valve, actuator and pharmaceutical composition. In one of the embodiments of the invention, the formulation of pharmaceutical composition also includes necessary excipients unique to pressurized metered dose inhaler devices. In addition to active substance used against viral diseases, pMDIs formulation, which is an aerosol formulation, can also contain at least one excipient selected from surfactants (such as oleic acid, PEG 1000, PEG 600, propylene glycol), solvents, co-solvents (such as ethanol), suspending agents, preservatives, flavouring agents and/or low volatility compounds in one of the embodiments. Ethanol can also be used to increase the solubility of drug to form a solution formulation.

The pressurized dose inhaler provides a technical application route for the present invention. Pressurized dose inhaler is the most effective delivery route out of all other options regarding use in lung diseases and similar complications concerning the lung area. The device of choice depends on the compliance of the patient when it comes to determining the most suitable option for the person. In one embodiment, wherein favipiravir is used as an active substance used against viral diseases, the initial target disease being COVID-19, it is expected to greatly reduce side effects seen with other administration routes of favipiravir. Since the lung is one of the main affected organs from viral diseases, an inhalation application of medication is convenient in terms of efficiency. Favipiravir, one of the active substances used against viral diseases, shows a higher treatment success in inhalation form.

There are three different filling processes that are used in the manufacturing of the present invention. First one is single-stage pressure filling which involves the dispensing of a formulation containing the API(s) along with any excipient and propellant in a single action into the primary packaging, usually composed of a crimped canister with metering valve. Second one is two-stage pressure filling which involves combining the API with some or all of the nonvolatile excipients to form a concentrate which can be dispensed into the open canister. Third one is single-stage cold filling, wherein the first step in cold filling is the preparation of the API with excipients. Processes may utilize an excipient and/or propellant that is liquid at ambient temperature and pressure, such as ethanol, to form a concentrate solution or slurry of suspended drug. Alternatively, the process might employ a pressurized addition of propellant to the API prior to chilling the formulation or pre-chill the propellant before adding the concentrate. Once the formulation contains all the required components, it must be sufficiently mixed and/or homogenized. In the case that extensive homogenization is required, care must be taken to ensure that the heat generated from homogenization does not cause the liquefied propellant to vaporize or substantially increase the solubility of the API.

The filling equipment utilizes a very high pressure, based on the valve manufacture’s specifications. During this process, it remains especially important to keep suspension formulations constantly recirculating and mixing to avoid vapor lock formation or settling or creaming of suspension in the pump lines or filling head. This can be aided by keeping the formulation cooled, around 5°C, to prevent a vapor lock in the feed lines and metering cylinder of the filler caused by slow evaporation of the propellant (pressure filling).

Maintaining adequate circulation and filling pressure is also a concern, as the chilling of the propellant reduces its vapor pressure well below the inlet pressure required by many pumps and fillers to accurately dispense formulation into the canister. As a result, it is common to maintain a compressed gas headspace, usually dried air or nitrogen, as a means of supplying pressure or by multiple pumps in series to scale system pressure (cold filling). Formulations of the present invention can be prepared by either pressure filling or cold filling techniques, both of which are well known to those skilled in the art.

The present invention aims to use active substance used against viral diseases via inhalation route during outbreaks specially focusing on the usage of pressured metered dose inhalers that usually consisting of a main body or can, acting as a reservoir for the aerosol formulation, a cap sealing the main body and a metering valve fitted in the cap. pMDIs use a propellant to deliver a fixed volume of solution or suspension to the patient in the form of an aerosol not a spray.

The invention comprises a pressurised canister that contains both propellant gases and pharmaceutical composition (medication) together and a metering dose valve that linked to an actuator. Pressing down on to the canister releases the drug in the form of an aerosol cloud and/or a sensor can be attached to the linked actuator which senses the patient inhalation pattern and synchronises dose delivery with that pattern.

Th present invention formulation has a particle size of 1 -5 pm. Those skilled in the art may choose to add one or more preservative, buffer, antioxidant, sweetener and/or flavors or other taste masking agents depending upon the characteristics of the formulation. The pharmaceutical composition(s) are suspended or dissolved in a liquefied propellant system, which may also contain excipients include but not limited to co-solvents, surfactants, preservatives, flavouring agents and low volatility compounds etc.

"Propellants" used herein mean pharmacologically inert liquids with boiling points from about 35°C to about -35° which alone or in combination exert a high vapor pressure at room temperature. Upon activation of the pMDI system, the high vapor pressure of the propellant in the pMDI forces a metered amount of drug formulation out through the metering valve. Then the propellant very rapidly vaporizes dispersing the drug particles. The propellant gases include but not limited to hydrofluorocarbon propellants known in the art which may be utilized in the first reservoir and/or second reservoir in pMDIs according to embodiments include tetrafluoroethane (HFC134a), tetrafluoroethane (P-134a), heptafluoropropane (P-227), combinations thereof, or any other suitable propellant.

The present invention provides particular API and/or hypertonic saline solution and/or mannitol in the deep lung region which is obtained through inhalation devices. The present invention uses sugar alcohol components to obtain hypertonic solution, to clear mucous layer etc.

The formulation of the present invention can be formulated as a solution. The solution can be but not limited to, for example, a solution of drug in water, physiological saline (0,9 % NaCI solution), half physiological saline (0.45% NaCI), phosphate buffer (pH 4.5-7.4), ethanol and/or a mixture thereof. The solvent is a hydroxy-type polar solvent, selected from one or more of water, ethanol, polyethylene glycol, propylene glycol, glycerol, butanol or p-pentanol or glycerol. The formulation will generally contain a solubilisation agent to aid solubilisation of the drug in the formulation.

Among the preferred solubilization enhancer as excipients are selected from propylene glycol diesters of medium chain fatty acids, triglyceride esters of medium chain fatty acids used for decreasing the discharge pressure, perfluorodimethylcyclobutane, perfluorocyclobutane, polyethylene glycol, menthol, propylene glycol monolaurate, diethylene glycol monoethylether, polyglycolized glyceride of medium chain fatty acids, alcohols such as ethanol, methanol and isopropanol and mixtures thereof. "Co-solvent" used herein means a substance having a higher polarity than that of the propellant. The present invention formulation may include one or more additional co-solvent to solubilize the active ingredient in the propellant. Advantageously the co-solvent is preferably but not limited to selected from the group of lower branched or linear alkyl (C1 -C4) alcohols such as ethanol and/or isopropyl alcohol. The cosolvent is usually an alcohol, preferably ethanol. The co-solvent will be present in an amount suitable to solubilize the active ingredient in the propellant in a concentration comprised between 1% and 20% (w/w) with respect to the total weight of the composition, co-solvent is preferably a polar cosolvent e.g., ethanol. Suitably, the drug formulation contains 50-100%, 80-100%, more preferably 90-100% w/w propellant.

A surfactant optionally may be added to lower the surface and interfacial tension between the medicaments and the propellant. Where the medicaments, propellant and excipient are to form a suspension, a surfactant may or may not be required. Where the medicament, propellant and excipient are to form a solution, a surfactant may or may not be necessary, depending in part, on the solubility of the particular medicament and excipient. The surfactant may be any suitable, non-toxic compound which is non-reactive with the medicament, and which substantially reduces the surface tension between the medicament, the excipient and the propellant and/or acts as a valve lubricant. Among the markedly available surfactants, bellowed mentioned examples can be included but not limited to: oleic acid, cetylpyridinium chloride, soya lecithin, polyoxyethylene (20) sorbitan monolaurate, polyoxyethylene (20) sorbitan monostearate, polyoxyethylene (20) sorbitan monooleate, polyoxyethylene (10) stearyl ether, polyoxyethylene (2) oleyl ether, polyoxyethylene-polyoxypropylene- ethylenediamine block copolymer, polyoxypropylene-polyoxyethylene block copolymers, castor oil ethoxylate and mixtures thereof.

The presence of the low volatility component in the solution formulation increases the fine particle mass (FPM) and also to increase the mass median aerodynamic diameter (MMAD) of the aerosol particles on actuation of the inhaler. The low volatility component, when present, is selected from the group of glycols, particularly propylene glycol, polyethylene glycol and glycerol, alkanols such as decanol (decyl alcohol), sugar alcohols including sorbitol, mannitol, lactitol and maltitol, glycofural (tetrahydro-furfurylalcohol) and dipropylene glycol, vegetable oils, organic acids for example saturated carboxylic acids including lauric acid, myristic acid and stearic acid; unsaturated carboxylic acids including sorbic acid, and especially oleic acid; saccharine, ascorbic acid, cyclamic acid, amino acids, or aspartame, esters for example ascorbyl palmitate, isopropyl myristate and tocopherol esters; alkanes for example dodecane and octadecane; terpenes for example menthol, eucalyptol, limonene; sugars for example lactose, glucose, sucrose; polysaccharides for example ethyl cellulose, dextran; antioxidants for example butylated hydroxytoluene, butylated hydroxyanisole; polymeric materials for example polyvinyl alcohol, polyvinyl acetate, polyvinyl pyrrolidone; amines for example ethanolamine, diethanolamine, triethanolamine; steroids for example cholesterol, cholesterol esters.

Pharmaceutical formulations may contain 0.0001 to 50% w/w, preferably 0.001 to 20%, for example 0.001 to 1 % of sugar relative to the total weight of the formulation. Generally, the ratio of medicament to sugar falls within the range of 1 : 0.01 to 1 : 100 preferably 1 : 0.1 to 1 : 10. Typical sugar relatives which may be used in the formulations include, for example, sucrose, lactose and dextrose, preferably lactose, trehalose and reducing sugars such as mannitol and sorbitol, or derivatives thereof may be in micronized or milled form. pMDIs are usually made of a conventional material such as aluminium, tin plate, glass, plastic and the like. According to the invention, part or all of the internal surfaces of the inhalers consists of stainless steel, anodised aluminium or is lined with an inert organic coating. One of the preferred coatings consists of epoxy-phenol resin. Any kind of stainless steel may be used. Suitable epoxy-phenol resins are commercially available. The proposed invention may be filled into the aerosol containers using conventional filling equipment. Since propellants that are used in the present invention may not be compatible with all elastomeric compounds currently utilized in present aerosol valve assemblies, it may be necessary to substitute other materials, such as white buna rubber, or to utilize excipients and optionally surfactants which mitigate the adverse effects of propellants that are used on the valve components.

In one embodiment of the invention, an example formulation comprises favipiravir 1 -20 mg, pH adjusting solution, ethanol and propellant. Targeted particle size is 1 -5 pm. The percentage of ethanol in the formulation can be at most 20%, preferably 1 -15% (w/w).

In one embodiment of the invention, favipiravir solution was prepared in phosphate buffer saline at pH 6.5 (Figure 1 ). This buffer specifically maintains favipiravir at the highest stability when pH is adjusted to higher than 6.0, preferably at pH 6.5. Favipiravir stability was examined at 40°C±2°C/75% RH±5% RH in three media, normal saline (0.9% sodium chloride solution) for which final pH was 3.4, in phosphate buffer saline (PBS) at pH 5.2, and in PBS at pH 6.5. The concentration of favipiravir in normal saline dropped dramatically to reach 16.5% after 14 days at 40°C. Only the PBS formulation with pH adjusted 6.5 was remarkably stable throughout 3 months storage at 40°C. This emphasizes the impact of pH on favipiravir stability, as it was least stable in normal saline at pH 3.4 and most stable in PBS at pH 6.5. Furthermore, upon the storage at 25°C±2°C/60% RH±5% RH, the calculated total impurities were found to be smaller when the pH was 6.5 (0.76%) compared to those of pH 5.2 (2.04%) after 3 months at 25°C. The proposed formulation consisting of favipiravir in phosphate buffer saline adjusted to pH 6.5 ensures the highest stability over time, and thus the longest shelf life. REFERENCES

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Claims

CLAIMS A pharmaceutical composition comprising aerosol formulation that comprises

- at least one excipient,

- at least one propellant and

- at least one active substance used against viral diseases selected from favipiravir, umifenovir, molnupiravir, ritonavir, pimodivir, hydroxychloroquine, remdesivir, acyclovir, gancyclovir, valganciclovir, valacyclovir, famciclovir, penciclovir, vidarabine, cidofovir, ribavirin, adefovir, entecavir, brincidofovir, Idoxuridine, trifluridine, tipiracil, edoxudine, brivudine, FV-100, sorivudine, cytarabine, lamivudine, lobucavir, telbivudine, clevudine, tenofovir disoproxil, tenofovir alafenamide, zidovudine, oseltamivir, zanamivir, peramivir, ribavirin, amantadine/rimantadine, interferon alpha, interferon beta, chloroquine, favilavir, lopinavir/ritonavir, triazavirin, efavirenz, atazanavir, baricitinib, tocilizumab, acalabrutinib, saquinavir, dolutegravir, asunaprevir, simeprevir, grazoprevir, daclatasvir, etravirine, entecavir, abacavir, penciclovir, danoprevir, telaprevir, darunavir, nelfinavir, indinavir, boceprevir, lomibuvir, raltegravir, amphotericin B, intraconazole, flucytosine, fluconazolem rifampin, rifabutin, isoniazid, prazinamide, ethambutol, pirfenidone, nintedanib, streptomycin, tocilizumab and a combination thereof, 4-(4-guanidinobenzoyloxy) phenylacetate, abacavir, acyclovir, adefovir, albuvirtide, amantadine, amprenavir, apricitabine, atazanavir, atovaquone, AT-527, ATR-002, azithromycin, balavir, baloxavir, baricitinib, bemcentinib, bicalutamide, bictegravir, BMS-955176, bequinar, brilacidin, bromhexine, cabotegravir, cenicriviroc, censavudine, cidofovir, clevudine, cobicistat, CS-8958, daclastavir, dalcetrapib, darunavir, decitabine, delaviridine, defibrotide, didanosine, docosanol, dolutegravir, doravirine, edoxudine, EDP1815, elvitegravir, emtricitabine, enfuvirtide, famiclovir, fosamprenavir, foscarnet, fosfonet, fostemsavir, FT 516, GS-9883, ibacitabine, ibalizumab, laninamivir, ibrutinib, idoxuridine, indinavir, ivermectin, lamivudine, letermovir, leflunomide, loviride, maraviroc, methisazone, moroxidine, N- (2-aminoethly)-1 -aziridine ethane amine, N4-hydroxycytidine (EIDD-1931 ), nitazoxanide, oseltamivir, penciclovir, peramivir, piconivir, PCT299, PRO 140, raltegravir, rilprivirine, rimantidine, ruxolitinib, saquinavir, silmatasertib, simeprevir, sofosbuvir, stavudine, telaprevir, telbivudine, tenovir, tenovir alafenamide, tenovir alafenamide fumarate, tenovir disoproxil, teriflunomide, tofacitinib, tipranavir, trifluridine, tromantadine, TXA127, tranexamic acid, ulinastatin, valaciclovir, VERU- 111 , viciviroc, vidarabine, viramidine, zalcatibine, zidovudine and salt forms thereof, cyclodextrin complexes thereof, and pharmaceutically acceptable derivatives thereof which are dissolved in a carrier solution to locally administer the pharmaceutical composition to the lungs for use in the treatment of viral lung diseases including COVID-19 caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) by means of pressurized metered dose inhaler through inhalation.

2. The pharmaceutical composition according to Claim 1 , wherein it comprises 1 -200 mg of active substance used against viral diseases which are dissolved in a carrier solution.

3. The pharmaceutical composition according to Claim 1 , wherein it comprises 5-200 mg of favipiravir and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, which is dissolved in a carrier solution.

4. The pharmaceutical composition according to Claim 1 , wherein it comprises 20-100 mg of remdesivir and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, which are dissolved in a carrier solution.

5. The pharmaceutical composition according to Claim 1 , wherein it comprises 5-100 mg of hydroxychloroquine and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, which are dissolved in a carrier solution.

6. The pharmaceutical composition according to Claim 1 , wherein it comprises 10-200 mg of umifenovir, molnupiravir, ritonavir, and/or pimodivir and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, which are dissolved in a carrier solution.

7. The pharmaceutical composition according to Claim 1 , wherein it comprises 10-100 mg of umifenovir, molnupiravir, ritonavir, and/or pimodivir and/or salt forms thereof and/or cyclodextrin complexes thereof and/or pharmaceutically acceptable derivatives thereof, which are dissolved in a carrier solution.

8. The pharmaceutical composition according to Claim 1 , wherein the excipient is selected from suspending agent, solvent, co-solvent, surfactant, preservative, flavouring agent, solubilization enhancer and low volatility component.

9. The pharmaceutical composition according to Claim 8, wherein the co-solvent selected from the group of lower branched or linear alkyl (C1 -C4) alcohols. The pharmaceutical composition according to Claim 8, wherein the co-solvent is selected from ethanol, isopropyl alcohol, polyethylene glycol, propylene glycol, glycerol, butanol, p-pentanol and glycerol. The pharmaceutical composition according to Claim 8, wherein the percentage of the co-solvent is between 1 -20% w/w with respect to the total weight of the composition. The pharmaceutical composition according to Claim 1 , wherein the propellant is selected from hydrofluorocarbon (HFC), hydrofluoroalkane (HFA), tetrafluoroethane, 1 ,1 ,1 ,2-Tetrafluoroethane (HFA 134a), 1 ,1 ,1 ,2,3,3,3-Heptafluoropropane (HFC227), HFO-1234yf (2,3,3,3-tetra- fluoropropene) and HFO-1234ze (1 ,3,3,3- tetrafluoropropene) heptafluoropropane and 1 ,1 -difluoroethane (HFA 152a). The pharmaceutical composition according to Claim 1 , characterized in that the active substance used against viral diseases is in water-soluble form, solution form or suspension form. The pharmaceutical composition according to Claim 13, wherein the solution form comprises a solvent selected from water, physiological saline (0.9% NaCI), half physiological saline (0.45% NaCI), phosphate buffer (pH 4.5-7.4), ethanol, polyethylene glycol, propylene glycol, glycerol, butanol, p-pentanol, propylene glycol, glycerol, alkanes, ethers, dimethoxymethane. The pharmaceutical composition according to Claim 8, wherein the excipient is solubilization enhancer and the solubilization enhancer is selected from propylene glycol diesters of medium chain fatty acids, triglyceride esters of medium chain fatty acids, perfluorodimethylcyclobutane, perfluorocyclobutane, polyethylene glycol, menthol, propylene glycol monolaurate, diethylene glycol monoethylether, polyglycolized glyceride of medium chain fatty acids, alcohols such as ethanol, methanol, isopropanol and eucalyptus oil. The pharmaceutical composition according to Claim 8, wherein the surfactant is selected from oleic acid, cetylpyridinium chloride, soya lecithin, polyoxyethylene (20) sorbitan monolaurate, polyoxyethylene (20) sorbitan monostearate, polyoxyethylene (20) sorbitan monooleate, polyoxyethylene (10) stearyl ether, polyoxyethylene (2) oleyl ether, polyoxyethylene-polyoxypropylene-ethylenediamine block copolymer, polyoxypropylene-polyoxyethylene block copolymers and castor oil ethoxylate. The pharmaceutical composition according to Claim 8, wherein the low volatility component is selected from glycol, propylene glycol, polyethylene glycol, glycerol, alkanol, decanol, sugar alcohol, sorbitol, mannitol, lactitol, maltitol, glycofural (tetrahydro-furfurylalcohol), dipropylene glycol, vegetable oil, organic acid, saturated carboxylic acid, lauric acid, myristic acid, stearic acid unsaturated carboxylic acid, sorbic acid, oleic acid, saccharine, ascorbic acid, cyclamic acid, amino acid, aspartame, ester, ascorbyl palmitate, isopropyl myristate, tocopherol ester, alkane, dodecane, octadecane, terpene, menthol, eucalyptol, limonene, sugar, lactose, glucose, sucrose, polysaccharide, ethyl cellulose, dextran, antioxidant, butylated hydroxytoluene, butylated hydroxyanisole, polymeric material, polyvinyl alcohol, polyvinyl acetate, polyvinyl pyrrolidone, amine, ethanolamine, diethanolamine, triethanolamine, steroid, cholesterol and cholesterol ester.

18. The pharmaceutical composition according to Claim 1 , characterized in that, it further comprises 0.0001 to 50% w/w of sugar relative to the total weight of the composition.

19. The pharmaceutical composition according to Claim 18, wherein it comprises 0.001 to 20% w/w of sugar relative to the total weight of the composition.

20. The pharmaceutical composition according to Claim 18 or Claim 19, wherein the sugar relative is selected from mannitol, trehalose, sucrose, lactose, dextrose and reducing sugars and derivatives thereof.

21. The pharmaceutical composition according to Claim 1 , characterized in that, it further comprises preservative, buffer, antioxidant, sweetener, flavor and/or taste masking agents.

22. The pharmaceutical composition according to Claim 1 , wherein the percentage of the propellant is between 50-100% w/w.

23. The pharmaceutical composition according to Claim 22, wherein the percentage of the propellant is between 80-100% w/w.

24. The pharmaceutical composition according to Claim 22, wherein the percentage of the propellant is between 90-100% w/w.

25. The pharmaceutical composition according to Claim 1 , wherein the composition has a particle size of 1 -5 pm.

26. The pharmaceutical composition according to Claim 1 , characterized in that the pharmaceutical composition is in sterile aqueous solution form, dispersion form, microemulsion form or liposome form.

27. The pharmaceutical composition according to Claim 3, wherein the the carrier solution comprises phosphate buffer saline (PBS) at pH 6.5.