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
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