Can Patients with Parkinson’s Disease Use Dry Powder Inhalers during Off Periods?

Abstract

Because of its rapid onset of action, pulmonary administration of levodopa is an interesting alternative to oral administration for the rescue treatment of Parkinson’s disease patients in an off period. We studied the ability of Parkinson’s disease patients to operate a dry powder inhaler (DPI) correctly during an off period. We used an instrumented test inhaler with three different resistances to air flow to record flow curves and computed various inhalation parameters. We observed that all (13) patients were able to generate pressure drops > 2 kPa over the highest resistance and 10 out of 13 patients achieved at least 4 kPa. Inhaled volumes (all resistances) varied from 1.2 L to 3.5 L. Total inhalation time and the time to peak inspiratory flow rate both decreased with decreasing inhaler resistance. Twelve out of thirteen patients could hold their breath for at least five seconds after inhalation and nine could extend this time to ten seconds. The data from this study indicate that patients with Parkinson’s disease will indeed be able to use a dry powder inhaler during an off period and they provide an adequate starting point for the development of a levodopa powder inhaler to treat this particular patient group.

Pharmacokinetics and tolerability of inhaled levodopa from a new dry-powder inhaler in patients with Parkinson’s disease

“…This promise is further strengthened by the fact that Parkinson’s disease patients are generally capable to perform a correct inhalation manoeuvre during an off period. 19…”

“…This promise is further strengthened by the fact that Parkinson's disease patients are generally capable to perform a correct inhalation manoeuvre during an off period. 19 So far, the only described dry-powder inhalation system for levodopa is the CVT301. 18 The CVT301 system is based on a spray-dried powder containing only 50% levodopa, with 25% dipalmitoyl phosphatidylcholine, 15% sodium citrate, and 10% calcium chloride as excipients.…”

Optimizing Spray-Dried Porous Particles for High Dose Delivery with a Portable Dry Powder Inhaler

“…In this example, Luinstra et al [90,91] co-milled levodopa with 2% w/w leucine. Thirty milligrams of the coated drug particles were loaded into the Cyclops single-use disposable DPI (packing density = 85.7 mg/mL), and the systemic pharmacokinetics (i.e., the target for CNS delivery) and tolerability of inhaled levodopa was assessed in eight patients with Parkinson's disease.…”

Profile of inhaled levodopa and its potential in the treatment of Parkinson’s disease: evidence to date

“…Of note, inhaled levodopa administered via a dry-powder inhaler has been studied by other investigators. 35 While conducting investigations into the ability of PD patients to perform an inhalation maneuver during an Off period, 36 , 37 the authors developed an alternate process to manufacture the dry powder with lower volume and fewer excipients, in conjunction with a preloaded unit-dose inhaler (rather than a capsule inhaler) that may be easier for PD patients to use, called Cyclops. 35 Dose reproducibility and deposition into the peripheral airways was demonstrated due to the high resistance and low flow rate of the inhaler.…”