Dose emission and aerodynamic characterization of the terbutaline sulphate dose emitted from a Turbuhaler at low inhalation flow

Abdelrahim, Mohamed; Assi, K.H.; Chrystyn, Henry

doi:10.3109/10837450.2011.620970

Cited by 45 publications

(48 citation statements)

References 22 publications

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“…At inhalation flow rate of 10, 20, 30, 40, 50 and 60 L min À1 the mean (SD) FPD were 1.6 (0.8), 1.9 (0.7), 5.9 (2.5), 12.8 (4.3), 24.2 (1.9) and 36.5 (5.1) % of the 500 mg terbutaline sulphate nominal dose, respectively. 24 This study showed that the terbutaline sulphate from Turbuhaler has a flow dependent dose emission property and flow dependent fine particle dose characteristic. The TED and FPD were significantly increased with the increase of the flow (p < 0.001).…”

Section: Discussionmentioning

confidence: 82%

Emitted dose and lung deposition of inhaled terbutaline from Turbuhaler at different conditions

Abdelrahim

2010

Respiratory Medicine

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Turbuhaler has a very high resistance hence patient inhalation flow when using it would be low. The total emitted dose (TED) of 500microg terbutaline sulphate from a Bricanyl Turbuhaler was determined using a range of inhalation flows (10-60L min(-1)) with inhalation volume of 2 and 4L using a DPI sampling apparatus after one and two inhalations. The relative lung and systemic bioavailability of terbutaline from Bricanyl Turbuhaler when used by healthy subjects and COPD patients were determined after one and two inhalations at slow and fast inhalation flows using a novel urinary terbutaline pharmacokinetic method. The TED resulted from the one and two inhalations increased significantly (p<0.05) with the increase of the inhalation flow at both 2 and 4L inhalation volumes. The relative lung and systemic bioavailability after one inhalation at fast inhalation flow were significantly higher (p<0.01) than at slow inhalation flow in both healthy subjects and patients. Also the healthy subjects results were significantly higher (p<0.05) than the COPD patients after one inhalation. However after two inhalations there was no significant difference between slow and fast inhalation flow or healthy subjects and COPD patients. Hence it is essential to inhale twice and as deep and hard as possible from each dose of Turbuhaler for patients with low inspiratory flow and limited inhalation volume as they may not receive much benefit from one inhalation.

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Section: Discussionmentioning

confidence: 82%

Emitted dose and lung deposition of inhaled terbutaline from Turbuhaler at different conditions

Abdelrahim

2010

Respiratory Medicine

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“…9 Only 7–46% of Turbuhaler (TH) users 10 and 13–50% of Accuhaler (ACC [Diskus] users) 10 are found to have correct technique, and incorrect technique is associated with worse asthma outcomes. 11 Training to improve the inhaler technique should thus be an important component of asthma education.…”

Section: Introductionmentioning

confidence: 99%

Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial

Basheti

Obeidat

Reddel

2017

npj Prim Care Resp Med

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Inhaler technique can be corrected with training, but skills drop off quickly without repeated training. The aim of our study was to explore the effect of novel inhaler technique labels on the retention of correct inhaler technique. In this single-blind randomized parallel-group active-controlled study, clinical pharmacists enrolled asthma patients using controller medication by Accuhaler [Diskus] or Turbuhaler. Inhaler technique was assessed using published checklists (score 0–9). Symptom control was assessed by asthma control test. Patients were randomized into active (ACCa; THa) and control (ACCc; THc) groups. All patients received a “Show-and-Tell” inhaler technique counseling service. Active patients also received inhaler labels highlighting their initial errors. Baseline data were available for 95 patients, 68% females, mean age 44.9 (SD 15.2) years. Mean inhaler scores were ACCa:5.3 ± 1.0; THa:4.7 ± 0.9, ACCc:5.5 ± 1.1; THc:4.2 ± 1.0. Asthma was poorly controlled (mean ACT scores ACCa:13.9 ± 4.3; THa:12.1 ± 3.9; ACCc:12.7 ± 3.3; THc:14.3 ± 3.7). After training, all patients had correct technique (score 9/9). After 3 months, there was significantly less decline in inhaler technique scores for active than control groups (mean difference: Accuhaler −1.04 (95% confidence interval −1.92, −0.16, P = 0.022); Turbuhaler −1.61 (−2.63, −0.59, P = 0.003). Symptom control improved significantly, with no significant difference between active and control patients, but active patients used less reliever medication (active 2.19 (SD 1.78) vs. control 3.42 (1.83) puffs/day, P = 0.002). After inhaler training, novel inhaler technique labels improve retention of correct inhaler technique skills with dry powder inhalers. Inhaler technique labels represent a simple, scalable intervention that has the potential to extend the benefit of inhaler training on asthma outcomes.

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“…57 Failure to do so results in partial delivery of the medication to the lungs 29 and increased drug deposition in the mouth and pharynx. 57,60,62,63 Maintaining a forceful and deep inhalation from the start of the inhalation maneuver and for as long as possible ensures that most patients can use a powder inhaler (Turbuhaler and Diskus) irrespective of the resistance of the device or their disease severity. 64 However, although most patients can achieve the required flow, 65,66 flow is more likely to be a problem for the Turbuhaler than for the lower resistance Diskus.…”

Section: Evidence For Inclusion Of Individual Technique Steps In Devimentioning

confidence: 99%

Checklists for Powder Inhaler Technique: A Review and Recommendations

et al. 2013

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Turbuhaler and Diskus are commonly used powder inhaler devices for patients with respiratory disease. Their effectiveness is limited in part by a patient's ability to use them correctly. This has led to numerous studies being conducted over the last decade to assess the correct use of these devices by patients and health care professionals. These studies have generally used device-specific checklists to assess technique, this being the most feasible and accessible method for assessment. However, divergence between the checklists and scoring systems for the same device in different studies makes direct comparison of results difficult and at times inappropriate. Little evidence is available to assess the relative importance of different criteria; however, brief patient training based on specific inhaler technique checklists leads to significant improvement in asthma outcomes. This paper reviews common checklists and scoring systems used for Turbuhaler and Diskus, discusses the problem of heterogeneity between different checklists, and finally recommends suitable checklists and scoring systems for these devices based on the literature and previous findings. Only when similar checklists are used across different research studies will accurate comparisons and meta-analysis be possible.

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Dose emission and aerodynamic characterization of the terbutaline sulphate dose emitted from a Turbuhaler at low inhalation flow

Cited by 45 publications

References 22 publications

Emitted dose and lung deposition of inhaled terbutaline from Turbuhaler at different conditions

Emitted dose and lung deposition of inhaled terbutaline from Turbuhaler at different conditions

Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial

Checklists for Powder Inhaler Technique: A Review and Recommendations

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