Higher lung deposition with Respimat^® Soft Mist™ Inhaler than HFA-MDI in COPD patients with poor technique

Abstract

Aerosols delivered by Respimat ® Soft Mist ™ Inhaler (SMI) are slower-moving and longer-lasting than those from pressurized metered-dose inhalers (pMDIs), improving the effi ciency of pulmonary drug delivery to patients. In this four-way cross-over study, adults with chronic obstructive pulmonary disease (COPD) and with poor pMDI technique received radiolabelled Berodual ® (fenoterol hydrobromide 50 μg/ipratropium bromide 20 μg) via Respimat ® SMI or hydrofl uoroalkane (HFA)-MDI (randomized order) on test days 1 and 2, with no inhaler technique training. The procedure was repeated on test days 3 and 4 after training. Deposition was measured by gamma scintigraphy. All 13 patients entered (9 males, mean age 62 years; FEV 1 46% of predicted) inhaled too fast at screening (peak inspiratory fl ow rate [IF]: 69-161 L/min). Whole lung deposition was higher with Respimat ® SMI than with pMDI for untrained (37% of delivered dose vs 21% of metered dose) and trained patients (53% of delivered vs 21% of metered dose) (p Sign-Test = 0.15; p ANOVA Ͻ 0.05). Training also improved inhalation profi les (slower average and peak IF as well as longer breath-hold time). Drug delivery to the lungs with Respimat ® SMI is more effi cient than with pMDI, even with poor inhaler technique. Teaching patients to hold their breath as well as to inhale slowly and deeply increased further lung deposition using Respimat ® SMI.

Pulmonary deposition of fluticasone propionate/formoterol in healthy volunteers, asthmatics and COPD patients with a novel breath-triggered inhaler

“…Interestingly, many of the publications which advocate the primacy of small particle size are based on extrafine beclometasone-HFA (Qvar ® /Aerobec ® ; MMAD 1.2 μm [30]); but neglect to mention that formulation's high FPF [31] or its advantageous plume character [32]. Similar considerations explain the high lung deposition that has been reported with the Respimat ® soft mist inhaler (MMAD ∼1-2 μm [33,34]). Collectively, these observations support the authors' view that FPF and plume character are major determinants of pulmonary drug deposition.…”

Consistent Pulmonary Drug Delivery with Whole Lung Deposition Using the Aerosphere Inhaler: A Review of the Evidence

“…46,47 This fraction is similar to, or higher than, that observed in previous gamma scintigraphy studies of other suspension MDIs in healthy subjects and patients with COPD or asthma. 46,[51][52][53][54] For both drugs, a very low fraction of the dose (<0.3%) was exhaled and the remainder (61% to 62%) was deposited in the oropharyngeal or stomach regions. 46,47 Regional deposition results indicated that GFF MDI and BGF MDI were delivered to both the central and peripheral lung regions.…”

Reduced Environmental Impact of the Reusable Respimat® Soft Mist™ Inhaler Compared with Pressurised Metered-Dose Inhalers

“…However, although HFAs and other GHGs have relatively high GWPs, the amount of emissions of these gases is dwarfed by emissions of carbon dioxide, nitrous oxide and methane [2]. The Respimat ® inhalers are propellant-free, handheld devices that achieve higher drug deposition in the lungs than pMDIs [3]; they comprise a pump with a nozzle, a dose-release button, a dose indicator and a cartridge that contains the aqueous solution. At each actuation, the measured dose is forced through the nozzle system, producing two fine jets merging at a controlled angle and resulting in a unique slow-moving “soft mist” [1].…”