Impact of Inhalation Flow, Inhalation Volume and Critical Handling Errors on Delivered Budesonide/Formoterol Dose in Different Inhalers: An In Vitro Study

Janson, Christer; Lööf, Thomas; Telg, Gunilla; Stratelis, Georgios

doi:10.1007/s41030-017-0042-6

Cited by 9 publications

(21 citation statements)

References 26 publications

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“…In an in vitro study, dose delivery was assessed for two strengths of budesonide/formoterol administered by Turbuhaler®, Easyhaler® and Spiromax®. 31 Compared with the results obtained at a simulated inhalation volume of 4 l, DD was unaffected by inhalation volume down to 1 l with Turbuhaler®, with significant differences only for the higher strength at 0.5 l, and both strengths at 0.25 l (all p < 0.0125). Easyhaler® DD was independent of inhalation volume down to 0.5 l, with a significant 10% decrease at 0.25 l for the formoterol component at the lower strength ( p < 0.0125).…”

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 67%

“…A key characteristic of DPIs is the dependency of the FPD on the inhalation flow rate. 31,32 The force required to create a turbulent energy and generate an aerosol is the product of patient inhalation flow and the internal resistance of the device: 6,33…”

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

“…However, as the dependency of FPD on the inhalation flow rate is a fundamental characteristic of DPIs, it was noted that the magnitude of decrease in FPD for some of the inhalers tested may have clinical implications in patients with low inhalation capacity or those not following inhaler instructions. 31…”

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

“…The inhalation volume required for complete dose emission is an important factor to consider, as a low volume could have a negative effect on the DD. 31 The DD from an inhaler depends on an effective discharge (dose emission) from the device during inhalation. In order for peripheral deposition to occur, the discharge must be completed in a fraction of a second and within the first litre of inhaled air.…”

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

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What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Lavorini

Janson

Braido

et al. 2019

Ther Adv Respir Dis

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Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.

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Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 67%

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

Section: Technical Factors To Consider When Selecting An Inhaler Devicementioning

confidence: 99%

See 2 more Smart Citations

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Lavorini

Janson

Braido

et al. 2019

Ther Adv Respir Dis

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show abstract

“…A recent study reported significant differences in performance of the DuoResp Spiromax after shaking versus the Symbicort Turbuhaler (Janson et al, 2017). The study found that shaking the low and high strength DuoResp Spiromax resulted in 20% and 80% decreases in the delivered dose of budesonide/formoterol, respectively.…”

Section: Discussionmentioning

confidence: 96%

Real-life budesonide and formoterol dose emission from the medium and high strength fixed dosed combinations in a Spiromax® dry powder inhaler using inhalation profiles from patients with chronic obstructive pulmonary disease

Bagherisadeghi

Chrystyn

Abadelah

et al. 2019

European Journal of Pharmaceutical Sciences

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Dry powder inhalers (DPIs) are passive devices used to administer inhaled medication for the management of asthma and chronic obstructive pulmonary disease (COPD). DPIs require patients to generate a sufficient internal turbulent airflow force during each inhalation to deaggregate the powdered drug formulation into an emitted dose containing particles with the greatest likelihood of lung deposition. This internal force is generated by the interaction between the user's inhalation flow and the resistance of the DPI. Traditional compendial in vitro methods of measuring dose emission use a vacuum pump to simulate inhalation. We have adapted this in vitro method by replacing the square wave inhalation profile generated by a vacuum pump with the inhalation profiles of patients using an empty DPI. This method enables accurate assessment of the actual dose they would have inhaled. In the present study, real-life inhalation profiles were selected from 15 patients with COPD who inhaled through an empty placebo Spiromax ® DPI. Ex vivo dose emissions were measured for the medium (emitted dose of 160 µg/4.5 µg) and high-strength (320 µg/9 µg) budesonide/formoterol formulations from the Spiromax DPI. These profiles were used to investigate the effect of the primary inhalation parameterpeak inhalation flow (PIF). Some profiles were modified to isolate other inhalation parameters (namely, inhaled volume [Vin] and acceleration rate of the inhalation maneuver [ACIM]). Both the medium-strength and high-strength DuoResp Spiromax displayed flow-dependent dose emission. When the PIF of a patient's inhalation maneuver increased from 26.8 L/min to 69.7 L/min, there was a significant (p < 0.05) effect on the dose-emission characteristics of the medium-strength and high-strength DuoResp Spiromax. At each PIF, an increase in Vin from approximately 500 mL to 2,000 mL had no effect on the dose-emission characteristics of either strength. However, at each Vin there was a significant (p < 0.05) effect on the dose-emission characteristics as PIF increased. The effect of ACIM on the dose-emission characteristics was small. The ex vivo methodology used in this study provides a practical approach to identify the actual dose a patient might inhale during routine real-life use of the DuoResp Spiromax.

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Numerical simulation of the effect of inhalation parameters, gender, age and disease severity on the lung deposition of dry powder aerosol drugs emitted by Turbuhaler®, Breezhaler® and Genuair® in COPD patients

Horváth¹,

Farkas

Szipőcs

et al. 2020

European Journal of Pharmaceutical Sciences

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Impact of Inhalation Flow, Inhalation Volume and Critical Handling Errors on Delivered Budesonide/Formoterol Dose in Different Inhalers: An In Vitro Study

Cited by 9 publications

References 26 publications

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Real-life budesonide and formoterol dose emission from the medium and high strength fixed dosed combinations in a Spiromax® dry powder inhaler using inhalation profiles from patients with chronic obstructive pulmonary disease

Numerical simulation of the effect of inhalation parameters, gender, age and disease severity on the lung deposition of dry powder aerosol drugs emitted by Turbuhaler®, Breezhaler® and Genuair® in COPD patients

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