Short-acting beta2 agonist (SABA) monotherapy is typically required to provide as needed short term relief of bronchoconstriction. The salbutamol EasyHaler† DPI has recently become available in the UK as an alternative to delivery by pressurized metered-dose inhaler. Our study evaluated delivery from this DPI at different inhalation flow rates.

Summary:

Presented at DDL 2017 in Edinburgh

• Valved holding chambers are widely prescribed to assist patients receiving inhaled medications by avoiding losses caused by imperfect coordination of inhalation and actuation and also to reduce oropharyngeal deposition.
• Regardless of whether using a solution based formulation (like Qvar) or a suspension formulation (Flovent), the use of a valved holding chamber reduced the amount of medication deposited in the mouth (oropharynx) and increased the potential for lung delivery
• This study can be used to help demonstrate the value of using a valved holding chamber for both solution and suspension formulated metered dose inhalers and for all patient populations, including adults

• The FRI deposition profiles highlight that the MDI/AeroChamber Plus* Flow-Vu* VHC delivered a significantly greater percentage of drug to the lung region than either of the two DPIs, irrespective of flow rate.
• This was reflected in much higher modelled oropharyngeal deposition for the two DPIs.
• The influence of inhalation flow profile was significant for one of the DPIs.

As current MDIs contain hydrofluorocarbon propellants, it would be beneficial to find ways to reduce carbon emissions without compromising patient safety.

This lab study investigated a way to optimize the modelled lung dose per actuation while at the same time minimizing the carbon emissions from the MDI

RDD 2020 - E-Poster Presentation

COPD is a chronic and progressive disease that requires regular self-administration of inhaled medications. However, as the disease progresses, reduced respiratory muscle strength may prevent patients from generating sufficient inspiratory effort to effectively use dry-powder inhalers (DPIs) [1, 2]. In contrast, patients can inhale slowly or breathe tidally from a pMDI with VHC without the need to coordinate with inhaler actuation [3].

Conclusions:

• The widely differing inspiratory flow profiles from Turbuhaler† DPI contributed to greater variability in delivered dose to the carina. 
• MDI delivery via the AeroChamber Plus* Flow-Vu* VHC resulted in significantly increased mass to the carinal region irrespective of inhalation maneuver as well as reduced oropharyngeal deposited mass which in vivo is likely to result in reduced throat irritation or thrush in the mouth and throat.

Conclusions:

• The DPI results suggest that inhalation breathing profiles can have an appreciable impact upon aerosol delivery, with one participant having much less predicted medication as fine particles
• In contrast, although the inhalation profiles across all participants were also divergent when asked to inhale from the pMDI + VHC, either tidal breathing or by a slow, deep inhalation, all volunteers would have received a relatively consistent amount of medication.
• It also appears that the pMDI + VHC platform delivers a larger FPM<5.0 µm for both APIs and a consequently smaller coarse particle mass. However, it is recognized that more investigation is warranted with a larger number of volunteers and with other passive DPIs having different resistances

Lab study evaluating medication delivery MDI alone vs new portable spacer  

RESULT: Portable spacer provides optimum delivery without need for inhalation coordination.

This study was presented at the Drug Delivery to the Lungs, 2022.

PRESENTED AT VIRTUAL ATS 2020

• Evaluations of inhaler use have demonstrated that mishandling of MDIs is commonplace.
• One of the most common errors is the failure to coordinate inhalation with actuation of the inhaler
• One of the reasons why VHCs are often prescribed, is to reduce the severity of this error
• This Functional Respiratory Imaging (FRI) based study assessed the likely severity of a short inhalation delay (from actuation) with an MDI alone and how it contrasted to the use with a VHC

This study was presented at the Drug Delivery to the Lungs Conference, 2022.

Conclusions:

From a UK perspective, BUD/F delivered via an MDI + VHC offers an economic benefit for the treatment of patients with mild asthma. Further analysis is required to determine if there would be any quality-adjusted life-year (QALY) effects based on the chosen intervention.

More consistent dose delivery was achieved with the breath actuated technology rather than breath enhanced. Delivering medication only when the patient inhales would result in more stable therapy if I:E ratio was to change with disease< progression or if the patient took breaks to talk during treatment.

More consistent dose delivery was achieved with the breath actuated technology rather than breath enhanced.
Delivering medication only when the patient inhales would result in more stable therapy if I:E ratio was to change with disease< progression or if the patient took breaks to talk during treatment.

Conclusion

• The FRI deposition profiles highlight that the MDI/AeroChamber Plus* Flow-Vu* VHC delivered a significantly greater percentage of drug to the lung region than either of the two DPIs, irrespective of flow rate.
• This was reflected in much higher modelled oropharyngeal deposition for the two DPIs.
• The influence of inhalation flow profile was significant for one of the DPIs.

Depending on the pMDI/spacer system chosen the delivery of medication can vary significantly and as a result will have implications on the potential carbon footprint.

In this case, the use of the AeroChamber Plus* Flow-Vu* VHC could potentially reduce the carbon footprint by three fold compared to the alternative spacers.

By maximizing the amount of each puff reaching the lungs the patient is likely to be able to get relief sooner and reduce the amount of puffs needed.

Does Spacer/Adapter Device Choice Affect Delivery of a Pressurized Metered Dose Inhaler (pMDI) through a Humidified Circuit to a Simulated Patient on Mecha

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.

Conclusions:

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.