Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice

Azouz, Wahida; Chrystyn, Henry

doi:10.4104/pcrj.2012.00010

Cited by 74 publications

(80 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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. 67,68 (4) Breath-holding following inhalation (Turbuhaler and Diskus) is included in most of the published checklists and the Global Initiative for Asthma web site checklists for both the Turbuhaler and the Diskus (www.ginasthma.…”

Section: Evidence For Inclusion Of Individual Technique Steps In Devimentioning

confidence: 99%

Checklists for Powder Inhaler Technique: A Review and Recommendations

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

Section: Evidence For Inclusion Of Individual Technique Steps In Devimentioning

confidence: 99%

Checklists for Powder Inhaler Technique: A Review and Recommendations

et al. 2013

View full text Add to dashboard Cite

show abstract

“…lower resistance (7)(8)(9)(10). However, the internal 'force' created by a low flow through a DPI with high resistance is higher than that created by a faster flow through a DPI with low resistance (11).…”

Section: Introductionmentioning

confidence: 99%

Study of the Emitted Dose After Two Separate Inhalations at Different Inhalation Flow Rates and Volumes and an Assessment of Aerodynamic Characteristics of Indacaterol Onbrez Breezhaler® 150 and 300 μg

et al. 2017

Self Cite

View full text Add to dashboard Cite

Abstract.Onbrez Breezhaler® is a low-resistance capsule-based device that was developed to deliver indacaterol maleate. The study was designed to investigate the effects of both maximum flow rate (MIF) and inhalation volume (Vin) on the dose emission of indacaterol 150 and 300 μg dose strengths after one and two inhalations using dose unit sampling apparatus (DUSA) as well as to study the aerodynamic characteristics of indacaterol Breezhaler® using the Andersen cascade impactor (ACI) at a different set of MIF and Vin. Indacaterol 150 and 300 μg contain equal amounts of lactose per carrier. However, 150 μg has the smallest carrier size. The particle size distribution (PSD) of indacaterol DPI formulations 150 and 300 μg showed that the density of fine particles increased with the increase of the primary pressure. For both strengths (150 μg and 300 μg), ED1 increased and ED2 decreased when the inhalation flow rate and inhaled volume increased. The reduction in ED1 and subsequent increase in ED2 was such that when the Vin is greater than 1 L, then 60 L/min could be regarded as the minimum MIF. The Breezhaler was effective in producing respirable particles with an MMAD ≤5 μm irrespective of the inhalation flow rate, but the mass fraction of particles with an aerodynamic diameter <3 μm is more pronounced between 60 and 90 L/min. The dose emission of indacaterol was comparable for both dose strengths 150 and 300 μg. These in vitro results suggest that a minimum MIF of 60 L/min is required during routine use of Onbrez Breezhaler®, and confirm the good practice to make two separate inhalations from the same dose.

show abstract

“…(5) Hence, more attention needs to be directed to the minimum acceptable PIF achieved through each DPI rather than to the optimal flow. Also, it has been suggested that the pressure changes that occur inside the inhalation channel of each DPI (13) and the initial acceleration rate of the inhalation maneuver (14,15) are more important than PIF in the generation of the fine particle dose. Similarly, inhaled volume is also considered an important parameter of the inhalation profile and can govern the quality of the emitted dose, (15) particularly in a capsule formulation (10,16) because of the need to empty the capsule.…”

Section: Introductionmentioning

confidence: 99%

The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

Azouz

Chetcuti

Hosker

et al. 2015

Journal of Aerosol Medicine and Pulmonary Drug Delivery

Self Cite

View full text Add to dashboard Cite

Background: The characteristics of each inhalation maneuver when patients use dry powder inhalers (DPIs) are important, because they control the quality of the emitted dose. Methods: We have measured the inhalation profiles of asthmatic children [CHILD; n¼16, mean forced expiratory volume in 1 sec (FEV 1 ) 79% predicted], asthmatic adults (ADULT; n¼53, mean predicted FEV 1 72%), and chronic obstructive pulmonary disease (COPD; n¼29, mean predicted FEV 1 42%) patients when they inhaled through an Aerolizer, Diskus, Turbuhaler, and Easyhaler using their ''real-life'' DPI inhalation technique. These are low-, medium-, medium/high-, and high-resistance DPIs, respectively. The inhalation flow against time was recorded to provide the peak inhalation flow (PIF; in L/min), the maximum pressure change (DP; in kPa), acceleration rates (ACCEL; in kPa/sec), time to maximum inhalation, the length of each inhalation (in sec), and the inhalation volume (IV; in liters) of each inhalation maneuver. Results: PIF, DP, and ACCEL values were consistent with the order of the inhaler's resistance. For each device, the inhalation characteristics were in the order ADULT > COPD > CHILD for PIF, DP, and ACCEL ( p < 0.001). The results showed a large variability in inhalation characteristics and demonstrate the advantages of DP and ACCEL rather than PIFs. Overall inhaled volumes were low, and only one patient achieved an IV > 4 L and DP > 4 kPa. Conclusion: The large variability of these inhalation characteristics and their range highlights that if inhalation profiles were used with compendial in vitro dose emission measurements, then the results would provide useful information about the dose patients inhale during routine use. The inhalation characteristics highlight that adults with asthma have greater inspiratory capacity than patients with COPD, whereas children with asthma have the lowest. The significance of the inhaled volume to empty doses from each device requires investigation.

show abstract

Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice

Cited by 74 publications

References 30 publications

Checklists for Powder Inhaler Technique: A Review and Recommendations

Checklists for Powder Inhaler Technique: A Review and Recommendations

Study of the Emitted Dose After Two Separate Inhalations at Different Inhalation Flow Rates and Volumes and an Assessment of Aerodynamic Characteristics of Indacaterol Onbrez Breezhaler® 150 and 300 μg

The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

Contact Info

Product

Resources

About