In vitro Comparison of Three Salbutamol-Containing Multidose Dry Powder Inhalers

Palander, Anne; Mattila, Terhi; Karhu, Mika; Muttonen, Esa

doi:10.2165/00044011-200020010-00004

Cited by 76 publications

(47 citation statements)

References 12 publications

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“…17 This finding is of importance since in vitro studies with the Turbohaler device 18,19 have highlighted the high variability of the emitted dose below this inhalation rate. Although some clinical response may be obtained at inhalation rates between 30 and 60 l/min through the Turbohaler device, 20 the response might be variable and in some cases slight.…”

Section: In-checkdialmentioning

confidence: 94%

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

Lavorini

Levy

Corrigan

et al. 2010

Primary Care Respiratory Journal

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Section: In-checkdialmentioning

confidence: 94%

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

Lavorini

Levy

Corrigan

et al. 2010

Primary Care Respiratory Journal

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“…When using a DPI, this is counterbalanced by the flow-dependent dose emission from a DPI. However, dose emission from an Aerolizer (35) and a Diskus (20) is less flow-dependent than that from other DPIs. Hence, the low resistance of these devices, together with the resultant fast inhalation flows, will tend to provide low lung deposition and high oropharyngeal impaction.…”

Section: Dry Powder Inhaler Inhalation Maneuversmentioning

confidence: 95%

“…(20) For each DPI, there will be a minimum threshold turbulent energy (corresponding to a measured pressure change) for efficient deaggregation of the dose. (5) It has been shown that, below 30 L min -1 , the turbulent energy generated inside a Turbuhaler is not sufficient to efficiently deaggregate the dose, (21) and that the clinical effect sharply decreases.…”

Section: Dry Powder Inhaler Inhalation Maneuversmentioning

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

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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.

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“…Thus, although the flow through the Easyhaler was the lowest, the turbulent energy available to deaggregate the dose was the highest. These energies may explain the different flow-dependent dose emissions of these DPIs 13 and why DPIs with a high resistance tend to provide greater lung deposition with less variability than those with a lower resistance.…”

Section: Inhale As Fast As You Can Through a Dpimentioning

confidence: 99%

“…13 In the past this relationship has been misrepresented by attempting to define an optimal flow. At present there is no evidence for an optimal flow through each DPI.…”

Section: Inhale As Fast As You Can Through a Dpimentioning

confidence: 99%

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

Azouz

Chrystyn

2012

Primary Care Respiratory Journal

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This review integrates pharmaceutical science with routine clinical practice to explain why inhalation manoeuvres through a dry powder inhaler (DPI) should start with a gentle exhalation, away from the inhaler. Place the inhaler in the mouth and ensure the lips form a tight seal. This should be followed by an immediate forceful inhalation that is as fast as possible and continued for as long as the patient can comfortably achieve. Although this is universally accepted, there has been a lot of attention on inhalation flow as an indicator of adequate inspiratory effort. This has led to the wrong assumption that inhalation flows through each DPI should be the same, and that low flows through some DPIs suggest that dose delivery is impaired. Most miss the concept that inhalation flow together with the resistance of the DPI combine to create a turbulent energy which de-aggregates the formulation and provides an effective emitted dose. A low flow through a DPI with high resistance generates the same turbulent energy as fast flow with low resistance. Therefore, depending on the device, different inhalation flows are compatible with potentially effective use. Flow measurements should be a guide to train patients to inhale faster. The focus of inhaler technique training should be the use of the above generic inhalation manoeuvre.

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In vitro Comparison of Three Salbutamol-Containing Multidose Dry Powder Inhalers

Cited by 76 publications

References 12 publications

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

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

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

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