Is there room for further innovation in inhaled therapy for airways disease?

Abstract

Inhaled medication is the cornerstone in the treatment of patients across a spectrum of respiratory diseases including asthma and chronic obstructive pulmonary disease. The benefits of inhaled therapy have long been recognised but the most important innovations have occurred over the past 60 years, beginning with the invention of the pressurised metered dose inhaler. However, despite over 230 different device and drug combinations currently being available, disease control is far from perfect.Here we look at how innovation in inhaler design may improve treatments for respiratory diseases and how new formulations may lead to treatments for diseases beyond the lungs. We look at the three main areas where innovation in inhaled therapy is most likely to occur: 1) device engineering and design; 2) chemistry and formulations; and 3) digital technology associated with inhalers. Inhaler design has improved significantly but considerable challenges still remain in order to continually innovate and improve targeted drug delivery to the lungs. Healthcare professionals want see innovations that motivate their patients to achieve their goal of improving their health, through better adherence to treatment. Patients want devices that are easy to use and to see that their efforts are rewarded by improvements in their condition.Key pointsThe dictionary definition of innovation is the introduction of new things, ideas or ways of doing something. We show how this definition can be applied to inhaled therapy.We take a look at the past to see what drove innovation in inhaler design and how this has led to the current devices.We look at the current drivers of innovation in engineering, chemistry and digital technology and predict how this may translate to new devices.Can innovation help the healthcare professional manage their patients better?What does the patient expect from innovation in their device?Educational aimsTo understand the importance of inhaled medication in the treatment of lung diseases.To understand how innovation has helped advance some of the devices patients use today from basic and inefficient designs.To understand the obstacles that prevent patients from receiving optimal treatment from their inhalers.To understand how innovation in inhaler design can lead to improved treatment for patients and widen the range of diseases that can be treated via the inhaled route.

<p>Nebulized Therapies in COPD: Past, Present, and the Future</p>

“…40,41 The AKITA2 ® APIXNEB (PARI Pharma GmbH, Gräfelfing, Germany) mesh nebulizer uses an adaptive aerosol delivery technology that coordinates drug delivery with the patient's breathing pattern. 42 Nebulizers are a form of aerosol generation and can be used at any age or COPD stage. With recent technological advances, nebulizers will continue to play an important role in the management of COPD.…”

“…40 , 41 The AKITA2 ® APIXNEB (PARI Pharma GmbH, Gräfelfing, Germany) mesh nebulizer uses an adaptive aerosol delivery technology that coordinates drug delivery with the patient’s breathing pattern. 42 …”

Asthma management with breath-triggered inhalers: innovation through design

“…The first pressurized inhaler was developed in 1858, and further advances in inhalation therapy and inhaler design were achieved in the early twentieth century [25][26][27]. The precursors of modern inhalers emerged in the 1940s/1950s with the development of the first commercial DPIs and pMDIs [25][26][27][28].…”

“…Appropriate inhaler techniques vary according to each device, particularly in the case of DPIs since each has its own specific operation method. DPIs and pMDIs also require different inhalation techniques and specific breathing patterns for optimal drug deposition in the lungs [1,6,28]. DPIs rely on the inspiratory force generated by the patient, both to extract the powdered drug from a reservoir or blister and to disaggregate the powder into respirable particles (those with the potential to reach and deposit in the lungs) [18].…”

Biological Obstacles for Identifying In Vitro-In Vivo Correlations of Orally Inhaled Formulations

“…Soft mist inhalers represent a new type of propellant-free inhaler that delivers a higher proportion of the emitted dose to the lung than pMDI or DPI. The device is easier to handle than pMDI because the mist from the inhaler continues for 1.5 s [10]. For further information on function, types, and use of inhalers the reader is referred to one of the many reviews focused on that topic (e.g., [11,12]).…”