Dry Powder Inhaler Devices Research Articles

Automated Filling Equipment Allows Increase in the Maximum Dose to Be Filled in the Cyclops® High Dose Dry Powder Inhalation Device While Maintaining Dispersibility.

In recent years there has been increasing interest in the pulmonary delivery of high dose dry powder drugs, such as antibiotics. Drugs in this class need to be dosed in doses far over 2.5 mg, and the use of excipients should therefore be minimized. To our knowledge, the effect of the automatic filling of high dose drug formulations on the maximum dose that can be filled in powder inhalers, and on the dispersion behavior of the powder, have not been described so far. In this study, we aimed to investigate these effects after filling with an Omnidose, a vacuum drum filler. Furthermore, the precision and accuracy of the filling process were investigated. Two formulations were used—an isoniazid formulation we reported previously and an amikacin formulation. Both formulations could be precisely and accurately dosed in a vacuum pressure range of 200 to 600 mbar. No change in dispersion was seen after automatic filling. Retention was decreased, with an optimum vacuum pressure range found from 400 to 600 mbar. The nominal dose for amikacin was 57 mg, which resulted in a fine particle dose of 47.26 ± 1.72 mg. The nominal dose for isoniazid could be increased to 150 mg, resulting in a fine particle dose of 107.35 ± 13.52 mg. These findings may contribute to the understanding of the upscaling of high dose dry powder inhalation products.

Development of Dry Powder Inhaler Patient Interfaces for Improved Aerosol Delivery to Children.

The objective of this study was to explore different internal flow passages in the patient interface region of a new air-jet-based dry powder inhaler (DPI) in order to minimize device and extrathoracic aerosol depositional losses using computational fluid dynamics (CFD) simulations. The best-performing flow passages were used for oral and nose-to-lung (N2L) aerosol delivery in pediatric extrathoracic airway geometries consistent with a 5-year-old child. Aerosol delivery conditions were based on a previously developed and tested air-jet DPI device and included a base flow rate of 13.3 LPM (delivered from a small ventilation bag) and an inhaled air volume of 750mL. Initial CFD models of the system clearly established that deposition on either the back of the throat or nasal cannula bifurcation was strongly correlated with the maximum velocity exiting the flow passage. Of all designs tested, the combination of a 3D rod array and rapid expansion of the flow passage side walls was found to dramatically reduce interface and device deposition and improve lung delivery of the aerosol. For oral aerosol administration, the optimal flow passage compared with a base case reduced device, mouthpiece, and mouth-throat deposition efficiencies by factors of 8-, 3-, and 2-fold, respectively. For N2L aerosol administration, the optimal flow pathway compared with a base case reduced device, nasal cannula, and nose-throat deposition by 16-, 6-, and 1.3-fold, respectively. In conclusion, a new patient interface design including a 3D rod array and rapid expansion dramatically improved transmission efficiency of a dry powder aerosol.

Nanoparticle-based dry Powder Inhaler-Based Approach for Corona Virus Disease-2019 Treatment: An Update

Corona virus disease-2019 (COVID 19) is a respiratory disorder caused by bunches of serious respiratory disorders (i.e., coughing, fever, and breathing problems) like severe acute respiratory syndrome (SARS), and the 79% homology as well as gene sequences are basically similar to SARS-CoV, thus the name of COVID-19 also be distinguish as SARS-CoV-2 on January 7th. Nanoparticles may also improve drug pulmonary efficacy by enhancing residence time, as a consequence the efficient mucus complexation between mucin and nanoparticles caused increment the rate of permeation and tissue uptake and displayed sustainable release property. Advances in device technology have led to the development of more efficient delivery systems capable of delivering larger doses and finer particles into the lung. As more efficient pulmonary delivery devices and sophisticated formulations become available, physicians, and health professionals will have a choice of a wide variety of device and formulation combinations that will target-specific cells or regions of the lung, avoid the lung's clearance mechanisms and be retained within the lung for longer periods. Dry powder inhalers (DPIs) exhibit many unique advantages that have contributed to the incredible growth in the number of DPI pharmaceutical products. To improve the performance, there are a relatively large number of DPI devices available for different inhalable powder formulations. The present review different type of nanoaparticles and DPIs used for the treatment of COVID 19 infections.

Lecithin-based modified soft agglomerate composite microparticles for inhalable montelukast: Development, tolerability and pharmacodynamic activity

In this work, montelukast (MTK) was incorporated in inhalable soft agglomerates (SA) exhibiting inherent characteristics for deep lung deposition while expressing good flowability and enhanced shelf-life stability. Mannitol and ovalbumin were used as particle shapers and lecithin as binder during microparticles (MPs) preparation by spray drying. The spontaneously agglomerated MPs with an adhesive surface were designed to deagglomerate under the effect of aerosolization with selected dry powder inhaler device, achieving satisfactory lung deposition. A pharmacodynamic study was also undertaken to evaluate MTK-SA effectiveness in asthmatic rats. Optimized SA showed agglomerated small MPs capable of dispersing into individual particles under pressures exceeding 1Bar. They exhibited high respirable fraction of >54% and were able to release MTK in <15 min. MTK-SA, delivered by pulmonary insufflation, was able to equally reduce the inflammatory response in asthmatic rats at a ten fold lower dose compared to oral tablet.

Characterization of acoustic emission analysis in applications for inhalation device performance assessment

Acoustic Emission (AE) measurement technology has gained wide appreciation in material sciences and process monitoring. In inhalation research, AE has been used for adherence indicating applications in clinical studies. Promising results from feasibility studies using AE combined with multivariate data analysis (AE-MVDA) in the analysis of devices for inhalation have prompted a broader study reported in this paper. This work presents the novel application of AE-MVDA for assessment of the combined inhalation device and formulation performance. The purpose is to evaluate the benefits that this technology can provide to inhalation product development programs. The work was carried out using two different dry powder inhaler device model systems while investigating different performance features. The devices were filled with dry powder formulations with both placebo and with active pharmaceutical ingredient (API). The acquired AE data was analyzed using multivariate data analysis tools such as Principal component analysis (PCA) and orthogonal projections to latent structures (OPLS). The AE profiles were indicative for device and formulation performance. Normal and deviating performances were readily picked up in the AE data. Moreover, performance trends between doses withdrawn from the inhalers were also observable. Lastly, differences in the AE profile between the formulations could be detected. The overall conclusion from the AE-MVDA measurement approach evaluation is that it has the potential to add value as a cost-effective, non-invasive quality and performance monitoring technology both in development and in production of inhaled medicines.

Knowledge and practice of dry powder inhalation among patients with chronic obstructive pulmonary disease in a regional hospital, Nepal.

PurposeDry powder inhalation is a cornerstone of treatment in patients with COPD. This study was undertaken to study the knowledge and practice of dry powder inhalation among such patients.Patients and methodsThe current study was a cross-sectional study conducted in Western Regional Hospital, Pokhara, Nepal. The study was conducted among 204 COPD patients (outpatients and inpatients) aged ≥20 years who had been using rotahaler, a dry powder inhaler device, and a purposive sampling technique was used. Data were collected from February 28, 2016, to March 26, 2016. A questionnaire was administered by the interviewer to assess the knowledge about dry powder inhaler (DPI) and inhalation while a Dutch Asthma Foundation observation checklist for rotahaler was used to evaluate the practice of dry powder inhalation. The collected data were analyzed using descriptive statistics and inferential statistics (chi-square test).ResultsFindings from the study showed that a low proportion of the respondents had accurate knowledge and correctly practiced inhalation technique (3.9%). However, majority of the respondents (77.5%) performed the critical steps correctly. The correct practice of dry powder inhalation was associated with younger age (p=0.008), urban residence (p=0.024), and literacy (p=0.012). The practice was comparatively more accurate among those who received practical classes/demonstration on the inhalation technique from health care providers (p<0.001).ConclusionBased on the study findings, it was concluded that COPD patients attending Western Regional Hospital possessed satisfactory knowledge but poor technique of dry powder inhalation. The most important modifiable factor for incorrect practice was a lack of demonstration on inhalation technique by the health care provider. Therefore, it is necessary for health care providers to supplement verbal instruction on dry powder inhalation with demonstration and re-demonstration from the patients to improve the knowledge and practice of dry powder inhalation for COPD patients.

Computational modelling and experimental validation of drug entrainment in a dry powder inhaler

In a passive dry powder inhaler (DPI) a patient inhales to entrain drug powder. The goal of this study is to demonstrate experimentally that an Eulerian-Eulerian (EE CFD) computational fluid dynamics (CFD) method can accurately predict the entrainment of the dry powder formulation in DPIs. A CFD method that makes accurate predictions of the entrainment process can be applied in DPI design and optimization processes. Three different DPI entrainment geometries were tested. For each geometry, a transparent entrainment module was prepared. In each experiment, the chosen entrainment module was first filled with lactose powder and attached to an inhalation simulator (a computer controlled pump). The entrainment process was recorded with a high-speed camera. The resulting video footage was analysed and compared with CFD predictions. The observed distribution of powder in the entrainment compartment and the measured rate of drug entrainment were in good agreement with CFD predictions. Through a process of experimental validation, this study established the first demonstration that two-dimensional EE CFD methodology provides robust and accurate predictions of aerosol generation from DPI entrainment chambers. The findings support the wider application of EE CFD for the design optimization of DPI devices.

Dosing challenges in respiratory therapies

The pulmonary route of administration has been commonly used for local lung conditions such as asthma and chronic obstructive pulmonary disease (COPD). Recently, with the advent of new technologies available for both formulation and device design, molecules usually delivered at high doses, such as antibiotics and insulin to treat cystic fibrosis (CF) and diabetes, respectively, can now be delivered by inhalation as a dry powder. These molecules are generally delivered in milligrams instead of traditional microgram quantities. High dose delivery is most commonly achieved via dry powder inhalers (DPIs), breath activated devices designed with a formulated powder containing micronized drug with aerodynamic diameters between 1 and 5 µm. The powder formulation may also contain other excipients and/or carrier particles to improve the flowability and aerosol dispersion of the powder. A drawback with high doses is that the formulation contains a great number of fine particles, leading to a greater degree of cohesive forces, producing strongly bound agglomerates. With greater cohesive forces holding fine particles together, higher dispersion forces are needed for efficient de-agglomeration and aerosolisation. This requirement of greater dispersion forces has led to different dry powder formulations and vastly different inhaler designs. The purpose of this review is to evaluate the different formulation types, various DPI devices currently available, and how these affect the aerosolisation process and delivery of high dosed inhalable dry powder formulations to the lungs.

Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers

ABSTRACTBackground: Many patients do not use inhalers correctly. Inhalers associated with good technique have the potential to improve symptom control and are often preferred by patients. Methods: Inhaler-naïve, adult volunteers were randomized to use empty Spiromax®, Easyhaler®, and Turbuhaler® dry powder inhalers (DPIs) in one of six possible sequences in this single-site, single-visit, crossover study conducted in Sweden. Randomization was stratified by age and gender. Participants attempted to use each device intuitively (no instructions) and after reading the instructions for use from the patient information leaflet. Device preference was surveyed after using all devices. Mastery of device handling (i.e. dose preparation) or inhalation was defined as having no healthcare-professional-observed errors. The primary endpoint was mastery of device handling after reading the instructions. Results: More participants mastered device handling with Spiromax vs Easyhaler or Turbuhaler, both intuitively (44%, 0%, and 10%, respectively) and after reading the instructions (99%, 56%, and 81%, respectively). Fewer participants had ≥1 device-handling error with Spiromax than with the other devices. The percentage of participants still showing inhalation errors after reading the instructions ranged between 21% for Spiromax and 40% for Easyhaler. After reading instructions, mastery of handling and inhalation was numerically lower among older (aged >60 years) vs younger participants across all devices. Most participants preferred Spiromax for device handling (59%) and intuitiveness/ease of use (61%). Conclusion: These findings highlight that important differences exist between DPI devices, which could have implications for disease control when selecting a device for a patient.

Inhaler technique: does age matter? A systematic review.

Poor inhaler technique and inferior asthma outcomes are evident in older adults. Reviews comparing metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques across older adults and younger cohorts are scarce. This systematic review aimed to determine whether differences exist between such cohorts with regards to the number and type of MDI and DPI errors made. A systematic literature search was conducted in Embase, Medline and PubMed from July 1 to December 31, 2016. Studies were selected in accordance with preset inclusion criteria, relevant data were extracted, and quality was assessed with validated checklists. 14 studies were identified. Evidence suggests a negative correlation between advancing age and correct technique across MDI and varying DPI devices when examined collectively. Differences appear to exist between older adult and younger cohorts prescribed MDIs in error types. There is evidence of age-associated differences in the number and type of inhaler technique errors. Further research is required to assess outcomes in individual DPIs, reproducibility and the effects of confounders.

The pharmacokinetics, safety, and tolerability of single, high-strength doses of fluticasone propionate and fluticasone propionate/salmeterol delivered via a novel multidose dry powder inhaler in adolescents and adults with persistent asthma

ABSTRACTObjective: Characterize fluticasone propionate (Fp) and combination fluticasone propionate and salmeterol (FS) pharmacokinetic and safety profiles, delivered via a novel, inhalation-driven, multidose dry powder inhaler (MDPI). Methods: This multicenter, open-label, four-period crossover, single-dose study randomized patients aged ≥12 years with persistent asthma to Fp MDPI 200 mcg, FS MDPI 200/12.5 mcg, Fp dry powder inhaler (DPI) 500 mcg (250 mcg × 2 inhalations), or FS DPI 500/50 mcg. Blood samples for determination of Fp and salmeterol pharmacokinetic parameters including Cmax, AUC0–t, AUC0–inf, tmax, and t½ were collected predose through 36 h postdose (14 time points). Safety assessments comprised adverse events, vital signs, and physical examinations. The institutional review board approved the study protocol. Results: The pharmacokinetic analysis set and safety population each included 40 patients. Fp systemic exposure (Cmax, AUC0–t, and AUC0–inf) was highest for Fp DPI 500 mcg and similar for Fp MDPI 200 mcg, FS MDPI 200/12.5 mcg, and FS DPI 500/50 mcg. Fp geometric mean t½ values were similar across treatments. Salmeterol Cmax was 20% lower and AUC0–t and AUC0–inf were approximately 50% lower with FS MDPI versus FS DPI. Median tmax and geometric mean t½ were similar between FS MDPI and FS DPI. Adverse events were similar across treatments with no relevant changes in vital signs, physical examinations, or hematology test results. Conclusions: Fp MDPI and FS MDPI produced similar or lower systemic exposure to Fp and salmeterol, despite lower doses, versus conventional DPI devices, suggesting improved efficiency due to formulation and device differences.

Requirements, Strengths and Weaknesses of Inhaler Devices for COPD Patients from the Expert Prescribers' Point of View: Results of the EPOCA Delphi Consensus

ABSTRACTThe study aimed to assess the preferences of expert physicians about the requirements for inhalation devices for patients with chronic obstructive pulmonary disease (COPD) and to identify the most relevant advantages and disadvantages to their prescription. In a two-round Delphi survey, 96 Spanish COPD-expert pulmonologists completed an internet-based questionnaire to evaluate the degree of importance of the characteristics of the inhaler devices in their choice for COPD. The requirements needed for use in COPD were that the device permits a high pulmonary deposit of the drug, allowed its dispensation at low inspiratory flows, did not require hand-mouth coordination, generated an exact and reproducible dose, its operation was easy to teach, provided the perception of a correct inhalation, had an intuitive use mechanism and security mechanisms to prevent overdosing and generates a reduced oropharyngeal deposit (very good consensus). Modulite®, Respimat® and NEXThaler® were associated with high pulmonary deposit, and Respimat® showed correct dispensation at low inspiratory flows. All dry-powder inhaler devices were associated with the advantage of not requiring coordination, and Respimat® was the only device considered as difficult to teach by more than 50% of the experts. Breezhaler® and Genuair® were positively associated with patients' awareness of correct inhalation, whereas Spiromax® stood out for its intuitive use mechanism. In conclusion, our study contributes to defining the inhaler device properties required for their use in patients with COPD, and to identify the devices that, in the opinion of experts, best meet each requirement.

Formulation of novel dry powder inhalation for fluticasone propionate and salmeterol xinafoate with capsule-based device

The aim of this study was to develop a novel fluticasone propionate (FP) and salmeterol xinafoate (SX)-loaded dry powder inhaler (DPI) system, which was composed of powder formulation and performance. The air flow resistances were determined with various types of DPI device, showing that the modified RS01 device gave the specific resistance similar to the commercial DPI device. The particle properties of FP, SX, and inhalation grade lactose particles, such as particle size, size distribution, and fine content, were assessed. Subsequently, the aerodynamic behaviors of the DPI powder formulations were evaluated by the in vitro deposition of drugs in the DPI products using Andersen cascade impactor. Amongst the DPI powder formulations tested, the formulation composed of FP, SX, Respitose® SV003, Respitose® SV010, and Respitose® ML006 at the weight ratio of 0.5/0.145/19/19/2 gave depositions, emitted dose, fine particle dose, fine particle fraction, and mass median aerodynamic diameter of drugs similar to the commercial product, suggesting that they had similar aerodynamic behaviors. Furthermore, it gave excellent content uniformity. Thus, this DPI using the modified RS01 device would be recommended as a candidate for FP and SX-loaded pharmaceutical DPI products.

Recent advances in capsule-based dry powder inhaler technology

Pulmonary drug delivery is currently the focus of accelerated research and development because of the potential to produce maximum therapeutic benefit to patients by directly targeting drug to the site of pathology in the lungs. Among the available delivery options, the dry powder inhaler (DPI) is the preferred device for the treatment of an increasingly diverse range of diseases. However, because drug delivery from a DPI involves a complex interaction between the device and the patient, the engineering development of this medical technology is proving to be a great challenge. Development of DPI systems that target the delivery of fine drug particles to the deeper airways in the lungs using a combination of improved drug formulations and enhanced delivery device technologies means that each of these factors contributes to overall performance of the aerosol system. There are a large range of devices that are currently available, or under development, for clinical use, however no individual device shows superior clinical efficacy. A major concern that is very relevant in day-to-day clinical practice is the inter- and intra-patient variability of the drug dosage delivered to the deep lungs from the inhalation devices, where the extent of variability depends on the drug formulation, the device design, and the patient’s inhalation profile. This variability may result in under-dosing of drug to the patient and potential loss of pharmacological efficacy. This article reviews recent advances in capsule-based DPI technology and the introduction of the ‘disposable’ DPI device.

DRY POWDER INHALER; SPECIAL EMPHASIS TO FORMULATION, DEVICES, CHARACTERIZATION &amp; PROCESS VALIDATION PROTOCOL: A REVIEW

The therapy was carried out by inhalation of medicinal plants to cure illness of respiratory tract by ancient people. A wide range of dry powder inhaler devices are presently available on the market to convey drugs into lungs with a view to capitalize on drug delivery with low variability. Drug powder inhalers also face copious clinical challenges, particularly related to capricious patient factors such as age, clinical condition and inspiratory flow. Due to the drug formulation and the design of devices, different drug powder inhalers do not demonstrate the same performance and manufacturers are taking an assortment of device design approaches. The characteristics of an ideal drug powder inhaler, current innovations in powder formulation and device design are not unanimously unswerving in terms of dose variability, clinical efficacy, user friendliness and economy. Particle Size of active pharmaceutical ingredient must be present in size range about 1-10 μm which also assurance that the patient gets the same dose every time at dissimilar airflow rate. Drug powder inhaler are formulated using four types of formulation strategies such as; Carrier free, Drug carrier, Drug additive, Drug carrier additive. Lung deposition study is accomplished by ‘Twin Stage Impingner’. The interior breath gadget is vital in accomplishing adequate transference of breathed in medication to lung which fundamentally grouped in view of measurements sort into single-unit and multi-dosage stores. Keywords: Drug Delivery, Nebulizer, Twinstage Impingner, Respirable particle Â

ADVANCEMENTS IN DRY POWDER INHALER

The dry powder inhaler (DPI) has become widely known as a very attractive platform for drug delivery. DPIs are being used for the treatment of asthma and chronic obstructive pulmonary disease by many patients. There are over 20 devices presently in the DPI market. DPIs are preferred over nebulizers and pressurized metered dose inhalers. However, some of the challenges of DPI are dependence on inspiratory flow (unsuitable for young children, elderly people), systemic absorption due to deposition of drug in deep lung (unsuitable for local diseases treatment), and increase in upper airway deposition of a large fraction of coarse particles. Hence, there is a need to address these unmet issues. The interpatient variation can be minimized by developing devices independent of patient’s inspiratory flow rate or active based powder mechanism. This article reviews DPI devices currently available, advantages of newly developed devices, and formulation technologies. The platform technologies are developed to improve aerosolization and dispersion from the device and decrease the patient related factors. The DPI delivery system has been expanded to treatment of non-respiratory diseases such as migraine and diabetes. The development of innovative DPI device and formulation technologies for delivering therapeutic proteins such as insulin has been accelerated to overcome the problems associated with conventional insulin therapy.Keywords: Dry powder inhaler, Inspiratory flow rate, Insulin, Platform technologies.

Which inhaled corticosteroid and long-acting β-agonist combination is better in patients with moderate-to-severe asthma, a dry powder inhaler or a pressurized metered-dose inhaler?

Two main types of devices are used to facilitate the administration of inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) in combination, dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). There are few reports comparing the effects of the two devices, and it is unknown which should be recommended for asthma patients with given sets of characteristics. In the current study, the beneficial effects and side effects associated with DPIs and pMDIs were compared, and the question of which device should be recommended for asthma patients was investigated. A prospective, randomized, crossover, comparative study in adult outpatients with asthma was conducted using salmeterol/fluticasone propionate combination (SFC) 50 μg/250 μg, one inhalation of Adoair® 250 Diskus® twice daily or two inhalations of Adoair® 125 Aerosol twice daily, for 8 weeks. Questionnaires, exhaled nitric oxide (FeNO) tests and pulmonary function tests were administered after the use of each device for 8 weeks, and the results derived from each device were compared. Sixty-eight subjects were included in the final analysis. There were no significant differences between quality-of-life scores, FeNO, spirometry test results and forced oscillation results. With regard to patient preferences, 57.4% preferred the Adoair® Aerosol and 35.3% preferred the Adoair® Diskus®, as determined via the comparative evaluation questionnaire. Although DPI prescription accounts for the predominant market share of combined ICS/LABA in Japan, patients preferred a pMDI device to a DPI device. Compared to DPIs, pMDIs may be the preferential choice for patients with asthma.

Pharmaceutical aerosols deposition patterns from a Dry Powder Inhaler: Euler Lagrangian prediction and validation

This study uses Computational Fluid Dynamics (CFD) to predict, analyze and validate the deposition patterns in a human lung for a Budesonide drug delivered from the Novolizer Dry Powder Inhaler device. We used a test case of known deposition patterns to validate our computational Euler Lagrangian-based deposition predictions. Two different lung models are used: (i) a basic ring-less trachea model and (ii) an advanced Human Zygote5 model. Unlike earlier attempts, the current simulations do not include the device in the computational domain. This greatly reduces the computational effort. To mimic the device, we model the inlet particle jet stream from the device as a spray entering the mouth in a conical fashion. Deposition studies in the various lung regions were performed. We were able to computationally predict and then demonstrate the enhanced deposition in the tracheal and first generation rings/ridges. The enhanced vorticity creation due to the ring structure and the geometrical design contributes to larger deposition in the Zygote5 model. These are in accord with existing data, unlike the ring-less model. Our validated results indicate the need to (i) introduce the ridges in the experimental casts and the CFD surface meshes to be anatomically consistent and obtain physiologically consistent depositions; (ii) introduce a factor to account for the recirculating lighter particles in empirical models.

Long-term safety of tiotropium delivered by Respimat&lt;sup&gt;&amp;reg;&lt;/sup&gt; SoftMist&amp;trade; Inhaler: patient selection and special considerations

Tiotropium bromide is a long-acting inhaled muscarinic antagonist used in patients with chronic respiratory disease. It has been available since 2002 as a single-dose dry powder formulation via the HandiHaler® dry powder inhaler (DPI) device, and since 2007 as the Respimat® SoftMist™ Inhaler (SMI). The latter is a novel method of medication delivery that utilizes a multidose aqueous solution to deliver the drug as a fine mist. Potential benefits include more efficient drug deposition throughout the respiratory tract, reduced systemic exposure, and greater ease of use and patient satisfaction compared with the use of HandiHaler DPI. Although tiotropium bromide delivered via the HandiHaler DPI has been clearly shown to improve lung function, dyspnea, and quality of life and to reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), there is accumulating evidence regarding the use of tiotropium HandiHaler in other respiratory diseases characterized by airflow limitation, such as asthma and cystic fibrosis. Developed more recently, tiotropium delivered via the Respimat SMI appears to have a similar efficacy and safety profile to the HandiHaler DPI, and early data raising the possibility of safety concerns with its use in COPD have been refuted by more recent evidence. The benefits over the HandiHaler DPI, however, remain unclear. This paper will review the evidence for tiotropium delivered via the Respimat SMI inhaler, in particular as an alternative to the HandiHaler DPI, and will focus on the safety profile for each of the chronic lung diseases in which it has been trialed, as well as an approach to appropriate patient selection.

Assessment of satisfaction with different dry powder inhalation devices in Greek patients with COPD and asthma: the ANASA study.

BackgroundPoor adherence to inhaled therapy is common in patients with asthma and COPD. An inhaler selection based on patients’ preference could be beneficial to adherence and treatment effectiveness. Properly designed questionnaires can assess patients’ satisfaction with their medication devices. The aim of this study was to estimate, using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire, the ease of use and satisfaction of patients regarding three different marketed dry powder inhalers (DPIs): Diskus® (DK), Elpenhaler® (EH), and Turbuhaler® (TH). The FSI-10 is a self-completed questionnaire to assess patients’ opinions regarding ease of use, portability, and usability of devices, irrespective of the drug used.Patients and methodsWe performed a 4-week, open, noninterventional, multicenter, parallel clinical study in 560 asthmatic and 561 COPD patients. During the first visit, patients were classified into three groups according to the DPI they were already using. Patients were regularly receiving their treatments (Seretide DK, Rolenium EH, and Symbicort TH) and agreed to complete the FSI-10 questionnaire in the second visit.ResultsA total of 517 COPD and 523 asthma patients completed the study. All DPIs tested received satisfactory results, while the EH obtained consistently higher scores in the FSI-10 in both COPD and asthma patients (44.7 and 44.1 vs 41.5 and 43 for TH, 40.8 and 41.4 for DK, P<0.001 and P<0.01, respectively). TH was rated better than DK by asthma patients. Patients suffering with severe COPD tended to express higher feeling of satisfaction than those with moderate or mild disease, irrespective of the device used.ConclusionAll DPIs tested were highly acceptable by asthma and COPD patients of different ages; nevertheless, EH received significantly higher ratings in most of the questionnaire domains. COPD patients in advanced stages of the disease generally expressed higher level of satisfaction with their devices.