Inhaler Devices Research Articles

Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly.

Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.

Factors contributing in non-adherence to inhaler therapy among patients with obstructive airway diseases in a tertiary care setting

Medication adherence is crucial for managing respiratory conditions effectively. This study aimed to explore the multifaceted factors influencing medication adherence among patients with respiratory illnesses. A comprehensive analysis was conducted, focusing on patient demographics, characteristics, clinical factors, beliefs about medications, and reasons for irregular medication use. A cross-sectional design assessed medication adherence and beliefs in COPD patients through questionnaires. The study identified a middle-aged population (average age: 48.5 years) with high smoking prevalence, aligning with established COPD risk factors. Medication adherence scores indicated moderate levels (average ARMS score: 62.7), but with significant individual variation. Financial burden emerged as the primary barrier, with nearly 28% of participants reporting cost-related non-adherence, particularly impacting lower socioeconomic status (SES) patients. Social stigma regarding respiratory illness, a novel factor, influenced adherence, especially in urban areas (19.8% reported experiencing stigma). The study found a positive correlation between positive medication beliefs and adherence, highlighting the importance of fostering trust in treatment effectiveness. Additionally, a confirmed COPD diagnosis and specific inhaler devices (DPI, PMDI with spacer) were linked to improved adherence. This study identified significant factors impacting medication adherence in COPD, including financial constraints, social stigma, medication beliefs, and inhaler device type.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines Reviewed.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for all clinicians who strive to provide optimal care to patients with chronic obstructive lung disease (COPD). The annual report of GOLD makes few revisions and updates besides including data from the preceding year. At an interval, GOLD comes up with a significant modification in its guidelines, which is generally a major overhaul of the pre-existing guidelines. According to the latest 2023 updates, published in November 2022, there have been significant advancements made in the field of COPD. These include the development of more precise definitions for COPD and its exacerbations, the introduction of a new set of parameters to measure exacerbation severity, and updating the COPD assessment tool. Additionally, revisions have been made to the initial and follow-up treatment guidelines. The report also simplifies the treatment algorithm and sheds light on new findings that suggest the use of pharmacological triple therapy can reduce mortality rates. Furthermore, the report includes discussions on inhaler device selection and adherence to COPD medications. These improvements demonstrate a continued effort to enhance COPD treatment and management. Although there are some areas that could benefit from more detailed guidance and explanation, such as the proper utilization of blood eosinophil counts for treatment decisions, and the establishment of treatment protocols post-hospitalization, the latest modifications to the GOLD recommendations will undoubtedly aid healthcare providers in addressing any gaps in patient care. We aim to highlight key changes in the GOLD 2023 report and present a viewpoint about their potential implications in a real-world clinical scenario.

Elderly and aged asthma have different characteristics: results of a multicenter study.

Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age. The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease.

Comparative Analysis of Peak Inspiratory Flow Rate at Discharge and Three-month Follow-up in Severe Acute Exacerbation of COPD Patients using Metered Dose Inhalers versus Dry Powder Inhalers: A Prospective Observational Study

Introduction: Patients discharged following hospitalisation for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) are prescribed Metered Dose Inhalers (MDI), Dry Powder Inhalers (DPI), or nebulisers. Drug dispersion from the inhaler and deposition in the lung depends on Peak Inspiratory Flow Rate (PIFR) among other factors. A low PIFR results in suboptimal drug delivery and is a risk factor for readmission. Aim: To estimate PIFR at discharge following AECOPD, assess the type of inhalers prescribed at discharge, and estimate the mean change in PIFR at three months follow-up in patients using MDI and DPI. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital, Goa Medical College, Goa, India on 138 patients over 15 months from November 2018 to February 2020. A sample size of 138 was calculated, and the study duration was 15 months. Patients admitted with AECOPD were enrolled in the study after obtaining informed consent. At discharge, baseline characteristics and co-morbidities were recorded, and PIFR was measured using an in-check dial peak inspiratory flow meter without resistance. Inhalers prescribed by the treating physician were verified and checked for errors. PIFR was measured at three months of follow-up. Optimal PIFR was defined as PIFR of ≥60 L/min. Statistical analysis was performed using the Statistical Package for Social Science Programs (SPSS) version 24.0 (IBM Corp, SPSS Inc, Chicago, IL). A paired t-test assessed the change in PIFR at discharge and three months follow-up, and Pearson’s correlation test was used to assess the correlation between continuous variables. Results: Total 138 were enrolled with a mean age of 69.8±7.5 years, 87 (63%) were males. The mean PIFR at discharge was 58.9±24.7 L/min. 85 (61.6%) had suboptimal PIFR and were older {71.9±7.8 versus 66.3±5.6, p-value=0.01}. A total of 59 (69.4%) with suboptimal PIFR received MDI. At three months, the suboptimal PIFR group receiving MDI showed a mean change in PIFR of 18.6±7.7, p-value&lt;0.001 while with DPI mean change was -3.8±6.3, p-value=0.005. Conclusion: 61.6% had suboptimal PIFR at discharge following hospitalisation with AECOPD. Patients with suboptimal PIFR receiving MDI showed improvement in PIFR at three months, while those with suboptimal PIFR using DPI showed significant deterioration. Identifying patients with suboptimal PIFR will aid appropriate prescription of inhaler devices.

IPREDICT: proof-of-concept study to develop a predictive model of changes in asthma control.

The individualized PREdiction of DIsease Control using digital sensor Technology (iPREDICT) program was developed for asthma management using digital technology. Devices were integrated into daily lives of patients to establish a predictive model of asthma control by measuring changes from baseline health status with minimal device burden. To establish baseline disease characteristics of the study participants, detect changes from baseline associated with asthma events, and evaluate algorithms capable of identifying triggers and predicting asthma control changes from baseline data. Patient experience and compliance with the devices were also explored. This was a multicenter, observational, 24-week, proof-of-concept study conducted in the United States. Patients (⩾12 years) with severe, uncontrolled asthma engaged with a spirometer, vital sign monitor, sleep monitor, connected inhaler devices, and two mobile applications with embedded patient-reported outcome (PRO) questionnaires. Prospective data were linked to data from electronic health records and transmitted to a secure platform to develop predictive algorithms. The primary endpoint was an asthma event: symptom worsening logged by patients (PRO); peak expiratory flow (PEF) < 65% or forced expiratory volume in 1 s < 80%; increased short-acting β2-agonist (SABA) use (>8 puffs/24 h or >4 puffs/day/48 h). For each endpoint, predictive models were constructed at population, subgroup, and individual levels. Overall, 108 patients were selected: 66 (61.1%) completed and 42 (38.9%) were excluded for failure to respond/missing data. Predictive accuracy depended on endpoint selection. Population-level models achieved low accuracy in predicting endpoints such as PEF < 65%. Subgroups related to specific allergies, asthma triggers, asthma types, and exacerbation treatments demonstrated high accuracy, with the most accurate, predictive endpoint being >4 SABA puffs/day/48 h. Individual models, constructed for patients with high endpoint overlap, exhibited significant predictive accuracy, especially for PEF < 65% and >4 SABA puffs/day/48 h. This multidimensional dataset enabled population-, subgroup-, and individual-level analyses, providing proof-of-concept evidence for development of predictive models of fluctuating asthma control.

Understanding perspectives of asthma among pulmonologists in Indian settings: results from a questionnaire-based survey

Background: Asthma is associated with high morbidity and mortality in India. This survey was undertaken to explore the perspectives of pulmonologists towards in-clinic management of patients with asthma. Methods: It was a cross-sectional survey of pulmonologists conducted across India. It was formulated to provide unbiased observations of real-world clinical practice focusing on methods of diagnosis of asthma and its treatment preferences. Results: The participants included 805 pulmonologists, with the majority primarily treating patients with asthma (62%), chronic obstructive pulmonary disease (19%) and allergic rhinitis (19%). More than 86% of pulmonologists consider clinical symptoms, history of childhood asthma, family history, and chronic allergic rhinitis for initial diagnosis. About 19-23% prefer spirometry alone or in combination with family history for confirmation of asthma. The preferred inhaled corticosteroids-long-acting bronchodilator (ICS-LABA) combination was budesonide-formoterol amongst 83% of pulmonologists. For both dry powder inhaler (DPI) and metered dose inhaler (MDI) devices, fine particle fraction per cent and delivered dose were ranked as the two most important attributes. Conclusions: Asthma is the most prevalent diagnosis among patients treated by pulmonologists on the basis of clinical presentation and medical history. The most commonly used pharmacotherapy for the treatment of asthma comprises ICS-LABA, with budesonide-formoterol being the preferred combination. Fine particle fraction per cent and magnitude of delivered dose influence the choice of asthma inhaler prescriptions the most.

Clinical impact of pharmaceutical consultations in patients treated for chronic obstructive pulmonary disease: Study protocol for a randomized controlled trial (BPCObs study)

BackgroundChronic obstructive pulmonary disease (COPD) is an irreversible chronic respiratory disease which outcome depends on medication adherence. Pharmacists may increase this adherence by advising patients on inhaler devices proper use. This paper presents the protocol for a randomized controlled trial, which assesses impact of pharmaceutical consultations on COPD exacerbations, medical care, adherence to inhaler devices and quality of life. MethodsThis trial will include 226 COPD patients treated with inhaler devices: 94 in a control group, 66 receiving a pharmaceutical consultation at hospital and 66 receiving up to 12 pharmaceutical consultations corresponding to dispensing at their community pharmacy. The aim of these interventions is to inform patients about COPD medication, train them in the use of inhaler devices and improve adherence. Patients included by hospital pharmacist will be randomly assigned to the control and hospital experimental groups. Community pharmacists (CP) will include patients in the experimental community group. CPs will follow-up all study patients for 12 months. Primary outcome is the mean number of COPD exacerbations. Secondary outcomes include number of medical consultations, emergency visits and hospitalizations, patients’ adherence devices and quality of life. DiscussionThis is the first French trial which assesses both hospital and community pharmaceutical interventions on COPD patients. Study limitations include recruitment and CP adherence to follow-up. Indeed, the success of this trial depends on the willingness of CPs to collect the data. This work is the first step towards building a network of CPs trained for clinical research. Trial registrationClinicaltrials.gov, NCT03704545. Registered on October 12th, 2018. https://clinicaltrials.gov/ct2/show/NCT03704545?cond=COPD&cntry=FR&city=nimes&draw=2&rank=1.

Optimization of Inhalation Technique Knowledge in the Pharmacies of Matosinhos Municipality, Portugal: An Intervention Project.

The therapeutic approach to the most common respiratory diseases, asthma and chronic obstructive pulmonary disease (COPD), involves the use of inhalation devices. Its use is essential, but incorrect use is frequent, and learning and reviewing the technique is necessary for the adequate management of these diseases. This study aims to increase the knowledge of health professionals from pharmacies in the municipality of Matosinhos, Portugal, about the correct inhalation technique. The project developed from May 2022 to June 2023 was based on a training session for pharmacy professionals that took place after professionals completed a questionnaire and after evaluating each participant's inhalation technique by the authorsusing a checklist. Both were reapplied three months after the first evaluation. Fifteen pharmacies in Matosinhos, Portugal, were invited, of which eight agreed to participate, with a total of 16 health professionals (30.8% of professionals in these pharmacies). We found that professionals questioned and taught users more times about the inhalation technique and that a greater number of professionals considered they knew how to correctly perform the inhalation technique in the second assessment. It was also possible to verify statistically significant differences (p<0.001) between the mean of correct steps in the inhalation technique between the first and second assessments. There was also an improvement in the qualitative analysis of errors in the inhalation technique. In the first assessment, the inhalation devices with the lowest percentage of correct steps were Forspiro® and Respimat®. In the second evaluation, the Diskus® and Ellipta® devices obtained 100% correct steps, with the K-haler® being the device with the lowest percentage. This study confirms the effectiveness of continuous training for health professionals and the importance of multidisciplinary cooperation in teaching inhalation techniques. Other studies are needed to complement these results, particularly with representative samples of the general population, or assessing the impact of this intervention in patients with respiratory diseases.

Features of external respiration in individuals using various methods of psychoactive substance consumption

The study of the influence of inhalation psychoactive substances (PAS) on the respiratory system is an important issue, given the speed and trend of the spread of various inhalation devices. Hookah is a device for smoking tobacco, the essence of which is the passage of tobacco smoke through a container with water or other liquids (milk, alcohol). The study was conducted among students of the Northern (Arctic) Federal University named after M.V. Lomonosov (SAFU), and the population permanently residing in the city of Arkhangelsk. The study was conducted from 2020 to 2022. The aim of this article is to compare the indicators of external respiration in individuals using PAS in different ways. Material and methods. External respiration was assessed by spirometry. Spirometry is a fairly simple, non-invasive and informative method for measuring airflows and volumes. The article presents an analysis of spirometry data from 155 people. Group I included individuals not using tobacco products, Group II included cigarette smokers only, and Group III included individuals using tobacco with a hookah. Results. Volume indicators (FVC, FEV1) in Group I were significantly higher than in representatives of Groups II and III (p &gt; 0.01); Also, in Group I, speed indicators were significantly higher. A significant decrease in the FEV indicator was found in Group III compared to Group II (p &gt; 0.01). Also, members of Groups II and III had a significant decrease in speed indicators compared to Group I.

Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment.

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient's characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.

Adherence to Inhalation Devices in Patients with Chronic Obstructive Pulmonary Disease

Adherence to Inhalation Devices in Patients with Chronic Obstructive Pulmonary Disease

Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that...

Achieving mastery in inhaler technique: An evaluation of training provided to general practice healthcare professionals

Abstract Introduction A local scoping questionnaire on previous training and confidence demonstrating inhaler technique in general practice (GP) healthcare professionals (HCP), identified that despite frequent consultations with patients with respiratory disease, 43% reported being self-taught on inhalers. In addition, the proportion of HCPs who reported confidence for demonstrating inhaler technique was low, approximately 60% for pressurised metered dose inhalers (pMDI), and 35-50% for the dry powder inhalers (DPIs) Ellipta, Easyhaler, and NEXThaler. Aim To evaluate the impact of an expert-led face-to-face inhaler technique workshop on HCP confidence and skills. Methods GP HCPs at seven Primary Care Networks (PCN) within Leeds Integrated Care Board (ICB) were invited to attend a multidisciplinary pilot inhaler training session in September 2022, led by a Consultant Respiratory Pharmacist and three facilitators. Inhaler technique was assessed at baseline and after education on the theory and practical issues of inhaler technique for the four most prescribed devices locally (Ellipta, Easyhaler, pMDI, NEXThaler). Inhaler technique was assessed using a seven-step checklist and scored as Optimal (no errors), Satisfactory (no critical errors, but some minor errors) or Unsatisfactory (at least 1 critical error).1 Each facilitator was allocated one inhaler device type and assessed all attendees with that same device. Attendees were asked to complete a post-training evaluation questionnaire, which asked about understanding of inhaler technique and confidence in demonstrating it. Data were subjected to descriptive statistical analysis. This evaluation of educational provision did not require ethical approval. Results Data was available for 23 of the 24 participants who completed the full session. Inhaler technique improved across all four devices post-training. The proportion of HCPs with satisfactory or optimal inhaler technique improved by 87% for Ellipta (from 4% to 91%), 65% for Nexthaler (from 22% to 87%), 17% for pMDI (from 0% to 17%) and 65% for Easyhaler (from 0% to 65%). The most common critical error made using pMDI, even after training, was inhaling too fast, whilst the most common critical error for Ellipta, Easyhaler and Nexthaler devices was not tilting the chin up prior to inhalation. This improved after training. 22 attendees completed a post-training session evaluation form. An improvement in understanding of correct inhaler technique was reported by 89% of HCPs, and 100% agreed they felt more confident demonstrating inhaler technique to patients. Discussion/Conclusion Evaluation of our expert-led inhaler technique training showed that HCPs were more likely to feel confident and achieve mastery in inhaler technique using DPIs than pMDI. Despite pMDIs being the device HCPs felt most confident using prior to training, this was the device HCPs performed poorly in. Post-training, many attendees described that to use a pMDI they inhale slowly and steadily, but on demonstration continued to inhale quickly and deeply, highlighting the difficulty in changing ingrained incorrect practice. Whilst understanding on how to use pMDIs correctly probably improved, it is likely that more practice is required. Consideration should be given to regular repeat training sessions, and the setting of these (in person, remote or eLearning) should be assessed in wider rollout of this initiative.

Improvement of asthma control in adult patients using extrafine inhaled beclomethasone/formoterol fixed combination as maintenance therapy as well as maintenance and reliever therapy – CONTROL study

IntroductionExtrafine formulation of beclomethasone/formoterol fixed combination (BDP/F pMDI HFA) is approved for both fixed maintenance and maintenance and reliever therapy (MART) of asthma, and recent data has proven that BDP/F pMDI HFA maintenance and reliever therapy is an effective alternative to other regimens. ObjectiveThis study aimed to assess the level of asthma control in a real-life setting in adult patients using extrafine BDP/F pMDI HFA fixed combination in a pressurized metered-dose inhaler (pMDI) as fixed maintenance dosing as well as maintenance and maintenance and reliever therapy. Additionally, we examined patients’ satisfaction with the inhaler device and compliance with therapy as essential factors determining asthma control. MethodsThis multicenter prospective non-interventional observational study lasted 4 months with 3 patient visits. We used the Asthma Control Questionnaire 7 (ACQ-7) to evaluate the degree of asthma control and Morisky Medication Adherence Scale (MMAS-4) to assess compliance. A self-developed questionnaire was used to assess satisfaction with the inhaler device. Results2179 patients using BDP/F pMDI HFA fixed combination as maintenance and reliever therapy or BDP/F pMDI HFA as maintenance therapy and SABA (short-acting beta2-agonist) as a reliever for at least 2 months were included. During the prospective follow-up, we observed an upward trend in the FEV1% (forced expiratory volume in 1 s) predicted values, improvement in the control of symptoms as indicated by a decline in the mean ACQ-7 score was noted (1.62 at Visit 1 vs. 1.21 at Visit 2 vs. 0.94 at Visit 3, p < 0.001) and increase in patients’ compliance (the number of patients that reported forgetting at times to take their medication was reduced from 49.7 % to 27.1 %, p < 0.001). At the same time, we noted a reduction in the number of as-needed doses used for symptom relief (p < 0.001). Most patients were satisfied with the pMDI, considered it easy and convenient to use, and preferred it to a dry powder inhaler (p < 0.001). ConclusionsThe use of extrafine BDP/F pMDI HFA as maintenance as well as reliever therapy seems to be associated with increased asthma control and better compliance to therapy.

The role of peak inspiratory flow in the selection of inhalation therapy in patients with chronic obstructive pulmonary disease

Pharmacotherapy for chronic obstructive pulmonary disease (COPD) primarily relies on inhalation therapy. The choice of an appropriate inhalation device is of particular importance as it impacts the frequency of device use errors, patient adherence to treatment, and overall treatment effectiveness. Peak inspiratory flow (PIF) represents the maximum air flow rate generated by a patient during inhalation and is measured in liters per minute. Dry powder inhalers (DPIs) possess internal device resistance that patients must overcome to activate the device. Measuring PIF is an integral component of optimizing COPD therapy when utilizing dry powder inhalers (DPIs). For most DPIs, an optimal PIF value is considered to be no less than 60 L/min, while with a PIF of less than 30 L/min, the medication can’t reach the lower airways. At the same time, the clinical effectiveness of the use of DPI at values of PIF from 30 L/min to 60 L/min may be insufficient, therefore, it is necessary to take into account the value of PIF for the selection of basic COPD therapy. Given the lack of portable fluometers among doctors in real clinical practice, it is important to identify risk factors for suboptimal PIF in patients with COPD. Patients with emphysema, pulmonary hyperinflation, elderly, female, short height, obesity and comorbidity are at risk for insufficient PIF value for further effective use of DPI.This review provides essential information about the role of inspiratory flow for the effective use of DPIs, presents methods for its measurement, discusses predictors of suboptimal PIF, and offers recommendations for selecting inhalation devices for COPD patients based on PIF values.

Chinese expert consensus on standardized inhaler device application in stable chronic airway diseases (2023)

Chinese expert consensus on standardized inhaler device application in stable chronic airway diseases (2023)

Inhaler devices: optimising use in children

Inhaled medication is the standard treatment for respiratory disease and wheezing in childhood. Effective treatment is dependent on patients following the right technique, which varies according to the type of inhaler device, the characteristics of the inhaled medicine, and on patient-related characteristics (e.g. inspiratory flow). This article looks at effective inhalation and education, as well as common barriers.

Review Article-A Concise Overview on Recent Advances in Pharmaceutical Aerosols and Their Commercial Application

For the treatment of various pulmonary disease such as asthma, chronic abstractive disease, pneumonia, bronchitis, and cystic fibrosis, localized drug delivery to the respiratory system has shown to be an increasingly effective and crucial approach. The global market for respiratory inhaler device is being propelled in large part by the increasing prevalence of respiratory disease. The main objective of this article is to present various aspect of pharmaceutical aerosol, including their various types, components, in-process and finished product quality control, and their commercial applications. Aerosol also known as a pressurized device work by continuously or metered applying a small mist spray to activate a suitable valve system. Aerosol is not only used for the treatment of asthma and chronic obstructive pulmonary disease but also used to treat a wide range of other conditions including diabetes, cancer, angina pectoris, bone disorder, and acute lung injury, bone disorders, and tuberculosis. The therapeutic efficacy of pharmaceutical aerosol is affected by wide range of factors, such as the types and characteristics of propellant, active ingredient, container, valve, actuator, spray pattern, valve crimping efficiency, and aerosol particle size. Key words: - Aerosol, types, metered dose inhaler, dry powder inhaler, nebulizers, commercial applications.

Prioritising Patient Outcomes and Reducing Environmental Burden: How Both Are Achievable in Respiratory Care

Patient outcomes must take precedence when considering environmental legislation related to the availability of inhaler devices, which are essential for the care of patients with respiratory diseases. This article reviews presentations and abstracts from the European Respiratory Society (ERS) International Congress 2023, held in Milan, Italy, in September 2023. The sessions focused on healthcare inequality and patient outcomes, highlighting the need for stakeholders to make patient-centric decisions in order to ensure access to essential inhaled medicines are prioritised. This is especially important during a period when there is an increasing need to reduce the carbon footprint associated with respiratory care. During a satellite symposium, co-chairs John Hurst, Professor of Respiratory Medicine at University College London (UCL), UK, and Helen Reddel, Research Leader at the Woolcock Institute of Medical Research, Sydney, Australia, emphasised the necessity of addressing environmentally sustainable respiratory care while prioritising patient outcomes. Christine Jenkins, Clinical Professor of Respiratory Medicine at the University of New South Wales (UNSW), Sydney, Australia, discussed the association between health inequity and uncontrolled chronic obstructive pulmonary disease (COPD) and asthma, and how that relates to the carbon footprint of treatment. Alberto Papi, Full Professor of Respiratory Medicine at the University of Ferrara, Italy, examined how implementing evidence-based guidelines can improve patient outcomes and reduce the carbon footprint of respiratory care, and the progress being made in the transition to near-zero propellants in pressurised metered-dose inhaler (pMDI) devices. Omar Usmani, Professor of Respiratory Medicine at the National Heart and Lung Institute (NHLI), Imperial College London, UK, stressed that pMDIs contain essential medicines, and inhaler regimens should not be considered readily interchangeable. He urged the respiratory community to ensure that their voice is heard in decisions where it relates to the environment regarding COPD and asthma care. The symposium emphasised the opportunities to reduce the environmental impact of respiratory care whilst prioritising patient outcomes. By supporting the transition to climate-friendly propellants in pMDI devices, and implementing guidelines to improve patient outcomes, the overall carbon footprint of respiratory care can be reduced. However, this must be done without limiting access to essential medicines, or increasing adverse health outcomes. The symposium identified pathways towards achieving patient-centric, sustainable respiratory care by improving outcomes, harnessing innovation, and promoting multi-stakeholder collaboration.