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de Pablo E, O'Connell P, Fernández-García R, Marchand S, Chauzy A, Tewes F, Dea-Ayuela MA, Kumar D, Bolás F, Ballesteros MP, Torrado JJ, Healy AM, Serrano DR. Targeting lung macrophages for fungal and parasitic pulmonary infections with innovative amphotericin B dry powder inhalers. Int J Pharm 2023; 635:122788. [PMID: 36863544 DOI: 10.1016/j.ijpharm.2023.122788] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023]
Abstract
The incidence of fungal pulmonary infections is known to be on the increase, and yet there is an alarming gap in terms of marketed antifungal therapies that are available for pulmonary administration. Amphotericin B (AmB) is a highly efficient broad-spectrum antifungal only marketed as an intravenous formulation. Based on the lack of effective antifungal and antiparasitic pulmonary treatments, the aim of this study was to develop a carbohydrate-based AmB dry powder inhaler (DPI) formulation, prepared by spray drying. Amorphous AmB microparticles were developed by combining 39.7 % AmB with 39.7 % γ-cyclodextrin, 8.1 % mannose and 12.5 % leucine. An increase in the mannose concentration from 8.1 to 29.8 %, led to partial drug crystallisation. Both formulations showed good in vitro lung deposition characteristics (80 % FPF < 5 µm and MMAD < 3 µm) at different air flow rates (60 and 30 L/min) when used with a DPI, but also during nebulisation upon reconstitution in water.
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Affiliation(s)
- E de Pablo
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - P O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - R Fernández-García
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - S Marchand
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France; Laboratoire de Toxicologie-Pharmacocinétique, CHU de Poitiers, 2, Rue de la milétrie, 86021 Poitiers, France
| | - A Chauzy
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France
| | - F Tewes
- UMR 1070, Université de PoitiersPôle Biologie Santé, 1, Rue Georges Bonnet, 86073 Poitiers, France; Laboratoire de Toxicologie-Pharmacocinétique, CHU de Poitiers, 2, Rue de la milétrie, 86021 Poitiers, France
| | - M A Dea-Ayuela
- Pharmacy Department, School of Life Sciences, Universidad Cardenal Herrera-CEU, Moncada 46113 Valencia, Spain
| | - D Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
| | - F Bolás
- Parasitology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - M P Ballesteros
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - J J Torrado
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - A M Healy
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
| | - D R Serrano
- Pharmaceutics and Food Technology Department, School of Pharmacy, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Universitario de Farmacia Industrial, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain.
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Vartiainen VA, Lavorini F, Murphy AC, Rabe KF. High inhaler resistance does not limit successful inspiratory maneuver among patients with asthma or COPD. Expert Opin Drug Deliv 2023; 20:385-393. [PMID: 36820500 DOI: 10.1080/17425247.2023.2179984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION There has been an active discussion on the sustainability of inhaler therapy in respiratory diseases, and it has cast a shadow on pMDIs which rely on propellant with high global warming potential (GWP). DPIs offer a lower GWP and effective alternative, but there has been concern whether all patients can generate sufficient inspiratory effort to disperse the drug. This review focuses on airflow resistance of DPIs and its clinical relevance. AREAS COVERED For this narrative review, we searched the literature for studies comparing flow patterns with different devices. We also included a section on clinical trials comparing reliever administration with DPI, pMDI with spacer, and nebulizer during exacerbation. EXPERT OPINION The evidence supports the efficacy of DPIs irrespective of respiratory condition or age of the patient even during acute exacerbations. Air flow resistance does not limit the use of DPIs and the patients were able to generate sufficient inspiratory flow rate with almost any device studied. None of 16 identified clinical trials comparing reliever administration via DPIs to other types of devices during exacerbation or bronchial challenge showed statistically significant difference between the device types in FEV1 recovery. DPIs performed as well as other types of inhaler devices even during asthma or COPD exacerbation.
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Affiliation(s)
- Ville A Vartiainen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Finland, Finland.,Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna C Murphy
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian Albrechts University Kiel, Germany
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Tony SM, Abdelrahman MA, Abd Elsalam M, Sameer Shafik M, Abdelrahim MEA. Effect of using acoustic flo-tone training device and its smartphone application on enhancing inhalation technique from metered-dose inhaler with spacer in asthmatic children. Exp Lung Res 2022; 48:224-238. [PMID: 35997099 DOI: 10.1080/01902148.2022.2113573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim of study: This research study aims to compare between two different counseling approaches; traditional verbal counseling vs. advanced counseling (in which we used the acoustic Flo-tone training device and its smartphone application combined with traditional verbal counseling) to determine the most beneficial counseling approach for asthmatic children who use metered-dose inhaler (MDI) with spacers concerning inhalation duration and inhalation technique mistakes. Methods: A total of 100 asthmatic children (8-18) years old were randomized into two groups (a control group, and an advanced group). Each group included 50 subjects. Every subject received 3 counseling meetings, one each month. Asthmatic children in the control group were trained on inhalation technique from MDI + spacer verbally (traditional counseling), while asthmatic children in advanced group were trained on inhalation technique from MDI + spacer verbally and by advanced counseling (whistling Flo-tone + smartphone application). At each visit mistakes in inhalation technique steps were; detected, corrected, and recorded and the inhalation duration was measured for every child in each group. Results: In both study groups, the total mean number of inhalation technique mistakes decreased significantly (p < 0.05) from visit 2, also the total mean inhalation durations in seconds showed a significant increase (p < 0.05) from visit 2. A significant (p < 0.05) reduction in the total mean number of mistakes and a significant (p < 0.05) increase in total mean inhalation durations were observed from visit 2 in advanced group compared to control group. Conclusion: Combination between traditional verbal and advanced counseling methods resulted in significant (P < 0.05) improvements in the number of inhalation technique mistakes and inhalation durations from MDI with spacer in children compared to using traditional verbal counseling alone.
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Affiliation(s)
- Sara M Tony
- Beni-Suef Specialized Hospital, Beni-Suef, Egypt
| | - Mona A Abdelrahman
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | | | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Lavorini F, Barreto C, van Boven JFM, Carroll W, Conway J, Costello RW, Dahl BH, Dekhuijzen RPN, Holmes S, Levy M, Molimard M, Roche N, Román-Rodriguez M, Scichilone N, Scullion J, Usmani OS. Spacers and Valved Holding Chambers-The Risk of Switching to Different Chambers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1569-1573. [PMID: 31927099 DOI: 10.1016/j.jaip.2019.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/09/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Abstract
Spacers are pressurized metered-dose inhaler (pMDI) accessory devices developed to reduce problems of poor inhaler technique with pMDIs. Spacers that feature a 1-way inspiratory valve are termed valved holding chambers (VHCs); they act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a 2-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Both spacers and VHCs have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce corticosteroid-related side effects such as throat irritation, dysphonia, and oral candidiasis commonly seen with the use of pMDIs alone. Spacers and VHCs are not all the same, and also are not interchangeable: the performance may vary according to their size, shape, material of manufacture and propensity to become electrostatically charged, their mode of interface with the patient, and the presence or otherwise of valves and feedback devices. Thus, pairing of a pMDI plus a spacer or a VHC should be considered as a unique delivery system. In this Rostrum we discuss the risk potential for a patient getting switched to a spacer or VHC that delivers a reduced dose medication.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Celeste Barreto
- Departamento de Pediatria, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Will Carroll
- Department of Paediatrics, University Hospital of North Midlands NHS Trust, Stoke-On-Trent, United Kingdom
| | - Joy Conway
- Computationally Intensive Imaging, University of Southampton, Southampton, United Kingdom
| | | | - Birthe Hellqvist Dahl
- Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stephen Holmes
- Park Medical Practice, Shepton Mallet, Somerset, United Kingdom
| | - Mark Levy
- Harrow Primary Care Trust, London, United Kingdom
| | - Mathieu Molimard
- Département de Pharmacologie, CHU de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes, Paris, France
| | - Miguel Román-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares, Mallorca, Spain
| | - Nicola Scichilone
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Jane Scullion
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Omar S Usmani
- Imperial College London & Royal Brompton Hospital, London, United Kingdom
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Dissanayake S, Nagel M, Falaschetti E, Suggett J. Are valved holding chambers (VHCs) interchangeable? An in vitro evaluation of VHC equivalence. Pulm Pharmacol Ther 2018; 48:179-184. [DOI: 10.1016/j.pupt.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
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6
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Dissanayake S, Suggett J. A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC. Ther Adv Respir Dis 2018; 12:1753465817751346. [PMID: 29378477 PMCID: PMC5937155 DOI: 10.1177/1753465817751346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022] Open
Abstract
Valved holding chambers (VHCs) reduce the need for inhalation-actuation coordination with pressurized metered dose inhalers (pMDIs), reduce oropharyngeal drug deposition and may improve lung deposition and clinical outcomes compared to pMDIs used alone. While VHCs are thus widely advocated for use in vulnerable patient groups within clinical and regulatory guidelines, there is less consensus as to whether the performance differences between different VHCs have clinical implications. This review evaluates the VHC literature, in particular the data pertaining to large- versus small-volume chambers, aerosol performance with a VHC adjunct versus a pMDI alone, charge dissipative/conducting versus non-conducting VHCs, and facemasks, to ascertain whether potentially meaningful differences between VHCs exist. Inconsistencies in the literature are examined and explained, and relationships between in vitro and in vivo data are discussed. A particular focus of this review is the AeroChamber Plus® Flow-Vu® Anti-static VHC, the most recent iteration of the AeroChamber VHC family.
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Affiliation(s)
| | - Jason Suggett
- Trudell Medical International, London, Ontario,
Canada
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Ninane V, Vandevoorde J, Cataldo D, Derom E, Liistro G, Munghen E, Peché R, Schlesser M, Verleden G, Vincken W. New developments in inhaler devices within pharmaceutical companies: A systematic review of the impact on clinical outcomes and patient preferences. Respir Med 2015; 109:1430-8. [PMID: 26439177 DOI: 10.1016/j.rmed.2015.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 08/21/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmaceutical companies offer an increasing number of inhaler devices, whether or not together with new substances, for maintenance treatment of patients with COPD or asthma. However, well-designed studies to support these developments are scarce. OBJECTIVES The aim of this research was to evaluate how far new developments of inhaler devices are scientifically supported and translate into improvements of patient preferences and/or clinical outcomes. METHODS A systematic literature review was performed to retrieve randomised controlled trials in patients with COPD or asthma that studied the in-company evolution of inhaler devices. Results were tabulated and discussed. RESULTS A total of 30 studies were found comparing Respimat(®) vs. HandiHaler(®), Diskus(®)(Accuhaler(®)) vs. Diskhaler(®)(Rotadisk(®)) or pMDI, Ellipta(®) vs. Diskus(®)(Accuhaler(®)), Nexthaler(®) vs. pMDI, or Breezhaler(®) vs. Aerolizer(®). These studies show that developments of inhaler devices may improve patient satisfaction but do not lead to demonstrable improvements in clinical efficacy. Current changes of devices are most commonly parallelled by changes in administration frequency towards once daily treatment. The only well-documented effect was found for the Respimat(®) Soft Mist™ Inhaler, which realises a more than 3-fold lowering of the once-daily tiotropium dose through increased performance of the inhaler device. There are however, no data on clinical efficacy or safety comparing the two devices at the same dosage. CONCLUSIONS Future developments of inhaler devices should all require well-designed studies to demonstrate patient benefit.
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Affiliation(s)
- Vincent Ninane
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Brussels, Belgium.
| | - Jan Vandevoorde
- Department of General Practice, Free University of Brussels, Brussels, Belgium
| | - Didier Cataldo
- Department of Respiratory Medicine, University Hospital Sart-Tilman, University of Liège, Liège, Belgium
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Giuseppe Liistro
- Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, Belgium
| | - Evert Munghen
- Department of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Rudi Peché
- Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium
| | - Marc Schlesser
- Department of Respiratory Medicine, University Hospital Luxembourg, Luxembourg
| | - Geert Verleden
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
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Delpierre S, Guillot C, Badier M. Same efficacies of ipratropium and salbutamol in reversing methacholine-induced bronchoconstriction. J Asthma 2007; 43:679-85. [PMID: 17092849 DOI: 10.1080/02770900600925502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Efficacy of salbutamol (S) was compared to that of ipratropium (I) or to their association, after methacholine challenge testing (MCT). MCT was performed in 4 groups of 10 patients suspected to suffer from asthma; mean changes in FEV1, maximal midexpiratory flow rate (MMFR), and airway resistance (Raw) were the same in all groups. After MCT, the group 1 patients inhaled S and then I, 10 min later; both drugs were given in the reverse order to the group 2 patients. The group 3 patients inhaled a mixture of both drugs just after MCT; the group 4 patients were not given any bronchodilator till the 20th min after MCT, when they inhaled S. Short-term (10 min) bronchodilator effects of S, I or S + I on spirometric variables were of the same magnitude and Raw returned to its baseline value. Further improvement (10-20 min) in FEV1 was mainly due to spontaneous recovery, whereas further increase in MMFR was due also to bronchodilator actions of drugs. It is concluded that ipratropium could be proposed as an alternative bronchodilator to salbutamol after MCT.
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Affiliation(s)
- S Delpierre
- Laboratoire d'Explorations Fonctionnelles Respiratoires, Marseille, France.
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