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Weers JG. Design of dry powder inhalers to improve patient outcomes: it's not just about the device. Expert Opin Drug Deliv 2024; 21:365-380. [PMID: 38630860 DOI: 10.1080/17425247.2024.2343894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Up to 50% of asthma/COPD patients make critical errors in dose preparation and dose inhalation with current marketed DPIs which negatively impact clinical outcomes. Others fail to adhere to their chronic treatment regimen. AREAS COVERED For this review, we describe how a human-factors approach to design of a dry powder inhaler can be used to improve usability, proficiency, and functionality of DPIs, while effectively mitigating critical errors associated with DPIs. The review highlights the critical importance of utilizing improved formulations with monomodal aerodynamic particle size distributions to reduce variability associated with oropharyngeal filtering of particles, flow rate dependence, and co-formulation effects. EXPERT OPINION Much of the variability in dose delivery with DPIs is associated with limitations of the bimodal APSDs inherent in current lactose blend formulations. Evidence supports that improved lung targeting and dose consistency can be achieved with drug-device combination products comprising spray-dried powders. Unfortunately, no data exists to assess whether these advances observed in in vitro and in vivo dose delivery studies will translate into improved clinical outcomes. Given the significant percentage of patients that receive suboptimal drug delivery with current DPIs it would behoove the industry to assess the efficacy of new approaches.
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Capstick TGD, Gudimetla S, Harris DS, Malone R, Usmani OS. Demystifying Dry Powder Inhaler Resistance with Relevance to Optimal Patient Care. Clin Drug Investig 2024; 44:109-114. [PMID: 38198116 PMCID: PMC10834657 DOI: 10.1007/s40261-023-01330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
The selection of an inhaler device is a key component of respiratory disease management. However, there is a lack of clarity surrounding inhaler resistance and how it impacts inhaler selection. The most common inhaler types are dry powder inhalers (DPIs) that have internal resistance and pressurised metered dose inhalers (pMDIs) that use propellants to deliver the drug dose to the airways. Inhaler resistance varies across the DPIs available on the market, depending largely on the design geometry of the device but also partially on formulation parameters. Factors influencing inhaler choice include measures such as flow rate or pressure drop as well as inhaler technique and patient preference, both of which can lead to improved adherence and outcomes. For optimal disease outcomes, device selection should be individualised, inhaler technique optimised and patient preference considered. By addressing the common clinically relevant questions, this paper aims to demystify how DPI resistance should guide the selection of the right device for the right patient.
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Affiliation(s)
| | | | | | | | - Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.
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Banat H, Csóka I, Paróczai D, Burian K, Farkas Á, Ambrus R. A Novel Combined Dry Powder Inhaler Comprising Nanosized Ketoprofen-Embedded Mannitol-Coated Microparticles for Pulmonary Inflammations: Development, In Vitro-In Silico Characterization, and Cell Line Evaluation. Pharmaceuticals (Basel) 2024; 17:75. [PMID: 38256908 PMCID: PMC10818896 DOI: 10.3390/ph17010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Pulmonary inflammations such as chronic obstructive pulmonary disease and cystic fibrosis are widespread and can be fatal, especially when they are characterized by abnormal mucus accumulation. Inhaled corticosteroids are commonly used for lung inflammations despite their considerable side effects. By utilizing particle engineering techniques, a combined dry powder inhaler (DPI) comprising nanosized ketoprofen-embedded mannitol-coated microparticles was developed. A nanoembedded microparticle system means a novel advance in pulmonary delivery by enhancing local pulmonary deposition while avoiding clearance mechanisms. Ketoprofen, a poorly water-soluble anti-inflammatory drug, was dispersed in the stabilizer solution and then homogenized by ultraturrax. Following this, a ketoprofen-containing nanosuspension was produced by wet-media milling. Furthermore, co-spray drying was conducted with L-leucine (dispersity enhancer) and mannitol (coating and mucuactive agent). Particle size, morphology, dissolution, permeation, viscosity, in vitro and in silico deposition, cytotoxicity, and anti-inflammatory effect were investigated. The particle size of the ketoprofen-containing nanosuspension was ~230 nm. SEM images of the spray-dried powder displayed wrinkled, coated, and nearly spherical particles with a final size of ~2 µm (nano-in-micro), which is optimal for pulmonary delivery. The mannitol-containing samples decreased the viscosity of 10% mucin solution. The results of the mass median aerodynamic diameter (2.4-4.5 µm), fine particle fraction (56-71%), permeation (five-fold enhancement), and dissolution (80% release in 5 min) confirmed that the system is ideal for local inhalation. All samples showed a significant anti-inflammatory effect and decreased IL-6 on the LPS-treated U937 cell line with low cytotoxicity. Hence, developing an innovative combined DPI comprising ketoprofen and mannitol by employing a nano-in-micro approach is a potential treatment for lung inflammations.
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Affiliation(s)
- Heba Banat
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös u.6, 6720 Szeged, Hungary; (H.B.); (I.C.)
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös u.6, 6720 Szeged, Hungary; (H.B.); (I.C.)
| | - Dóra Paróczai
- Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Dóm Square 10, 6720 Szeged, Hungary; (D.P.); (K.B.)
| | - Katalin Burian
- Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Dóm Square 10, 6720 Szeged, Hungary; (D.P.); (K.B.)
| | - Árpád Farkas
- Centre for Energy Research, Hungarian Academy of Sciences, 1121 Budapest, Hungary;
| | - Rita Ambrus
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös u.6, 6720 Szeged, Hungary; (H.B.); (I.C.)
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Akhuemokhan P, Green NA, Haddrell A, Lewis D, Reid JP, Forbes B. How to engineer aerosol particle properties and biopharmaceutical performance of propellant inhalers. Int J Pharm 2023; 634:122676. [PMID: 36738807 PMCID: PMC10685293 DOI: 10.1016/j.ijpharm.2023.122676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Given the environmental compulsion to reformulate pressurised metered dose inhalers (pMDI) using new propellants with lower global warming potential, this study investigated how non-volatile excipients can be used to engineer aerosol particle microphysics and drug release. The dynamics of change in particle size, wetting and physical state were measured for single particles (glycerol/ethanol/beclomethasone dipropionate; BDP) in the aerosol phase at different relative humidity (RH) using an electrodynamic balance. BDP dissolution rates were compared for aerosols from pMDI containing different ratios of BDP:glycerol or BDP:isopropyl myristate (IPM). In 45 % RH, ethanol loss was followed by evaporation of condensed water to generate spherical particles with solid inclusions or compact irregular-shaped solid particles, according to the presence or absence of glycerol. In RH > 95 %, condensed water did not evaporate and BDP formed solid inclusions in water/glycerol or water droplets. Varying the non-volatile component, 0-50 % w/w, in pMDI resulted in a concentration-dependent 4-8-fold reduction in BDP dissolution rate. These findings demonstrate that non-volatile excipients provide a means of engineering aerosol properties and, modifying the rate of drug release from aerosol medicines. We also demonstrated differences between particles formed in vitro in ambient humidity versus higher humidity, more like that encountered during oral inhalation.
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Affiliation(s)
| | | | - Allen Haddrell
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
| | - David Lewis
- Oz-UK Limited, Corsham, Wiltshire SN13 9BY, UK
| | - Jonathan P Reid
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
| | - Ben Forbes
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK
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Deagglomeration of selected high-load API-carrier particles in swirl-based dry powder inhalers. POWDER TECHNOL 2022. [DOI: 10.1016/j.powtec.2022.117800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Damiański P, Kardas G, Panek M, Kuna P, Kupczyk M. Improving the risk-to-benefit ratio of inhaled corticosteroids through delivery and dose: current progress and future directions. Expert Opin Drug Saf 2021; 21:499-515. [PMID: 34720035 DOI: 10.1080/14740338.2022.1999926] [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: 10/19/2022]
Abstract
INTRODUCTION Inhaled corticosteroids (ICS) are known to increase the risk of systemic and local adverse effects, especially with high doses and long-term use. Hence, considerable resources are invested to improve pharmacokinetic/pharmacodynamic (PK/PD) properties of ICS, effective delivery systems and novel combination therapies to enhance the risk-to-benefit ratio of ICS. AREAS COVERED There is an unmet need for new solutions to achieve optimal clinical outcomes with minimal dose of ICS. This paper gives an overview of novel treatment strategies regarding the safety of ICS therapy on the basis of the three most recent molecules introduced to our everyday clinical practice - ciclesonide, mometasone furoate, and fluticasone furoate. Advances in aerosol devices and new areas of inhalation therapy are also discussed. EXPERT OPINION Current progress in improving the risk-to-benefit ratio of ICS through dose and delivery probably established pathways for further developments. This applies both to the improvement of the PK/PD properties of ICS molecules but also includes technical aspects that lead to simplified applicability of the device with simultaneous optimal drug deposition in the lungs. Indubitably, the future of medicine lies not only in the development of new molecules but also in technology and digital revolution.
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Affiliation(s)
- Piotr Damiański
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Kardas
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Michał Panek
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Piotr Kuna
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Maciej Kupczyk
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
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Mukhtar M, Szakonyi Z, Farkas Á, Burian K, Kókai D, Ambrus R. Freeze-dried vs spray-dried nanoplex DPIs based on chitosan and its derivatives conjugated with hyaluronic acid for tuberculosis: In vitro aerodynamic and in silico deposition profiles. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Alfano FO, Benassi A, Gaspari R, Di Renzo A, Di Maio FP. Full-Scale DEM Simulation of Coupled Fluid and Dry-Coated Particle Flow in Swirl-Based Dry Powder Inhalers. Ind Eng Chem Res 2021. [DOI: 10.1021/acs.iecr.1c02864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrea Benassi
- DP Manufacturing & Innovation, Chiesi Farmaceutici SpA, 43122 Parma, Italy
- International School for Advanced Studies (SISSA), 34136 Trieste, Italy
| | - Roberto Gaspari
- DP Manufacturing & Innovation, Chiesi Farmaceutici SpA, 43122 Parma, Italy
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Melani AS. Inhaler technique in asthma and COPD: challenges and unmet knowledge that can contribute to suboptimal use in real life. Expert Rev Clin Pharmacol 2021; 14:991-1003. [PMID: 33983092 DOI: 10.1080/17512433.2021.1929922] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Inhalers are the most commonly used devices for lung drug delivery in asthma and COPD. Inhaler use offers several advantages but requires the user's proper mastery. The issue of inhaler technique is very important as inhaler misuse remains common in real life regardless of the inhaler used and is associated with poor disease control.Areas covered:This narrative review analyses the key-steps of inhaler mastery and the significance of the errors of use for the main devices. There are uncertainties on many tasks of inhaler use and on those variations from recommended steps that are considered as critical errors.Expert opinion: Despite technological advancements, an easy-to-use device is not yet available. Whatever the chosen inhaler, health care givers' proper practical education with the opportunity of feedback learning has a key-role for improving inhaler technique, but is time-consuming, and remains limited to few successful experiences. Newer digital technologies will be applied to the field of inhaler education, but the lack of knowledge on many practical aspects of inhaler technique might be a limit for its extensive implementation. Possibly digital innovation might substantially contribute to reduce inhaler misuse only if clinicians, manufacturers, and subjects will cooperate together on this issue.
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Affiliation(s)
- Andrea S Melani
- Dipartimento Scienze Mediche, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Chetta A, Yorgancioglu A, Scuri M, Barile S, Guastalla D, Dekhuijzen PNR. Inspiratory flow profile and usability of the NEXThaler, a multidose dry powder inhaler, in asthma and COPD. BMC Pulm Med 2021; 21:65. [PMID: 33632183 PMCID: PMC7905605 DOI: 10.1186/s12890-021-01430-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Inhaler selection is important when managing respiratory conditions; a patient’s inhalation technique should be appropriate for the selected device, and patients should ideally be able to use a device successfully regardless of disease severity. The NEXThaler is a multidose dry-powder inhaler with a breath-actuated mechanism (BAM) and dose counter that activates only following inhalation, so effectively an ‘inhalation counter’. We assessed inspiratory flow through the NEXThaler in two studies and examined whether inhalation triggered the BAM.
Methods The two studies were open-label, single-arm, and single visit. One study recruited patients with asthma aged ≥ 18 years; the other recruited patients with chronic obstructive pulmonary disease (COPD) aged ≥ 40 years. All patients inhaled twice through a placebo NEXThaler. The inspiratory profile through the device was assessed for each inhalation using acoustic monitoring, with flow at and time to BAM firing, peak inspiratory flow (PIF), and total inhalation time assessed. Results A total of 40 patients were enrolled in the asthma study: 20 with controlled asthma and 20 with partly controlled/uncontrolled asthma. All patients were able to trigger the BAM, as evidenced by the inhalation counter activating on closing the device. Mean flow at BAM firing following first inhalation was 35.0 (range 16.3–52.3) L/min; mean PIF was 64.6 (35.0–123.9) L/min. A total of 72 patients were enrolled in the COPD study, with data analysed for 69 (mean forced expiratory volume in 1 s 48.7% predicted [17–92%]). As with the asthma study, all patients, regardless of airflow limitation, were able to trigger the BAM. Mean flow at BAM firing following first inhalation was 41.9 (26.6–57.1) L/min; mean PIF was 68.0 (31.5–125.4) L/min. Device usability was rated highly in both studies, with 5 min sufficient to train the patients, and a click heard shortly after inhalation in all cases (providing feedback on BAM firing). Conclusions Inhalation flows triggering the BAM in the NEXThaler were similar between patients with controlled and partly controlled/uncontrolled asthma, and were similar across COPD airflow limitation. All enrolled patients were able to activate the device. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01430-9.
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Affiliation(s)
- Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Arzu Yorgancioglu
- Department of Pulmonology, Medical Faculty, Celal Bayar University, Manisa, Turkey
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11
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Mukhtar M, Pallagi E, Csóka I, Benke E, Farkas Á, Zeeshan M, Burián K, Kókai D, Ambrus R. Aerodynamic properties and in silico deposition of isoniazid loaded chitosan/thiolated chitosan and hyaluronic acid hybrid nanoplex DPIs as a potential TB treatment. Int J Biol Macromol 2020; 165:3007-3019. [DOI: 10.1016/j.ijbiomac.2020.10.192] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 12/21/2022]
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12
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Horváth A, Farkas Á, Szipőcs A, Tomisa G, Szalai Z, Gálffy G. Numerical simulation of the effect of inhalation parameters, gender, age and disease severity on the lung deposition of dry powder aerosol drugs emitted by Turbuhaler®, Breezhaler® and Genuair® in COPD patients. Eur J Pharm Sci 2020; 154:105508. [DOI: 10.1016/j.ejps.2020.105508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
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13
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Fröhlich E. Biological Obstacles for Identifying In Vitro- In Vivo Correlations of Orally Inhaled Formulations. Pharmaceutics 2019; 11:E316. [PMID: 31284402 PMCID: PMC6680885 DOI: 10.3390/pharmaceutics11070316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 12/26/2022] Open
Abstract
Oral inhalation of drugs is the classic therapy of obstructive lung diseases. In contrast to the oral route, the link between in vitro and in vivo findings is less well defined and predictive models and parameters for in vitro-in vivo correlations are missing. Frequently used in vitro models and problems in obtaining in vivo values to establish such models and to identify the action of formulations in vivo are discussed. It may be concluded that major obstacles to link in vitro parameters on in vivo action include lack of treatment adherence and incorrect use of inhalers by patients, variation in inhaler performance, changes by humidity, uncertainties about lung deposition, and difficulties to measure drug levels in epithelial lining fluid and tissue. Physiologically more relevant in vitro models, improvement in inhaler performance, and better techniques for in vivo measurements may help to better understand importance and interactions between individual in vitro parameters in pulmonary delivery.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University of Graz, 8010 Graz, Austria.
- Research Center Pharmaceutical Engineering GmbH, 8010 Graz, Austria.
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Su YY, Miles REH, Li ZM, Reid JP, Xu J. The evaporation kinetics of pure water droplets at varying drying rates and the use of evaporation rates to infer the gas phase relative humidity. Phys Chem Chem Phys 2018; 20:23453-23466. [PMID: 30182100 DOI: 10.1039/c8cp05250f] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Numerous analytical models have been applied to describe the evaporation/condensation kinetics of volatile components from aerosol particles for use in many applications. However, the applicability of these models for treating cases that lead to substantial and rapid changes in particle temperature due to, for example, evaporative cooling remain to be compared with measurements. We consider three typical treatments, comparing predictions of the evaporation rates of pure water droplets over a wide range in gas phase relative humidity (RH) and exploring the sensitivity of the predictions to uncertainties in the thermophysical gas and condensed-phase parameters. We also compare predictions from the three treatments to measurements of the evaporation rates of pure water droplets with varying RH using an electrodynamic balance (EDB), concluding that only two of the model treatments are sufficiently able to account for the level of evaporative cooling (typically as high as 12 K). Finally, we show that the RH can be inferred accurately from the evaporation rate of pure water droplets over the full range in accessible RH and comparison with the model predictions (within absolute uncertainties of 2.5% RH over the range 20% to 95% RH), considering the level of agreement with independent measurements made through determining the equilibrated size of aqueous sodium chloride and sodium nitrate droplets.
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Affiliation(s)
- Yong-Yang Su
- Northwest Institute of Nuclear Technology, P.O. Box 69-14, Xi'an, 710024, Shaanxi, P. R. China.
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15
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Novel dry powder inhaler formulation containing antibiotic using combined technology to improve aerodynamic properties. Eur J Pharm Sci 2018; 123:20-27. [PMID: 30016647 DOI: 10.1016/j.ejps.2018.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/01/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022]
Abstract
Dry Powder Inhaler (DPI) could offer a propellant-free, easy-to-use powder form ensuring better stability than liquid dosage forms. Therefore the development of traditional carrier-based and carrier-free new generation systems is a determinative factor in the field of DPI formulation. The purpose of our research work was to combine these two systems, utilizing their beneficial properties to produce a novel pulmonary drug delivery system containing ciprofloxacin hydrochloride (CIP). Co-spray drying, surface smoothing and the preparation of an interactive physical mixture were applied as the technological procedures of sample preparation. The carrier-based and carrier-free formulations, as well as the developed novel product were compared to each other. Structural investigations were made by X-ray powder diffraction and micrometric properties (habit, bulk density) were determined. Particle interactions were also evaluated to investigate surface free energy, cohesive-adhesive forces, and spreading coefficient. In vitro aerodynamic properties (mass median aerodynamic diameter), fine particle fraction (FPF) and emitted dose of DPIs were measured using Andersen Cascade Impactor. A novel in silico Stochastic Lung Model was also used to quantify the amount of particles deposited at the target area. The novel-formulated composition presented amorphous spherical particles with an average size of about 2 μm. The in vitro aerodynamic investigations showed a variance in FPF as a function of formulation method (carrier-based: 24%, carrier-free: 54% and applying the novel combination method: 63%). The in silico deposition results were in line with the in vitro measurements and yielded increased lung doses for the sample prepared by the combined technology. This novel DPI formulation provides an opportunity for a more effective therapy with deeper deposition of CIP.
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Farkas Á, Horváth A, Kerekes A, Nagy A, Kugler S, Tamási L, Tomisa G. Effect of delayed pMDI actuation on the lung deposition of a fixed-dose combination aerosol drug. Int J Pharm 2018; 547:480-488. [PMID: 29886099 DOI: 10.1016/j.ijpharm.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/27/2023]
Abstract
Lack of coordination between the beginning of the inhalation and device triggering is one of the most frequent errors reported in connection with the use of pMDI devices. Earlier results suggested a significant loss in lung deposition as a consequence of late actuation. However, most of our knowledge on the effect of poor synchronization is based on earlier works on CFC devices emitting large particles with high initial velocities. The aim of this study was to apply numerical techniques to analyse the effect of late device actuation on the lung dose of a HFA pMDI drug emitting high fraction of extrafine particles used in current asthma and COPD therapy. A computational fluid and particle dynamics model was combined with stochastic whole lung model to quantify the amount of drug depositing in the extrathoracic airways and in the lungs. High speed camera measurements were also performed to characterize the emitted spray plume. Our results have shown that for the studied pMDI drug late actuation leads to reasonable loss in terms of lung dose, unless it happens in the second half of the inhalation period. Device actuation at the middle of the inhalation caused less than 25% lung dose reduction relative to the value characterizing perfect coordination, if the inhalation time was between 2 and 5 s and inhalation flow rate between 30 and 150 L/min. This dose loss is lower than the previously known values of CFC devices and further support the practice of triggering the device shortly after the beginning of the inhalation instead of forcing a perfect synchronization and risking mishandling and poor drug deposition.
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Affiliation(s)
- Árpád Farkas
- Centre for Energy Research, Hungarian Academy of Sciences, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary.
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, 1125 Budapest, Hungary; Chiesi Hungary Ltd., Dunavirág u. 2, 1138 Budapest, Hungary
| | - Attila Kerekes
- Wigner Research Centre for Physics, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary
| | - Attila Nagy
- Wigner Research Centre for Physics, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary
| | - Szilvia Kugler
- Wigner Research Centre for Physics, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, 1125 Budapest, Hungary
| | - Gábor Tomisa
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, 1125 Budapest, Hungary; Chiesi Hungary Ltd., Dunavirág u. 2, 1138 Budapest, Hungary
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Beeh KM, Emirova A, Prunier H, Santoro D, Nandeuil MA. Dose-response of an extrafine dry powder inhaler formulation of glycopyrronium bromide: randomized, double-blind, placebo-controlled, dose-ranging study (GlycoNEXT). Int J Chron Obstruct Pulmon Dis 2018; 13:1701-1711. [PMID: 29872288 PMCID: PMC5973313 DOI: 10.2147/copd.s168493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction An extrafine formulation of the long-acting muscarinic antagonist, glycopyrronium bromide (GB), has been developed for delivery via the NEXThaler dry powder inhaler (DPI). This study assessed the bronchodilator efficacy and safety of different doses of this formulation in patients with COPD to identify the optimal dose for further development. Patients and methods This was a multicenter, randomized, double-blind, placebo-controlled, incomplete block, three-way crossover study, including three 28-day treatment periods, each separated by a 21-day washout period. Eligible patients had a diagnosis of COPD and post-bronchodilator forced expiratory volume in 1 s (FEV1) 40%-70% predicted. Treatments administered were GB 6.25, 12.5, 25 and 50 μg or matched placebo; all were given twice daily (BID) via DPI, with spirometry assessed on Days 1 and 28 of each treatment period. The primary end point was FEV1 area under the curve from 0 to 12 h (AUC0-12 h) on Day 28. Results A total of 202 patients were randomized (61% male, mean age 62.6 years), with 178 (88%) completing all the three treatment periods. For the primary end point, all the four GB doses were superior to placebo (p<0.001) with mean differences (95% CI) of 114 (74, 154), 125 (85, 166), 143 (104, 183) and 187 (147, 228) mL for GB 6.25, 12.5, 25 and 50 μg BID, respectively. All four GB doses were also statistically superior to placebo for all secondary efficacy end points, showing clear dose-response relationships for most of the endpoints. Accordingly, GB 25 μg BID met the criteria for the minimally acceptable dose. Adverse events were reported by 15.5, 16.2, 10.9 and 14.3% of patients receiving GB 6.25, 12.5, 25 and 50 μg BID, respectively, and 14.8% receiving placebo. Conclusion This study supports the selection of GB 25 μg BID as the minimal effective dose for patients with COPD when delivered with this extrafine DPI formulation.
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Affiliation(s)
- Kai M Beeh
- Insaf Respiratory Research Institute, Wiesbaden, Germany
| | - Aida Emirova
- Global Clinical Development, Chiesi S.A.S, Bois-Colombes, France
| | - Hélène Prunier
- Global Clinical Development, Chiesi S.A.S, Bois-Colombes, France
| | - Debora Santoro
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
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Jetzer M, Morrical B, Schneider M, Edge S, Imanidis G. Probing the particulate microstructure of the aerodynamic particle size distribution of dry powder inhaler combination products. Int J Pharm 2018; 538:30-39. [DOI: 10.1016/j.ijpharm.2017.12.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
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