1
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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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2
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Singh G, Tang P, Cheng S, Chan HK, Kourmatzis A. From laminar to turbulent flow in a dry powder inhaler: The effect of simple design modifications. Int J Pharm 2022; 616:121556. [PMID: 35131350 DOI: 10.1016/j.ijpharm.2022.121556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 01/28/2023]
Abstract
In order to better understand powder dispersion in dry powder inhaler (DPI) devices, a new powder disperser was designed, which uses flow modifiers to alter powder fluidization behavior so as to physically replicate various flow conditions observed in a range of commercial DPIs. The influence of these modifiers on the performance of the DPI was analyzed for flowrates progressing from laminar (15 L/min) to transitional (30 L/min), and finally turbulent flow regimes (60 L/min) in the device. The aerosol performance of the disperser was measured using a Next Generation Impactor. For flowrate in the laminar regime, powder evacuation from the disperser was generally insufficient (<30%), which was increased to >85% when the device was operated in the turbulent flow regime. In contrast, the highest fine particle fraction (FPF) and lowest throat deposition were achieved when operating in the transitional flow regime. The FPF could be increased further by applying flow modifications such as narrowing the air passage before the powder pocket, inducing localized turbulence (by a grid) near the powder pocket, and by changing the loading position of the powder. Flow modifiers had the most noticeable effect under a laminar flow regime, however, the device operated most efficiently under a transitional flow regime.
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Affiliation(s)
- Gajendra Singh
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006, Australia; School of Engineering, IIT Mandi, HP 175075, India
| | - Patricia Tang
- Sydney Pharmacy School, The University of Sydney, NSW 2006, Australia
| | - Shaokoon Cheng
- School of Engineering, Macquarie University, NSW 2109, Australia
| | - Hak-Kim Chan
- Sydney Pharmacy School, The University of Sydney, NSW 2006, Australia
| | - Agisilaos Kourmatzis
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006, Australia.
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3
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Chaugule V, Wong CY, Inthavong K, Fletcher DF, Young PM, Soria J, Traini D. Combining experimental and computational techniques to understand and improve dry powder inhalers. Expert Opin Drug Deliv 2022; 19:59-73. [PMID: 34989629 DOI: 10.1080/17425247.2022.2026922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION : Dry Powder Inhalers (DPIs) continue to be developed to deliver an expanding range of drugs to treat an ever-increasing range of medical conditions; with each drug and device combination needing a specifically designed inhaler. Fast regulatory approval is essential to be first to market, ensuring commercial profitability. AREAS COVERED : In vitro deposition, particle image velocimetry, and computational modelling using the physiological geometry and representative anatomy can be combined to give complementary information to determine the suitability of a proposed inhaler design and to optimise its formulation performance. In combination they allow the entire range of questions to be addressed cost-effectively and rapidly. EXPERT OPINION : Experimental techniques and computational methods are improving rapidly, but each needs a skilled user to maximize results obtained from these techniques. Multidisciplinary teams are therefore key to making optimal use of these methods and such qualified teams can provide enormous benefits to pharmaceutical companies to improve device efficacy and thus time to market. There is already a move to integrate the benefits of Industry 4.0 into inhaler design and usage, a trend that will accelerate.
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Affiliation(s)
- V Chaugule
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - C Y Wong
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - K Inthavong
- Mechanical and Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW 2006, Australia
| | - P M Young
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Department of Marketing, Macquarie Business School, Macquarie University, NSW 2109, Australia
| | - J Soria
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - D Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Macquarie Medical School, Department of Biological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
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4
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Baloira A, Abad A, Fuster A, García Rivero JL, García-Sidro P, Márquez-Martín E, Palop M, Soler N, Velasco JL, González-Torralba F. Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion. Int J Chron Obstruct Pulmon Dis 2021; 16:1021-1033. [PMID: 33907390 PMCID: PMC8064620 DOI: 10.2147/copd.s297980] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim was to describe: 1) lung deposition and inspiratory flow rate; 2) main characteristics of inhaler devices in chronic obstructive pulmonary disease (COPD). METHODS A systematic literature review (SLR) was conducted to analyze the features and results of inhaler devices in COPD patients. These devices included pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and a soft mist inhaler (SMI). Inclusion and exclusion criteria were established, as well as search strategies (Medline, Embase, and the Cochrane Library up to April 2019). In vitro and in vivo studies were included. Two reviewers selected articles, collected and analyzed data independently. Narrative searches complemented the SLR. We discussed the results of the reviews in a nominal group meeting and agreed on various general principles and recommendations. RESULTS The SLR included 71 articles, some were of low-moderate quality, and there was great variability regarding populations and outcomes. Lung deposition rates varied across devices: 8%-53% for pMDIs, 7%-69% for DPIs, and 39%-67% for the SMI. The aerosol exit velocity was high with pMDIs (more than 3 m/s), while it is much slower (0.84-0.72 m/s) with the SMI. In general, pMDIs produce large-sized particles (1.22-8 μm), DPIs produce medium-sized particles (1.8-4.8 µm), and 60% of the particles reach an aerodynamic diameter <5 μm with the SMI. All inhalation devices reach central and peripheral lung regions, but the SMI distribution pattern might be better compared with pMDIs. DPIs' intrinsic resistance is higher than that of pMDIs and SMI, which are relatively similar and low. Depending on the DPI, the minimum flow inspiratory rate required was 30 L/min. pMDIs and SMI did not require a high inspiratory flow rate. CONCLUSION Lung deposition and inspiratory flow rate are key factors when selecting an inhalation device in COPD patients.
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Affiliation(s)
- Adolfo Baloira
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Antonia Fuster
- Hospital Unvidersitario Son Llàtzer, Palma de Mallorca, Spain
| | | | | | - Eduardo Márquez-Martín
- Hospital Virgen del Rocío, Sevilla, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - J L Velasco
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Affiliation(s)
- Andrew R. Martin
- 10-324 Donadeo Innovation Center for Engineering, University of Alberta, Alberta, Canada
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Sahay S, Holy R, Lyons S, Parsley E, Maurer M, Weers J. Impact of human behavior on inspiratory flow profiles in patients with pulmonary arterial hypertension using AOS™ dry powder inhaler device. Pulm Circ 2021; 11:2045894020985345. [PMID: 33532060 PMCID: PMC7829465 DOI: 10.1177/2045894020985345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022] Open
Abstract
Relative to healthy subjects, patients with pulmonary arterial hypertension often
present with decreased respiratory muscle strength, resulting in decreased
maximum inspiratory pressure. Little is known about the impact of reduced
respiratory muscle strength on the ability to achieve the peak inspiratory
pressures needed for effective drug delivery when using portable dry powder
inhalers (≥1.0 kPa). The objective of this study was to assess the impact of
inhaler resistance and patient instruction on the inspiratory flow profiles of
pulmonary arterial hypertension patients when using breath-actuated dry powder
inhalers. The inspiratory flow profiles of 35 patients with pulmonary arterial
hypertension were measured with variants of the RS01 dry powder inhaler.
Profiles were determined with a custom inspiratory flow profile recorder.
Results showed that going from the low resistance RS01 dry powder inhaler to the
high resistance AOS® dry powder inhaler led to increases in mean peak
inspiratory pressures for pulmonary arterial hypertension subjects from 3.7 kPa
to 6.5 kPa. Instructions that ask pulmonary arterial hypertension subjects to
inhale with maximal effort until their lungs are full led to a mean peak
inspiratory pressures of 6.0 kPa versus 2.1 kPa when the same subjects are asked
to inhale comfortably. Significant decreases in mean peak inspiratory pressures
are also observed with decreases in lung function, with a mean peak inspiratory
pressures of 7.2 kPa for subjects with FEV1 > 60% predicted, versus 3.3 kPa
for those subjects with FEV1 < 50% predicted. In conclusion, despite having
reduced respiratory muscle strength, subjects with pulmonary arterial
hypertension can effectively use a breath-actuated dry powder inhaler. The
probability of achieving effective dose delivery may be increased by using dry
powder inhalers with increased device resistance, particularly when subjects do
not follow the prescribed instructions and inhale comfortably.
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Affiliation(s)
- Sandeep Sahay
- Houston Methodist Lung Center, Houston Methodist Hospital, Houston, TX, USA
| | - Royanne Holy
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | - Mari Maurer
- Respira Therapeutics, Inc, Burlingame, CA, USA
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Cazzola M, Cavalli F, Usmani OS, Rogliani P. Advances in pulmonary drug delivery devices for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Deliv 2020; 17:635-646. [DOI: 10.1080/17425247.2020.1739021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesco Cavalli
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Omar S. Usmani
- Imperial College London and Royal Brompton Hospital, Airways Disease Section, National Heart and Lung Institute (NHLI), London, UK
| | - Paola Rogliani
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
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8
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Sala V, Murabito A, Ghigo A. Inhaled Biologicals for the Treatment of Cystic Fibrosis. ACTA ACUST UNITED AC 2020; 13:19-26. [PMID: 30318010 PMCID: PMC6751348 DOI: 10.2174/1872213x12666181012101444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
Background: Cystic Fibrosis (CF), one of the most frequent genetic diseases, is characterized by the production of viscous mucus in several organs. In the lungs, mucus clogs the airways and traps bacteria, leading to recurrent/resistant infections and lung damage. For cystic fibrosis patients, respiratory failure is still lethal in early adulthood since available treatments display incomplete efficacy. Objective: The objective of this review is to extend the current knowledge in the field of available treat-ments for cystic fibrosis. A special focus has been given to inhaled peptide-based drugs. Methods: The current review is based on recent and/or relevant literature and patents already available in various scientific databases, which include PubMed, PubMed Central, Patentscope and Science Direct. The information obtained through these diverse databases is compiled, critically interpreted and presented in the current study. An in-depth but not systematic approach to the specific research question has been adopted. Results: Recently, peptides have been proposed as possible pharmacologic agents for the treatment of respiratory diseases. Of note, peptides are suitable to be administered by inhalation to maximize efficacy and reduce systemic side effects. Moreover, innovative delivery carriers have been developed for drug administration through inhalation, allowing not only protection against proteolysis, but also a prolonged and controlled release. Conclusion: Here, we summarize newly patented peptides that have been developed in the last few years and advanced technologies for inhaled drug delivery to treat cystic fibrosis.
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Affiliation(s)
- Valentina Sala
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy.,S.C. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Alessandra Murabito
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
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9
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Clark AR, Weers JG, Dhand R. The Confusing World of Dry Powder Inhalers: It Is All About Inspiratory Pressures, Not Inspiratory Flow Rates. J Aerosol Med Pulm Drug Deliv 2019; 33:1-11. [PMID: 31613682 PMCID: PMC7041319 DOI: 10.1089/jamp.2019.1556] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dry powder inhalers (DPIs) all have the ability to aerosolize dry powders, but they each offer different operating mechanisms and resistances to inhaled airflow. This variety has resulted in both clinician and patient confusion concerning DPI performance, use, and effectiveness. Particularly, there is a growing misconception that a single peak inspiratory flow rate (PIFR) can determine a patient's ability to use a DPI effectively, regardless of its design or airflow resistance. For this review article, we have sifted through the relevant literature concerning DPIs, inspiratory pressures, and inspiratory flow rates to provide a comprehensive and concise discussion and recommendations for DPI use. We ultimately clarify that the controlling parameter for DPI performance is not the PIFR but the negative pressure generated by the patient's inspiratory effort. A pressure drop ∼≥1 kPa (∼10 cm H2O) with any DPI is a reasonable threshold above which a patient should receive an adequate lung dose. Overall, we explore the underlying factors controlling inspiratory pressures, flow rates and dispensing, and dispersion characteristics of the various DPIs to clarify that inspiratory pressures, not flow rates, limit and control a patient's ability to generate sufficient flow for effective DPI use.
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Affiliation(s)
| | | | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
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10
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Farkas D, Hindle M, Bonasera S, Bass K, Longest W. Development of an Inline Dry Powder Inhaler for Oral or Trans-Nasal Aerosol Administration to Children. J Aerosol Med Pulm Drug Deliv 2019; 33:83-98. [PMID: 31464559 DOI: 10.1089/jamp.2019.1540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Dry powder inhalers (DPIs) offer a number of advantages, such as rapid delivery of high-dose inhaled medications; however, DPI use in children is often avoided due to low lung delivery efficiency and difficulty in operating the device. The objective of this study was to develop a high-efficiency inline DPI for administering aerosol therapy to children with the option of using either an oral or trans-nasal approach. Methods: An inline DPI was developed that consisted of hollow inlet and outlet capillaries, a powder chamber, and a nasal or oral interface. A ventilation bag or compressed air was used to actuate the device and simultaneously provide a full deep inspiration consistent with a 5-year-old child. The powder chamber was partially filled with a model spray-dried excipient enhanced growth powder formulation with a mass of 10 mg. Device aerosolization was characterized with cascade impaction, and aerosol transmissions through oral and nasal in vitro models were assessed. Results: Best device performance was achieved when all actuation air passed through the powder chamber (no bypass flow) resulting in an aerosol mean mass median aerodynamic diameter (MMAD) <1.75 μm and a fine particle fraction (<5 μm) ≥90% based on emitted dose. Actuation with the ventilation bag enabled lung delivery efficiency through the nasal and oral interfaces to a tracheal filter of 60% or greater, based on loaded dose. In both oral and nose-to-lung (N2L) administrations, extrathoracic depositional losses were <10%. Conclusion: In conclusion, this study has proposed and initially developed an efficient inline DPI for delivering spray-dried formulations to children using positive pressure operation. Actuation of the device with positive pressure enabled effective N2L aerosol administration with a DPI, which may be beneficial for subjects who are too young to use a mouthpiece or to simultaneously treat the nasal and lung airways of older children.
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Affiliation(s)
- Dale Farkas
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia
| | - Serena Bonasera
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia
| | - Karl Bass
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia
| | - Worth Longest
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia.,Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia
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11
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Weers JG, Son YJ, Glusker M, Haynes A, Huang D, Kadrichu N, Le J, Li X, Malcolmson R, Miller DP, Tarara TE, Ung K, Clark A. Idealhalers Versus Realhalers: Is It Possible to Bypass Deposition in the Upper Respiratory Tract? J Aerosol Med Pulm Drug Deliv 2019; 32:55-69. [DOI: 10.1089/jamp.2018.1497] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Yoen-Ju Son
- Merck Research Laboratories, Merck & Co., Rahway, New Jersey
| | | | | | | | | | - John Le
- iPharma, Ltd., Union City, California
| | - Xue Li
- Bristol-Myers Squibb, Hopewell, New Jersey
| | | | | | | | - Keith Ung
- iPharma, Ltd., Union City, California
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12
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The development of a single-use, capsule-free multi-breath tobramycin dry powder inhaler for the treatment of cystic fibrosis. Int J Pharm 2016; 514:392-398. [DOI: 10.1016/j.ijpharm.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
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13
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The Impact of Inspiratory Flow Rate on Drug Delivery to the Lungs with Dry Powder Inhalers. Pharm Res 2016; 34:507-528. [PMID: 27738953 DOI: 10.1007/s11095-016-2050-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022]
Abstract
Current marketed dry powder inhalers utilize the energy from patient inspiration to fluidize and disperse bulk powder agglomerates into respirable particles. Variations in patient inspiratory flow profiles can lead to marked differences in total lung dose (TLD), and ultimately patient outcomes for an inhaled therapeutic. The present review aims to quantitate the flow rate dependence in TLD observed for a number of drug/device combinations using a new metric termed the Q index. With this data in hand, the review explores key attributes in the design of the formulation and device that impact flow rate dependence. The review also proposes alternative in vitro methods to assess flow rate dependence that more closely align with in vivo observations. Finally, the impact of variations in flow rate on lung function for inhaled bronchodilators is summarized.
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14
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Design of spray dried insulin microparticles to bypass deposition in the extrathoracic region and maximize total lung dose. Int J Pharm 2016; 511:1070-9. [DOI: 10.1016/j.ijpharm.2016.07.073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/13/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
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16
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Effects of ramp-up of inspired airflow on in vitro aerosol dose delivery performance for certain dry powder inhalers. Eur J Pharm Sci 2016; 84:46-54. [PMID: 26780380 DOI: 10.1016/j.ejps.2016.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/14/2015] [Accepted: 01/06/2016] [Indexed: 11/23/2022]
Abstract
This study investigated the effect of airflow ramp-up on the dose delivery performance of seven dry powder inhalers, covering a broad range of powder formulations and powder dispersion mechanisms. In vitro performance tests were performed at a target pressure drop of 4kPa, using two inspiratory flow ramp-up conditions, representing slow and fast ramp-up of airflow, respectively. The fluidization of bulk powder and aerosol clearance from the inhaler was assessed by laser photometer evaluation of aerosol emission kinetics and measurement of the delivered dose (DD). The quality of aerosol dispersion (i.e. de-agglomeration) and associated lung targeting performance was assessed by measuring the total lung dose (TLD) using the Alberta idealized mouth-throat model. The ratio of DD and TLD under slow/fast ramp conditions was used as a metric to rank-order flow ramp effects. Test results show that the delivered dose is relatively unaffected by flow ramp (DD ratio ~1 for all dry powder inhalers). In contrast, the total lung dose showed significantly more variation as a function of flow ramp and inhaler type. Engineered (spray dried) powder formulations were associated with relatively high TLD (>50% of nominal dose) compared to lactose blend and agglomerate based formulations, which had a lower TLD (7-40% of nominal dose), indicative of less efficient targeting of the lung. The TLD for the Tobi Podhaler was the least influenced by flow ramp (TLD ratio ~1), while the TLD for the Asmanex Twisthaler was the most sensitive to flow ramp (TLD ratio ≪1). The relatively high sensitivity of the Asmanex Twisthaler to flow ramp is attributed to rapid aerosol clearance (from the inhaler) combined with a strong effect of flow-rate on particle de-agglomeration and resulting size distribution.
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17
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Weers JG, Miller DP. Formulation Design of Dry Powders for Inhalation. J Pharm Sci 2015; 104:3259-88. [DOI: 10.1002/jps.24574] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 11/09/2022]
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18
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Sugianto TD, Chan HK. Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives. Expert Opin Drug Deliv 2015; 13:7-22. [DOI: 10.1517/17425247.2015.1078309] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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19
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Weers JG, Clark AR, Rao N, Ung K, Haynes A, Khindri SK, Perry SA, Machineni S, Colthorpe P. In Vitro–In Vivo Correlations Observed With Indacaterol-Based Formulations Delivered with the Breezhaler®. J Aerosol Med Pulm Drug Deliv 2015; 28:268-80. [DOI: 10.1089/jamp.2014.1178] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeffry G. Weers
- Novartis Pharmaceuticals Corporation, San Carlos, California, United States
| | - Andrew R. Clark
- Novartis Pharmaceuticals Corporation, San Carlos, California, United States
| | - Nagaraja Rao
- Novartis Pharmaceuticals Corporation, San Carlos, California, United States
| | - Keith Ung
- Novartis Pharmaceuticals Corporation, San Carlos, California, United States
| | - Alfred Haynes
- Novartis Pharmaceuticals Corporation, San Carlos, California, United States
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20
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Can Patients with Parkinson's Disease Use Dry Powder Inhalers during Off Periods? PLoS One 2015; 10:e0132714. [PMID: 26173114 PMCID: PMC4501550 DOI: 10.1371/journal.pone.0132714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Abstract
Because of its rapid onset of action, pulmonary administration of levodopa is an interesting alternative to oral administration for the rescue treatment of Parkinson’s disease patients in an off period. We studied the ability of Parkinson’s disease patients to operate a dry powder inhaler (DPI) correctly during an off period. We used an instrumented test inhaler with three different resistances to air flow to record flow curves and computed various inhalation parameters. We observed that all (13) patients were able to generate pressure drops > 2 kPa over the highest resistance and 10 out of 13 patients achieved at least 4 kPa. Inhaled volumes (all resistances) varied from 1.2 L to 3.5 L. Total inhalation time and the time to peak inspiratory flow rate both decreased with decreasing inhaler resistance. Twelve out of thirteen patients could hold their breath for at least five seconds after inhalation and nine could extend this time to ten seconds. The data from this study indicate that patients with Parkinson’s disease will indeed be able to use a dry powder inhaler during an off period and they provide an adequate starting point for the development of a levodopa powder inhaler to treat this particular patient group.
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21
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Miller DP, Tan T, Tarara TE, Nakamura J, Malcolmson RJ, Weers JG. Physical Characterization of Tobramycin Inhalation Powder: I. Rational Design of a Stable Engineered-Particle Formulation for Delivery to the Lungs. Mol Pharm 2015; 12:2582-93. [DOI: 10.1021/acs.molpharmaceut.5b00147] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Trixie Tan
- Novartis Pharmaceuticals, San Carlos, California 94070, United States
| | - Thomas E. Tarara
- Novartis Pharmaceuticals, San Carlos, California 94070, United States
| | - John Nakamura
- Novartis Pharmaceuticals, San Carlos, California 94070, United States
| | | | - Jeffry G. Weers
- Novartis Pharmaceuticals, San Carlos, California 94070, United States
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22
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Weers J. Reply to the comment by de Boer and Hoppentocht on: inhaled antimicrobial therapy - barriers to effective treatment, by J. Weers, Adv. Drug Deliv. Rev. (2015), http://dx.doi.org/10.1016/j.addr.2014.08.013. Adv Drug Deliv Rev 2015; 85:e3-5. [PMID: 25913567 DOI: 10.1016/j.addr.2015.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jeffry Weers
- Novartis Pharmaceuticals Corporation, 150 Industrial Road, San Carlos, CA, USA.
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23
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Inhaled antimicrobial therapy – Barriers to effective treatment. Adv Drug Deliv Rev 2015; 85:24-43. [DOI: 10.1016/j.addr.2014.08.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023]
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24
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Healy AM, Amaro MI, Paluch KJ, Tajber L. Dry powders for oral inhalation free of lactose carrier particles. Adv Drug Deliv Rev 2014; 75:32-52. [PMID: 24735676 DOI: 10.1016/j.addr.2014.04.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/24/2014] [Accepted: 04/04/2014] [Indexed: 02/07/2023]
Abstract
Dry powder inhaler (DPI) products have traditionally comprised a simple formulation of micronised drug mixed with a carrier excipient, typically lactose monohydrate. The presence of the carrier is aimed at overcoming issues of poor flowability and dispersibility, associated with the cohesive nature of small, micronised active pharmaceutical ingredient (API) particles. Both the powder blend and the DPI device must be carefully designed so as to ensure detachment of the micronised drug from the carrier excipient on inhalation. Over the last two decades there has been a significant body of research undertaken on the design of carrier-free formulations for DPI products. Many of these formulations are based on sophisticated particle engineering techniques; a common aim in formulation design of carrier-free products being to reduce the intrinsic cohesion of the particles, while maximising dispersion and delivery from the inhaler. In tandem with the development of alternative formulations has been the development of devices designed to ensure the efficient delivery and dispersion of carrier-free powder on inhalation. In this review we examine approaches to both the powder formulation and inhaler design for carrier-free DPI products.
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Abstract
The market for inhalable dry powder medication has consistently grown over past years. Targeting the lungs has been recognized to offer several advantages compared with oral application of drugs. The successive development of inhalation products has led to advances in local treatment of different respiratory diseases, but has also demonstrated the possibility to utilize the lungs for systemic drug delivery. Since a dry powder inhalation product is always a combination of drug formulation and inhalation device, the requirements for the development of such a system may be particularly complex. Therefore, this review aims to give an overview of the necessary considerations for a successful dry powder inhaler development.
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Abstract
Spray–dried PulmoSphere™ formulations comprise phospholipid-based small, porous particles. Drug(s) may be incorporated in or with PulmoSphere formulations in three formats: solution-, suspension-, and carrier-based systems. The multiple formats may be administered to the respiratory tract with multiple delivery systems, including portable inhalers (pressurized, metered-dose inhaler and dry-powder inhaler), nebulizers, and via liquid dose instillation in conjunction with partial liquid ventilation. The PulmoSphere platform (particles, formats, delivery systems) enables pulmonary delivery of a broad range of drugs independent of their physicochemical properties and lung dose. The engineered particles provide significant improvements in lung targeting and dose consistency, relative to current marketed inhalers.
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27
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Modeling and Optimization of Terbutaline Emitted from a Dry Powder Inhaler and Influence on Systemic Bioavailability Using Data Mining Technology. J Pharm Innov 2014. [DOI: 10.1007/s12247-014-9171-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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