RDD 2020 - E-Poster Presentation

COPD is a chronic and progressive disease that requires regular self-administration of inhaled medications. However, as the disease progresses, reduced respiratory muscle strength may prevent patients from generating sufficient inspiratory effort to effectively use dry-powder inhalers (DPIs) [1, 2]. In contrast, patients can inhale slowly or breathe tidally from a pMDI with VHC without the need to coordinate with inhaler actuation [3].

Summary:

Presented at DDL 2017 in Edinburgh

• Valved holding chambers are widely prescribed to assist patients receiving inhaled medications by avoiding losses caused by imperfect coordination of inhalation and actuation and also to reduce oropharyngeal deposition.
• Regardless of whether using a solution based formulation (like Qvar) or a suspension formulation (Flovent), the use of a valved holding chamber reduced the amount of medication deposited in the mouth (oropharynx) and increased the potential for lung delivery
• This study can be used to help demonstrate the value of using a valved holding chamber for both solution and suspension formulated metered dose inhalers and for all patient populations, including adults

• The FRI deposition profiles highlight that the MDI/AeroChamber Plus* Flow-Vu* VHC delivered a significantly greater percentage of drug to the lung region than either of the two DPIs, irrespective of flow rate.
• This was reflected in much higher modelled oropharyngeal deposition for the two DPIs.
• The influence of inhalation flow profile was significant for one of the DPIs.

As current MDIs contain hydrofluorocarbon propellants, it would be beneficial to find ways to reduce carbon emissions without compromising patient safety.

This lab study investigated a way to optimize the modelled lung dose per actuation while at the same time minimizing the carbon emissions from the MDI

Medications to manage care of bronchiectasis and NTM patients are often delivered via a nebulizer. This study compares a number of different OPEP/Nebulizer combinations using salbutamol as the modelled medication.

Conclusion

• The delivery of medication from the AEROECLIPSE* II BAN* to the lungs was not affected by the incorporation of the Aerobika* OPEP device. Aerosol deposition within the lung was unaltered by the addition of the OPEP device as evidenced by the near identical percentage of the dose being deposited in both the peripheral and central airways.
• BAN+OPEP therapy could offer the clinician the opportunity for combined treatment thereby reducing the time needed for the patient to take both nebulizer and OPEP treatments separately.

Depending on the pMDI/spacer system chosen the delivery of medication can vary significantly and as a result will have implications on the potential carbon footprint.

In this case, the use of the AeroChamber Plus* Flow-Vu* VHC could potentially reduce the carbon footprint by three fold compared to the alternative spacers.

By maximizing the amount of each puff reaching the lungs the patient is likely to be able to get relief sooner and reduce the amount of puffs needed.

The FRI deposition profiles highlighted significant differences between the VHCs on test, with intrathoracic delivery for the AeroChamber Plus* Flow-Vu* VHC system being almost double that of the other two VHC systems and being similar to the MDI alone with perfect coordination

This study was presented at the Drug Delivery to the Lungs, 2022.

This study was presented at the Drug Delivery to the Lungs Conference, 2022.

PRESENTED AT VIRTUAL ATS 2020

• Evaluations of inhaler use have demonstrated that mishandling of MDIs is commonplace.
• One of the most common errors is the failure to coordinate inhalation with actuation of the inhaler
• One of the reasons why VHCs are often prescribed, is to reduce the severity of this error
• This Functional Respiratory Imaging (FRI) based study assessed the likely severity of a short inhalation delay (from actuation) with an MDI alone and how it contrasted to the use with a VHC

Conclusions:

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.

Conclusions:

• The DPI results suggest that inhalation breathing profiles can have an appreciable impact upon aerosol delivery, with one participant having much less predicted medication as fine particles
• In contrast, although the inhalation profiles across all participants were also divergent when asked to inhale from the pMDI + VHC, either tidal breathing or by a slow, deep inhalation, all volunteers would have received a relatively consistent amount of medication.
• It also appears that the pMDI + VHC platform delivers a larger FPM<5.0 µm for both APIs and a consequently smaller coarse particle mass. However, it is recognized that more investigation is warranted with a larger number of volunteers and with other passive DPIs having different resistances

Asthma impacts different people in different ways. Most people are able to control their asthma with regular use of their controller medication and using their reliever medication when necessary. However, for many it can be difficult to recognize when their asthma is not controlled. When asthma is well-controlled, you will experience little to no asthma symptoms.

• Results from this study demonstrate a reduction in the proportion of patients requiring COPD/chronic bronchitis related readmission within 30 days and 12 months of the Aerobika^® OPEP device therapy initiation compared to an alternative OPEP device.
• This further supports the use of the Aerobika^® OPEP device as an add-on to usual care to manage COPD/chronic bronchitis patients post-exacerbation and highlights that not all OPEP devices are the same in terms of 30-day and 12-month readmissions

Conclusions:

COPD/chronic bronchitis patients given an Aerobika* OPEP device compared to an alternative OPEP device had delayed time to re-admission. This supports use of the Aerobika* OPEP device as an add-on to usual care post-exacerbation and highlights differences in OPEP device effectiveness.

Conclusions:

From a UK perspective, BUD/F delivered via an MDI + VHC offers an economic benefit for the treatment of patients with mild asthma. Further analysis is required to determine if there would be any quality-adjusted life-year (QALY) effects based on the chosen intervention.

This study aims to determine if a portable VHC could improve MART therapy effectiveness outside of the home. 

COPD/chronic bronchitis patients given an Aerobika* OPEP device compared to an alternative OPEP device had delayed time to re-admission. This supports use of the Aerobika* OPEP device as an add-on to usual care post-exacerbation and highlights differences in OPEP device effectiveness.

Asthma impacts different people in different ways. Most people are able to control their asthma with regular use of their controller medication and using their reliever medication when necessary. However, for many it can be difficult to recognize when their asthma is not controlled. When asthma is well-controlled, you will experience little to no asthma symptoms.

Conclusions:

• The most efficient and effective delivery method remains that recommended in the device IFU (one actuation inhaled at a time, as well inhalation as soon as possible after actuation)
• However, this laboratory-based study has indicated that a modified common-canister protocol with an anti-static VHC as the aerosol transfer vehicle has the potential to be a viable ‘off-label’ proposition in hospital situations where there is an urgent need to conserve pMDI medication as well as avoid cross-contamination from pathogenic viruses or bacteria