New information regarding the efficiency and effectiveness of different oscillating positive expiratory pressure devices was presented at CHEST 2017 in Toronto, Canada.

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.

Patient use & evaluations of Aerobika* device across 23 UK Centres

RESULT: Improved CAT scores, 92% patients continuing Tx, 87% HCP (very) happy.

• 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.

Efficacy is a major aspect when selecting an OPEP device for airway clearance.

This study was presented at the North American Cystic Fibrosis Conference 2022.

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.

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

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 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

• 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.

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:

• 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.

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

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

This lab study compared a number of VHCs for patient usability and safety factors.