Real‐life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred‐dose inhalers in patients with asthma treated with ICS/LABA

The release of drug from dry powder inhalers is strongly dependent on the patient's inhalation profile. To maximise the effect of the treatment, it is necessary to optimise dry powder inhalers to achieve drug delivery that (A) is independent of the inhalation manoeuvre and (B) is targeted to the correct site in the lung. The purpose of this study is to develop a dry powder inhaler with an adaptive bypass element that achieves desired drug delivery behaviour. Computational and experimental methods are used. First, the effect of a generic variable bypass element on entrainment behaviour is modelled. This is done by modelling a dry powder inhaler as a network of flow. Second, the behaviour of a potential variable bypass element, a flap valve, is studied both computationally and experimentally. Third, the flow resistances are optimised to achieve consistent and desired entrainment behaviour for patients with very different inhalation manoeuvres. A simulated dry powder inhaler device design was found that achieves an approximately constant entrainment flow rate of 12 L/min when total flow rates larger than 20 L/min are applied. The developed dry powder inhaler is predicted to accurately deliver drug for patients with highly different inhalation manoeuvres.

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Patients' usability of seven most used dry-powder inhalers in COPD

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2019.29 ◽

2019 ◽

Vol 14 ◽

Author(s):

Roberto W. Dal Negro ◽

Paola Turco ◽

Massimiliano Povero

Keyword(s):

Indirect Comparison ◽

Real Life ◽

Small Sample ◽

Dry Powder Inhalers ◽

Dry Powder ◽

Inhalation Devices ◽

Therapeutic Outcomes ◽

Copd Patients ◽

Specialist Centre ◽

Ranking Order

Introduction: Inhalation devices affect both the effectiveness and the therapeutic outcomes in persistent airway obstruction, and the effects are largely independent of the drug(s) assumed. Usability is a complex and comprehensive indicator of inhalation devices’ performance. The Global Usability Score (GUS) Questionnaire is an investigational tool designed to assess objectively the patients’-related and unrelated domains of devices’ usability. Methods: The GUS questionnaire was administered to all consecutive COPD patients referring for three months to the Lung Unit of CEMS Specialist Centre (Verona, Italy). The usability of seven Dry Powder Inhalers (DPIs) indicated as appropriate in COPD was tested and compared: Breezhaler, Diskus, Ellipta, Genuair, Nexthaler, Spiromax, and Turbohaler. Patients were divided in two groups, checked separately, according to their DPIs previous experience. A Bayesian Indirect Comparison (IC) model was built to assess “global usability” ranking. Results: A total of 103 patients were investigated: 74 patients already instructed in DPI use and 29 naive to DPIs. IC analysis proved Ellipta as the device characterized by the highest usability, while Breezhaler the device with the lowest usability in both groups of COPD patients (both with probability > 90%). Moreover, Turbohaler ranked second according to the Bayesian pooling, followed by Diskus, Spiromax, Nexthaler, and Genuair in patients already instructed in DPI use, while the ranking order was not as much well defined in naïve patients, likely due to their too small sample. Conclusions: Usability is a multifaceted indicator that contributes to assess the factual DPIs’ convenience in real life. DPIs are characterized by different levels of real-life usability, which can be checked, compared and ranked by means of the GUS score.

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The Use of Video Instructions in Patient Education Promoting Correct Technique for Dry Powder Inhalers: An Investigation on Inhaler-Naïve Individuals

Pharmacy ◽

10.3390/pharmacy6040106 ◽

2018 ◽

Vol 6 (4) ◽

pp. 106 ◽

Cited By ~ 5

Author(s):

Sofia von Schantz ◽

Nina Katajavuori ◽

Anne Juppo

Keyword(s):

Disease Management ◽

Dry Powder Inhaler ◽

Dry Powder Inhalers ◽

Inhaler Technique ◽

Dry Powder ◽

Educational Method ◽

Inhaler Device ◽

Correct Technique ◽

Study Participants ◽

To Receive

Introduction: The correct use of a prescribed inhaler device is crucial for achieving successful disease management in asthma. This study investigates non-verbal, demonstrational videos as a method of teaching inhaler naïve individuals how to use a dry powder inhaler (DPI). Methods: Video instructions for four DPIs were examined using a mixed methodology; 31 inhaler-naïve individuals participated in the study. Participants were each shown a demonstrational video of one the four inhalers, after each video the participant demonstrated how they would use the inhaler. After demonstrating the use, participants crossed over to the next inhaler. The demonstrations were videotaped. A common questionnaire was filled at the beginning of the study and four inhaler-specific questionnaires which were filled out by the participant after each inhaler demonstration. Results: The frequency of participant error varied between inhalers. When asked about how they perceived the video instructions, participants often stated they would have liked to receive feedback on their performance. The importance of feedback was further highlighted by the fact that participants tended to overestimate their own inhaler technique. Conclusion: Non-verbal videos may be more efficient for some DPIs than for others as a method for providing inhaler instructions. Lack of feedback on the participants’ inhaler performance emerged as a clear shortcoming of this educational method. Some steps in the inhalation process may be harder for individuals to remember and therefore require extra emphasis in order to achieve correct inhaler technique.

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Correction to: Patients’ usability of seven most used dry-powder inhalers in COPD

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2019.65 ◽

2019 ◽

Vol 14 ◽

Author(s):

Roberto W. Dal Negro ◽

Paola Turco ◽

Massimiliano Povero

Keyword(s):

Real Life ◽

Original Research ◽

Dry Powder Inhalers ◽

Original Research Article ◽

Dry Powder ◽

Intrinsic Resistance ◽

Research Article ◽

Copd Patients ◽

Basic Characteristics

Correction to: Multidiscip RespirMed (2019) 14:30 https://doi.org/10.1186/s40248-019-0192-5After publication of the Original research article [1] it was brought to our attention that the sentence at the bottom of the section entitled Discussion (pag 6 of 9, just below Fig. 4) must be corrected as follows: “In real life, DPIs are highly prescribed in Italian COPD patients being their prescription usually independent of their known basic characteristics and technical differences, such as the different number of main actions required for their actuation (7 for Breezhaler, 4 for Turbohaler, and 3 for the remaining devices),” and their intrinsic resistance, ranging from 0.017 kPa0.5 L/min to 0.039 kPa0 .5 L/min [28, 29].

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A Bayesian Framework to Assess the Usability of Dry Powder Inhalers in a Cohort of Asthma Adolescents in Italy

Children ◽

10.3390/children9010028 ◽

2021 ◽

Vol 9 (1) ◽

pp. 28

Author(s):

Roberto Walter Dal Negro ◽

Massimiliano Povero

Keyword(s):

Short Form ◽

Indirect Comparison ◽

Real Life ◽

Pairwise Comparisons ◽

Dry Powder Inhalers ◽

Current Clinical Practice ◽

Dry Powder ◽

Asthma Patients ◽

Time Required ◽

Short Time

The useability of DPIs (dry powder inhalers) depends on several factors that are influenced by the patients’ subjectivity and objectivity. The short-form global usability score (S-GUS), a specific tool for the quick ranking and comparison in real life of an inhaler’s usability, was used to investigate six of the most prescribed DPIs (Breezhaler, Diskus, Ellipta, Nexthaler, Spiromax, and Turbohaler) in consecutive asthma patients aged <18 years. A Bayesian indirect comparison (IC) was carried out to merge all pairwise comparisons between the six DPIs. Thirty-three subjects participated: eighteen tested Breezhaler, Spiromax, Nexthaler, and Ellipta simultaneously, while fifteen tested Breezhaler, Spiromax, Diskus, and Turbohaler. The estimates of the S-GUS, by the IC model, allowed us to rank the DPIs by their degree of usability: Ellipta, Diskus, and Spiromax were classified as “good to pretty good” (S-GUS > 15), while Spiromax, Turbohaler, and Breezhaler were classified as “insufficient” (S-GUS < 15). The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible. The S-GUS proves particularly suitable in current clinical practice because of the short time required for its use in adolescents.

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