Patient Handling of a Dry-Powder Inhaler in Clinical Practice

CHEST Journal ◽  
2001 ◽  
Vol 120 (5) ◽  
pp. 1480-1484 ◽  
Author(s):  
Stanley Epstein ◽  
Ari Maidenberg ◽  
David Hallett ◽  
Kay Khan ◽  
Kenneth R. Chapman
Keyword(s):  
Clinical Practice ◽  
Dry Powder Inhaler ◽  
Dry Powder ◽  
Patient Handling

scholarly journals REVIEW ON DRY POWDER INHALERS: CURRENT ADVANCES AND LIMITATIONS

2021 ◽  
pp. 63-67
Author(s):  
A. V. Badarinath ◽  
S A Sreenivas ◽  
M. Suresh Babu
Keyword(s):  
Clinical Practice ◽  
Focal Point ◽  
Dry Powder Inhaler ◽  
Dry Powder Inhalers ◽  
Clinical Use ◽  
Expected Loss ◽  
Dry Powder ◽  
Everyday Clinical Practice ◽  
Innovative Work

Inhalers are the focal point of quickened innovative work as a result of the possibility to deliver greatest medication to the site of pathology in the lungs. Among the accessible conveyance choices, the dry powder inhaler (DPI) is the favoured gadget for the treatment of an undeniably different scope of ailments. Advancement of DPI frameworks that focus on the conveyance of fine medication particles to the more profound aviation routes in the lungs utilizing a mix of improved medication definitions and upgraded conveyance gadget advances implies that every one of these variables adds to in general execution of the vaporized framework. There are enormous scopes of gadgets for clinical use, anyway no individual gadget shows prevalent clinical viability. A significant worry that is pertinent in everyday clinical practice is the between and intra-understanding fluctuation of the medication measurements conveyed to the profound lungs from the inward breath gadgets, where the degree of changeability relies upon the medication definition, the gadget plan, and patient's breath profile. This fluctuation may result in under-dosing of medication to the patient and expected loss of pharmacological viability. This article audits ongoing advances in container based DPI innovation and the presentation of the 'dispensable' DPI gadget.

scholarly journals The Global Usability Score Short-Form for the simplified assessment of dry powder inhalers (DPIs) usability

2020 ◽  
Vol 15 ◽  
Author(s):  
Massimiliano Povero ◽  
Paola Turco ◽  
Luca Bonadiman ◽  
Roberto W. Dal Negro
Keyword(s):  
Clinical Practice ◽  
Short Form ◽  
Objective Assessment ◽  
Indirect Comparison ◽  
Real Life ◽  
Dry Powder Inhaler ◽  
High Specificity ◽  
Lasso Regression ◽  
Dry Powder ◽  
Specificity And Sensitivity

Background: The choice of the Dry Powder Inhaler (DPI) to prescribe is a critical issue. The estimation of DPIs usability depends on the objective assessment of several indices related to both subjective and objective determinants. The Global Usability Score (GUS) Questionnaire is a comprehensive tool usable for checking, comparing, and ranking inhalers’ usability objectively in real life, but it takes some time to fill.Aim: The aim of this study was to favour the quicker check of DPIs usability in clinical practice by means of a simplified short-form GUS (S-GUS) Questionnaire, while maintaining the high specificity and sensitivity of the original, extended version of the Questionnaire (O-GUS questionnaire).Methods: The usability of the six most prescribed DPIs was assessed in 222 patients with persistent airway obstruction and needing long-term inhalation treatments. LASSO regression and multicollinearity test were used to select the subset of questions of the O-GUS questionnaire, with the highest information power. Each item was then scored using the corresponding coefficient in the linear regression (normalized at 50 as the O-GUS score). Agreement between the original and the short-form questionnaire was evaluated using the Cohen’s kappa statistic (κ). The overall S-GUS values obtained for each DPI were then compared to those from the O-GUS, in the same patients, using a Bayesian indirect comparison (IC) model.Results: After the statistical selection of the items mostly contributing to the overall score, the novel S-GUS questionnaire consists of twelve items only. Nine items are related to patients’ opinion before DPIs handling, and three to the nurse’s assessment after DPIs practicality. O-GUS and S-GUS score were strongly correlated (R2=0.9843, p<0.0001) and the usability score calculated for each DPI by means of the O- and of S- GUS overlapped almost completely (κ=84.5%, 95% CI 81.3% to 89.2%). Furthermore, S-GUS was much faster to complete than O-GUS (mean time 6.1 vs 23.4 minutes, p<0.001). Estimates of S-GUS, obtained from the IC model, allowed to propose a simple classification of usability: “good” by GUS values >25; “pretty good” by values ≤25≥15, and “insufficient” by values <15.Conclusions: The S-GUS proves as much specific and suitable as the extended O-GUS questionnaire in measuring DPIs usability, while maintaining the same high sensitivity. As the time required for its use is quite shorter, S-GUS is also particularly suitable and helpful in current clinical practice.

A generic fluticasone propionate and salmeterol dry powder inhaler: Evidence of usability, function, and robustness

2021 ◽  
Vol 42 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Donald P. Tashkin ◽  
Arkady Koltun ◽  
Róisín Wallace
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Fluticasone Propionate ◽  
Healthy Volunteers ◽  
Pulmonary Disease ◽  
Dry Powder Inhaler ◽  
Chemical Degradation ◽  
Chronic Obstructive ◽  
Dry Powder ◽  
Obstructive Pulmonary Disease ◽  
Flow Rates

Background: A generic combination of fluticasone propionate and salmeterol xinafoate inhalation powder in a premetered, multidose, nonreusable inhaler was recently approved. Objective: To assess the performance of the generic device. Methods: Findings from three studies with regard to device usability, function, and robustness were reviewed. Results: In a study to assess device function in patients and healthy volunteers, the generic device was successfully used by patients with asthma and chronic obstructive pulmonary disease who were either dry powder inhaler users or dry powder inhaler‐naive, even though they were not trained beyond being provided the instructions for use. In a study to measure inhaled flow rates generated by patients and healthy volunteers, the generic device consistently simulated the delivery of a full dose of drug, even to patients with severe respiratory disease and reduced inspiratory flow rates. Although the generic device had a slightly higher airflow resistance, this study demonstrated that this difference did not result in any clinically meaningful differences in terms of drug delivery. Pressure drop, a key parameter that drives the fluidization and aerosolization of the powder dose, was found to be comparable between the devices. In an open-label study, the generic device met all U.S. Food and Drug Administration specifications for device robustness after 21.5 days of twice-daily dosing via oral inhalation among 111 participants with asthma or chronic obstructive pulmonary disease. All inhalers tested demonstrated conformity with a pharmacopeia with respect to key quality parameters (assay, delivered dose uniformity, aerodynamic size distribution). There was no evidence of chemical degradation of the active ingredients, nor of microbial or water ingress into the powder, as a result of inhaler use.

scholarly journals Flow and Particle Modelling of Dry Powder Inhalers: Methodologies, Recent Development and Emerging Applications

Pharmaceutics ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 189
Author(s):  
Zhanying Zheng ◽  
Sharon Shui Yee Leung ◽  
Raghvendra Gupta
Keyword(s):  
Dry Powder Inhaler ◽  
Research Direction ◽  
Particle Methods ◽  
Future Research ◽  
High Dose ◽  
Dry Powder ◽  
Multi Scale ◽  
Wide Range ◽  
Computational Fluid Dynamics Cfd ◽  
Discrete Element Methods

Dry powder inhaler (DPI) is a device used to deliver a drug in dry powder form to the lungs. A wide range of DPI products is currently available, with the choice of DPI device largely depending on the dose, dosing frequency and powder properties of formulations. Computational fluid dynamics (CFD), together with various particle motion modelling tools, such as discrete particle methods (DPM) and discrete element methods (DEM), have been increasingly used to optimise DPI design by revealing the details of flow patterns, particle trajectories, de-agglomerations and depositions within the device and the delivery paths. This review article focuses on the development of the modelling methodologies of flow and particle behaviours in DPI devices and their applications to device design in several emerging fields. Various modelling methods, including the most recent multi-scale approaches, are covered and the latest simulation studies of different devices are summarised and critically assessed. The potential and effectiveness of the modelling tools in optimising designs of emerging DPI devices are specifically discussed, such as those with the features of high-dose, pediatric patient compatibility and independency of patients’ inhalation manoeuvres. Lastly, we summarise the challenges that remain to be addressed in DPI-related fluid and particle modelling and provide our thoughts on future research direction in this field.

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