Satisfaction with and use of inhalation devices in patients with bronchial asthma v1

Introduction:Greater patient satisfaction with his or her inhalation device is associated with better adherence to pharmacological therapy and better clinical outcomes, such as improved quality of life, greater asthma control and fewer exacerbations. Objective: To determine the satisfaction level of a group of patients diagnosed with bronchial asthma with respect to their devices for inhalation of bronchodilators and glucocorticoids. Methods: This was a cross-sectional study of patients treated in the Colombian health system. Satisfaction with inhalation devices was evaluated with the FSI-10 instrument (Evaluation of Satisfaction with the Inhaler). A score of ≥ 44 points indicated high satisfaction. Results: In total, 362 patients from 59 cities were identified, their median age was 55 years, and 74.6% were women. The average score was 44.6; 68.5% of patients showed high satisfaction, especially with metered-dose inhalers, and 63.4% did not use them with an inhalocamera. Users of metered-dose inhalers (OR: 1.80; 95% CI: 1.05–3.10) and those who received training by medical specialists (OR: 2.29; 95% CI: 1.33–3.97) had high satisfaction, while patients who were older (40–64 vs. <40 years: OR: 0.38; 95% CI: 0.19–0.78 and ≥ 65 vs. <40 years: OR: 0.35; 95% CI: 0.15–0.81), resided in the Caribbean region (OR: 0.48; 95% CI: 0.29–0.81) and had a university education (OR: 0.54; 95% CI: 0, 32–0.90) had lower satisfaction. Conclusions: The majority of patients with asthma used metered-dose inhalers without an inhalocamera, and their overall satisfaction was higher than that of patients using other inhalation devices. Patients who received special training from medical specialists showed better satisfaction.

Understanding the Importance of Capsules in Dry Powder Inhalers

Pulmonary drug delivery is currently the focus of research and development because of its potential to produce maximum therapeutic benefit to patients by directing the drug straight to the lung disease site. Among all the available delivery options, one popular, proven and convenient inhaler device is the capsule-based dry powder inhaler (cDPI) for the treatment of an increasingly diverse range of diseases. cDPIs use a hard capsule that contains a powder formulation which consists of a mixture of a micronized drug and a carrier usually the lactose, known for its good lung tolerance. The capsule is either inserted into the device during manufacturer or by the patient prior to use. After perforating, opening or cut the capsule in the device, patients take a deep and rapid breath to inhale the powder, using air as the vector of drug displacement. The system is simple, relatively cheap and characterized by a lower carbon footprint than that of pressurized metered dose inhalers. This article reviews cDPI technology, focusing particularly on the importance of capsule characteristics and their function as a drug reservoir in cDPIs.

Medication Administration With Inhalers or Nebulizers

Delivery of medication via metered-dose inhalers to children or adults with asthma, or adults with chronic obstructive pulmonary disease at emergency departments or intensive care units, may be as effective as nebulizers in terms of clinical parameters and health care resource use. Limited data on adverse events showed no significant differences between metered-dose inhalers and nebulizers. No evidence was found on the clinical effectiveness of dry powder inhalers in comparison with nebulizers or metered-dose inhalers. No evidence was found on the cost-effectiveness of medication administration via metered-dose inhalers, nebulizers, or dry powder inhalers in comparison with each other. No evidence-based guidelines with recommendations regarding the comparative use of metered-dose inhalers, dry powder inhalers, or nebulizers for administration of medication were identified.

Study of pressurised metered dose inhalers for the purpose of standardization of quality attributes characterizing uniformity of dosing

Aim. The purpose was to provide the rationale of test in regard to uniformity of fine particles dose for pressurised metered dose inhalers (pMDIs). Materials and methods. The pMDIs containing suspensions of salbutamol sulfate (SS) or solutions of beclometasone dipropionate (BD) were studied by laser diffraction and high performance liquid chromatography (HPLC). The particle size distribution of SS, the average dose mass and uniformity of dose mass, the average delivered dose and the uniformity of delivered dose, the average fine particles dose and uniformity of fine particles dose were determined. Apparatus A was used for assessment of fine particles dose. Results. The two analytical procedures for the quantitative determination of SS and BD by HPLC were validated in the ranges with low concentrations of these substances. The 5 medicinal products in pMDI dosage form were studied: 3 preparations were with SS and 2 ones contained BD. It was shown that three products with SS were very similar in regard to particle size distribution in containers and the average values of delivered dose were almost the same, but these products were different in the average dose mass and fine particle dose. According to the research results, the expediency of determining the average dose mass and the tests concerning uniformity of dosing of preparations by dose mass and by fine particle dose was substantiated. It was shown that in the case of pMDI the dosing of solutions of BD was more uniform compared to suspensions of SS. The approaches of leading and other pharmacopoeias concerning uniformity of dosing for pMDIs were critically discussed. The expediency of determination of uniformity of fine particle dose at the stage of pharmaceutical development was substantiated, as the therapeutic effect depends on fine particle dose. Issues concerning standardization pMDIs in regard to uniformity of fine particle dose were discussed. Conclusions. The expediency of standardization and quality control of pMDIs in regard to such attributes as the average dose mass, which characterizes the volume of the metering chamber of the valve as well as the uniformity of the dose mass and the uniformity of fine particle dose, which assure the therapeutic effect of each dose of the product was substantiated