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.

Response Surface Methodology (RSM) Approach for Optimizing the Actuator Nozzle Design of Pressurized Metered-Dose Inhaler (pMDI)

Recently, a remarkable scientific interest in the inhalation therapy for respiratory disease was spiked attributed to the growing prevalence of asthma, chronic obstructive pulmonary disease (COPD), and coronavirus disease 2019 (COVID-19) pandemic. A pressurized metered-dose inhaler (pMDI) is the best option by providing fast and efficient symptomatic relief within the lung. However, the rapid development of new inhalation devices could be critical in this competitive environment, and optimizing the inhalation devices could be costly and time-consuming. Therefore, the computational fluid dynamic (CFD) approach was used to shorten the development time. In this study, response surface methodology (RSM) in ANSYS version 19.2 was introduced to discover the optimal design for the actuator nozzle to increase the performance of pMDI. Three (3) parameters (orifice diameter, length, and actuator angle) were optimized, and the best design was selected according to the analysis of particle tracking. The analysis of spray plume was also conducted and compared to analyze the spray plume characteristic produced by three designs. The result showed that RSM generated three (3) models for the new design of the actuator nozzle (Design A, Design B, and Design C). Among three (3) designs, actuator nozzle design C showed the highest injection particle number (232457) and the only one that produced maximum particles velocity magnitude in the acceptable ranges (35.67m/s). All three designs showed a similar pattern as maximum particle velocity magnitude decreased along the axial length until they match the air velocity (0.03-0.04 m/s). Furthermore, the spray plume length, angle, and width were observed to increase linearly with the decreasing maximum particle velocity magnitude. Thus, this study suggested that design C might have the potential as a new actuator nozzle to develop future pMDI to relieve the respiratory condition.

Degradation of lipid based drug delivery formulations during nebulization

Encapsulating pharmaceuticals in protective lipid based nanoparticles, and nebulizing them towards the target area in the body offers a range of clinical advantages. However, the process of nebulization might possibly damage sensitive nanoparticle structures, such as liposomes, resulting in loss of active pharmaceutical ingredients. We compare this loss for two types of lung inhalation devices: high-frequency piezo-actuated vibrating mesh nebulizers and non-actuated continuous jet nebulizers. We find that vibrating mesh nebulizers cause model liposomes to release more than ten times as much encapsulated material as the continuous jet nebulizers because the energies involved in nebulization are much larger. This result highlights the importance of applying a mild nebulization technology when administering shear-sensitive drug formulations such as lipid nanoparticle based drugs to the lungs.

SUBTLETIES OF USING INHALATION DEVICES IN PEDIATRIC PRACTICE

SUBTLETIES OF USING INHALATION DEVICES IN PEDIATRIC PRACTICE O. Katilov National Pirogov Memorial Medical University, Vinnytsya, Ukraine Abstract. Inhalation therapy plays an important role in the treatment of a number of respiratory diseases. Due to the direct delivery of drugs to the respiratory tract, the development of systemic side effects is minimized, which is extremely important for pediatric patients. Today, inhalation therapy is the basic method of treating bronchial asthma. But about 1/3 of patients with bronchoobstructive diseases perform inhalations with serious technical errors. As a result of improper inhalation technique, the drug enters the respiratory tract in insufficient quantities, which leads to poor disease control and frequent exacerbations. Particular difficulties in the use of inhalation devices arise in pediatric practice. Children under 3 years of age are usually unable to perform specific breathing maneuvers. Therefore, for children under 5 years of age, the best choice among delivery devices is metered-dose inhaler (MDI) with a valve spacer. An alternative method of drug delivery is nebulizer therapy. Children older than 5 years can already use dry powder inhalers (DPI). This literature review presents the classification and types of DPI, considers their main technical characteristics, the criteria of the “ideal” delivery device. Based on the literature, it is established that the most optimal inhalation device for children older than 5 years is Easyhaler, which has a number of advantages. It is easy to use. The MDI-like design contributes to the commitment and correct, without technical errors, use of the inhaler. Easyhaler has the appropriate aerodynamic characteristics of the released dose, safe and efficient delivery of the drug. Key words: inhalation therapy, delivery devices, dry powder inhalers, children, bronchial asthma.