Dry-powder inhaler

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Three types of dry powder inhalers: Turbuhaler, Accuhaler and Ellipta devices. Dry powder inhalers.jpg
Three types of dry powder inhalers: Turbuhaler, Accuhaler and Ellipta devices.

A dry-powder inhaler (DPI) is a device that delivers medication to the lungs in the form of a dry powder. DPIs are commonly used to treat respiratory diseases such as asthma, bronchitis, emphysema and COPD although DPIs (such as inhalable insulin) have also been used in the treatment of diabetes mellitus. [1]

Contents

DPIs are an alternative to the aerosol-based inhalers commonly called metered-dose inhaler (or MDI). The DPIs may require some procedure to allow a measured dose of powder to be ready for the patient to take. The medication is commonly held either in a capsule for manual loading or in a proprietary form inside the inhaler. Once loaded or actuated, the operator puts the mouthpiece of the inhaler into their mouth and takes a sharp, deep inhalation (ensuring that the medication reaches the lower parts of the lungs), holding their breath for 5–10 seconds.

There are a variety of such devices. The dose that can be delivered is typically less than a few tens of milligrams in a single breath since larger powder doses may lead to provocation of cough.

Most DPIs rely on the force of patient inhalation to entrain powder from the device and subsequently break-up the powder into particles that are small enough to reach the lungs. [2] For this reason, insufficient patient inhalation flow rates may lead to reduced dose delivery and incomplete deaggregation of the powder, leading to unsatisfactory device performance. Thus, most DPIs have a minimum inspiratory effort that is needed for proper use and it is for this reason that such DPIs are normally used only in older children and adults.

Inhaler Technique and Use

While DPIs are commonly used in the treatment of lung-based disorders, their use requires dexterity to complete the required sequential steps to achieve application of these devices. Incorrect completion of one or more steps in the use of a DPI can substantially reduce the delivery of the administrated medication and consequently its effectiveness and safety. Numerous studies have demonstrated that between 50 and 100% of patients do not use their inhaler devices correctly, with patients often unaware that they are using their inhaled medication incorrectly. [3] [4] Incorrect inhaler technique has been associated with poorer outcomes. [4] [5]

Lactose

Some powder inhalers use lactose to:

  1. Carry the fine particles of the active pharmaceutical ingredient (which must be fine to reach its target)
  2. Improve the flow-ability of the powder during manufacturing and to aid handling
  3. Act as a bulking agent
  4. Aid in powder uptake from the device during inhalation and aerosolization

It has been suggested that such lactose may be harmful to lactose intolerant people, [6] and some doctors advise patients not to use lactose containing DPIs [7] to minimize the risk of hypersensitivity reactions. [8]

Storage

DPI medication must be stored in a dry place in a temperature of not more than 25 °C (77 °F) and humidity between 40 and 50% in a sealed packaging, since exposure of the powder to moisture degrades the ability of the device to disperse its medication as a fine powder upon inhalation. Some medication also needs photo protection.

See also

Related Research Articles

A bronchodilator or broncholytic is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. Bronchodilators may be originating naturally within the body, or they may be medications administered for the treatment of breathing difficulties, usually in the form of inhalers. They are most useful in obstructive lung diseases, of which asthma and chronic obstructive pulmonary disease are the most common conditions. Although this remains somewhat controversial, they might be useful in bronchiolitis and bronchiectasis. They are often prescribed but of unproven significance in restrictive lung diseases.

<span class="mw-page-title-main">Inhaler spacer</span> Medical device

A spacer is a device used to increase the ease of giving aerosolized medication from a metered-dose inhaler (MDI). It adds space in the form of a tube or "chamber" between the mouth and canister of medication. Most spacers have a one-way valve that allows the person to inhale the medication while inhaling and exhaling normally; these are often referred to as valved holding chambers (VHC).

<span class="mw-page-title-main">Salbutamol</span> Short-acting bronchodilator used for acute asthma

Salbutamol, also known as albuterol and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist that causes relaxation of airway smooth muscle. It is used to treat asthma, including asthma attacks and exercise-induced bronchoconstriction, as well as chronic obstructive pulmonary disease (COPD). It may also be used to treat high blood potassium levels. Salbutamol is usually used with an inhaler or nebulizer, but it is also available in a pill, liquid, and intravenous solution. Onset of action of the inhaled version is typically within 15 minutes and lasts for two to six hours.

<span class="mw-page-title-main">Nebulizer</span> Drug delivery device

In medicine, a nebulizer or nebuliser is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of asthma, cystic fibrosis, COPD and other respiratory diseases or disorders. They use oxygen, compressed air or ultrasonic power to break up solutions and suspensions into small aerosol droplets that are inhaled from the mouthpiece of the device. An aerosol is a mixture of gas and solid or liquid particles.

<span class="mw-page-title-main">Ipratropium bromide</span> Type of anticholinergic

Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.

<span class="mw-page-title-main">Salmeterol</span> Chemical compound

Salmeterol is a long-acting β2 adrenergic receptor agonist (LABA) used in the maintenance and prevention of asthma symptoms and maintenance of chronic obstructive pulmonary disease (COPD) symptoms. Symptoms of bronchospasm include shortness of breath, wheezing, coughing and chest tightness. It is also used to prevent breathing difficulties during exercise.

<span class="mw-page-title-main">Budesonide/formoterol</span> Medication for asthma & chronic obstructive pulmonary disease

Budesonide/formoterol, sold under the brand name Symbicort among others, is a fixed-dose combination medication used in the management of asthma or chronic obstructive pulmonary disease (COPD). It contains budesonide, a steroid and formoterol, a long-acting β2-agonist (LABA). The product monograph does not support its use for sudden worsening or treatment of active bronchospasm. However, a 2020 review of the literature does support such use. It is used by breathing in the medication.

<span class="mw-page-title-main">Formoterol</span> Bronchiodilator Drug

Formoterol, also known as eformoterol, is a long-acting β2 agonist (LABA) used as a bronchodilator in the management of asthma and chronic obstructive pulmonary disease (COPD). Formoterol has an extended duration of action compared to short-acting β2 agonists such as salbutamol (albuterol), which are effective for 4 h to 6 h. Formoterol has a relatively rapid onset of action compared to other LABAs, and is effective within 2-3 minutes. The 2022 Global Initiative for Asthma report recommends a combination formoterol/inhaled corticosteroid inhaler as both a preventer and reliever treatment for asthma in adults. In children, a short-acting β2 adrenergic agonist is still recommended.

<span class="mw-page-title-main">Inhaler</span> Medical device used to deliver medicines into lungs

An inhaler is a medical device used for delivering medicines into the lungs through the work of a person's breathing. This allows medicines to be delivered to and absorbed in the lungs, which provides the ability for targeted medical treatment to this specific region of the body, as well as a reduction in the side effects of oral medications. There are a wide variety of inhalers, and they are commonly used to treat numerous medical conditions with asthma and chronic obstructive pulmonary disease (COPD) being among the most notable.

Beta<sub>2</sub>-adrenergic agonist Compounds that bind to and activate adrenergic beta-2 receptors

Beta2-adrenergic agonists, also known as adrenergic β2 receptor agonists, are a class of drugs that act on the β2 adrenergic receptor. Like other β adrenergic agonists, they cause smooth muscle relaxation. β2 adrenergic agonists' effects on smooth muscle cause dilation of bronchial passages, vasodilation in muscle and liver, relaxation of uterine muscle, and release of insulin. They are primarily used to treat asthma and other pulmonary disorders. Bronchodilators are considered an important treatment regime for chronic obstructive pulmonary disease (COPD) and are usually used in combination with short acting medications and long acting medications in a combined inhaler.

<span class="mw-page-title-main">Fluticasone propionate</span> Medication

Fluticasone propionate, sold under the brand names Flovent and Flonase among others, is a glucocorticoid steroid medication. When inhaled it is used for the long term management of asthma and COPD. In the nose it is used for hay fever and nasal polyps. It can also be used for mouth ulcers. It works by decreasing inflammation.

<span class="mw-page-title-main">Metered-dose inhaler</span> Device that helps deliver a specific amount of medication to the lungs

A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases. The medication in a metered dose inhaler is most commonly a bronchodilator, corticosteroid or a combination of both for treating asthma and COPD. Other medications less commonly used but also administered by MDI are mast cell stabilizers, such as cromoglicate or nedocromil.

<span class="mw-page-title-main">Fluticasone furoate</span> Corticosteroid

Fluticasone furoate, sold under the brand name Flonase Sensimist among others, is a corticosteroid for the treatment of non-allergic and allergic rhinitis administered by a nasal spray. It is also available as an inhaled corticosteroid to help prevent and control symptoms of asthma. It is derived from cortisol. Unlike fluticasone propionate, which is only approved for children four years and older, fluticasone furoate is approved in children as young as two years of age when used for allergies.

Ciclosporin is a cyclic polypeptide that has been used widely as an orally-available immunosuppressant. It was originally used to prevent transplant rejection of solid organs but has also found use as an orally administered agent to treat psoriasis, rheumatoid arthritis, dry eye and other auto-immune related conditions. A variety of pre-clinical and clinical studies have been and are investigating its use to treat lung-related disorders via inhalation.

<span class="mw-page-title-main">Tiotropium bromide</span> Long-acting bronchodilator in the maintenance of COPD and asthma

Tiotropium bromide, sold under the brand name Spiriva among others, is a long-acting bronchodilator used in the management of chronic obstructive pulmonary disease (COPD) and asthma. Specifically it is used during periods of breathing difficulty to prevent them from getting worse, rather than to prevent them from happening. It is used by inhalation through the mouth. Onset typically begins within half an hour and lasts for 24 hours.

Ellipta is part of GlaxoSmithKline's trade names of several inhalable asthma and chronic obstructive airway disease (COPD) combination medications that make use of the same type of inhaler:

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Budesonide/glycopyrronium bromide/formoterol, sold under the brand name Breztri Aerosphere among others, is an inhalable fixed-dose combination medication for the treatment of chronic obstructive pulmonary disease (COPD). It contains budesonide, glycopyrronium bromide, and formoterol fumarate dihydrate. It is inhaled.

Commonly prescribed drugs are drugs that are frequently provided by doctors in a prescription to treat a certain disease. These drugs are often first-line treatment for the target diseases and are effective in tackling the symptoms. An example of the target disease is ischemic heart disease. Some examples of commonly prescribed drugs for this disease are beta-blockers, calcium-channel blockers and nitrates.

<span class="mw-page-title-main">Pulmonary drug delivery</span> Route of administration by inhalation

Pulmonary drug delivery is a route of administration in which patients use an inhaler to inhale their medications and drugs are absorbed into the bloodstream via the lung mucous membrane. This technique is most commonly used in the treatment of lung diseases, for example, asthma and chronic obstructive pulmonary disease (COPD). Different types of inhalers include metered-dose inhalers (MDI), dry powder inhalers (DPI), soft mist inhalers (SMI) and nebulizers. The rate and efficacy of pulmonary drug delivery are affected by drug particle properties, breathing patterns and respiratory tract geometry.

References

  1. "Exubera Prescribing Information" (PDF). FDA.gov. Pfizer. April 2008. Archived from the original (PDF) on January 18, 2009. Retrieved 2009-02-27.
  2. Finlay, Warren H. (2001). The mechanics of inhaled pharmaceutical aerosols: an introduction. Boston: Academic Press. ISBN   978-0-12-256971-5.
  3. Vanderman, Adam J.; Moss, Jason M.; Bailey, Janine C.; Melnyk, S. Dee; Brown, Jamie N. (February 2015). "Inhaler Misuse in an Older Adult Population". The Consultant Pharmacist. 30 (2): 92–100. doi:10.4140/tcp.n.2015.92. PMID   25695415.
  4. 1 2 Gregoriano, Claudia; Dieterle, Thomas; Breitenstein, Anna-Lisa; Dürr, Selina; Baum, Amanda; Maier, Sabrina; Arnet, Isabelle; Hersberger, Kurt E.; Leuppi, Jörg D. (2018-12-03). "Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial". Respiratory Research. 19 (1): 237. doi: 10.1186/s12931-018-0936-3 . ISSN   1465-993X. PMC   6276152 . PMID   30509268.
  5. Maricoto, Tiago; Monteiro, Luís; Gama, Jorge M. R.; Correia-de-Sousa, Jaime; Taborda-Barata, Luís (2018-10-06). "Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis". Journal of the American Geriatrics Society. 67 (1): 57–66. doi: 10.1111/jgs.15602 . hdl: 10400.6/9162 . ISSN   1532-5415. PMID   30291745.
  6. Changes in Inhaler Devices for Asthma And COPD – Health – RedOrbit
  7. "Milk Proteins and Allergy Medications". Archived from the original on 2015-11-28. Retrieved 2016-01-27.
  8. Robles, J; Motheral, L (2014). "Hypersensitivity reaction after inhalation of a lactose-containing dry powder inhaler". J Pediatr Pharmacol Ther. 19 (3): 206–11. doi:10.5863/1551-6776-19.3.206. PMC   4187530 . PMID   25309152.

Further reading