Effective Treatment of Respiratory Disease

Treatment could be limited by a one-size-fits-all approach to inhaler design.

To challenge the current ‘one-size-fits-all’ approach to inhaler design and manufacture, researchers at technology and product development company Sagentia, have released findings around the correlation between the effectiveness of dry powder inhalers (DPIs) and a person’s unique physiological characteristics, such as age and height. The research, being presented for the first time today at the annual Drug Delivery to the Lungs conference in Edinburgh, has important implications for the effective treatment of asthma and chronic obstructive pulmonary disease (COPD).

DPIs rely on a ‘forced inspiratory manoeuvre’, or deep breath, by the patient in order to disperse the powdered drug and deliver a therapeutic aerosol to the lungs.  Sagentia’s data, obtained from a study of 90 healthy volunteers aged 4 to 50, revealed that the forced inspiratory manoeuvre of an adult produces three times the energy of that of a child.  More importantly, it was revealed that even a young child produces far more energy in a single breath than is required to disperse and aerosolise drug formulation in a DPI.  To illustrate the amount of excess energy produced, consider that only half of the energy provided in one forced inspiratory manoeuvre by a child would be required to accelerate a typical dose of drug formulation to a speed of 1,500 mph.  A healthy adult could accelerate the same dose to a velocity five times the speed of sound.

 

The researchers believe that the energy available could be used to improve the effectiveness of drug delivery to the lungs and help increase the compliant use of inhalers.  This is important because research has shown that inhalers are typically misused in more than 50% of cases (up to 90% during clinical trials[1]) and the most widely prescribed dry powder inhaler on the market delivers little more than 20% of the drug to the lungs[2].  The implications of this become clear when you consider that a US study revealed that the non compliant use of inhalers can cost up to $15.7bn per year excluding the knock-on costs associated with hospital admissions and productive time lost.[3]
Sagentia’s in-house research indicates that an important factor in the compliant use of DPIs could be the airflow resistance of the inhaler:  the lower the resistance, the more comfortable the device is to use.  Until now, however, many devices have been designed with higher airflow resistances in order to improve the dispersion of the drug ready for delivery to the lungs across all patient groups.  Sagentia’s research suggests that the airflow resistance of a typical DPI could be halved without reducing the energy budget to disperse the drug.

 

David Harris , an expert in respiratory drug delivery at Sagentia who will present his findings at the Drug Delivery to the Lungs conference, comments:  “Developing a better understanding of the physics at play in DPIs, combined with good usability research and design, should allow better devices to be developed in the future.

 

“Because these data are based on healthy individuals further research is now required, amongst larger and more targeted sample groups, to test the energy values and airflow resistance preferences for sufferers of asthma and COPD at different ages, heights and also severity of disease.  These data could then be used to design an inhaler device that is more efficient and comfortable to use across all target groups.  This is important because a device that is deemed too uncomfortable may not be used at all.”

 

The Science:
A child’s inspiratory manoeuvre produces an average of 4.9 joules of energy, compared to an average of 14.8 joules for an adult, at airflow resistances at or above 25 Pa1/2 L s-1.  In contrast, only tens of millijoules of energy are typically required to disperse and aerosolise a dose of powdered drug formulation.

 

As a child grows into an adult:
  •  Peak inspiratory power increases three fold, from 8 aW for children to 22 aW for adults
  • Peak power flow rate and peak inspiratory flow rate approximately double (110 to 220 L/min and 200 to 400 L/min respectively)

 

A strong correlation was found between a person’s height and the energy they produced during inspiration above resistances of 25 Pa1/2 L s-1:
§          E ≈ 0.036e3.41h
§          Where E = energy (J) and h = height (m)

 

All volunteers generally preferred lower airflow resistances, with their peak preference occurring at ~17 Pa1/2 L s-1.

 


[2] de Boer AH et.al., Intl J Pharm, 1996; 138:45-56.

 

[3] Fink, J.B. & Rubin, B.K., Respiratory Care, vol 50 No. 10, pp1360-1375.