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Published in: Advances in Therapy 10/2019

Open Access 01-10-2019 | Bronchial Asthma | Commentary

Understanding Dry Powder Inhalers: Key Technical and Patient Preference Attributes

Authors: Mark L. Levy, Will Carroll, José L. Izquierdo Alonso, Claus Keller, Federico Lavorini, Lauri Lehtimäki

Published in: Advances in Therapy | Issue 10/2019

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Abstract

Inhalable medications for patients with asthma and chronic obstructive pulmonary disease (COPD) can be confusing even for health care professionals because of the multitude of available devices each with different operating principles. Dry powder inhalers (DPI) are a valuable option for almost all of the patients with asthma or COPD. Based on recorded patient inspiratory profiles, the peak inspiratory flow requirement of 30 L min−1 of high-resistance devices does not usually pose any practical limitations for the patients. Suboptimal adherence and errors in device handling are common and require continuous checking and patient education in order to avoid these pitfalls of all inhalation therapy. The aim of this opinion paper is to describe the working principles of DPIs and to summarise their key properties in order to help prescribing the correct inhaler for each patient.
Funding: Orion Pharma.
Literature
2.
go back to reference Chrystyn H. Closer to an “ideal inhaler” with the Easyhaler: an innovative dry powder inhaler. Clin Drug Investig. 2006;26:175–83.CrossRefPubMed Chrystyn H. Closer to an “ideal inhaler” with the Easyhaler: an innovative dry powder inhaler. Clin Drug Investig. 2006;26:175–83.CrossRefPubMed
4.
5.
go back to reference Lavorini F, Corrigan CJ, Barnes PJ, Dekhuijzen PRN, Levy ML, Pedersen S, et al. Retail sales of inhalation devices in European countries: so much for a global policy. Respir Med. 2011;105:1099–103.CrossRefPubMed Lavorini F, Corrigan CJ, Barnes PJ, Dekhuijzen PRN, Levy ML, Pedersen S, et al. Retail sales of inhalation devices in European countries: so much for a global policy. Respir Med. 2011;105:1099–103.CrossRefPubMed
6.
go back to reference Sellers WFS. Asthma pressurised metered dose inhaler performance: propellant effect studies in delivery systems. Allergy, Asthma Clin Immunol. 2017;13:30.CrossRef Sellers WFS. Asthma pressurised metered dose inhaler performance: propellant effect studies in delivery systems. Allergy, Asthma Clin Immunol. 2017;13:30.CrossRef
8.
go back to reference Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37:1308–417.CrossRefPubMed Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37:1308–417.CrossRefPubMed
9.
go back to reference Frijlink HW, De Boer AH. Dry powder inhalers for pulmonary drug delivery. Expert Opin Drug Deliv. 2004;1:67–86.CrossRefPubMed Frijlink HW, De Boer AH. Dry powder inhalers for pulmonary drug delivery. Expert Opin Drug Deliv. 2004;1:67–86.CrossRefPubMed
10.
go back to reference Kinnunen H, Hebbink G, Peters H, Shur J, Price R. An investigation into the effect of fine lactose particles on the fluidization behaviour and aerosolization performance of carrier-based dry powder inhaler formulations. AAPS PharmSciTech. 2014;15:898–909.CrossRefPubMedPubMedCentral Kinnunen H, Hebbink G, Peters H, Shur J, Price R. An investigation into the effect of fine lactose particles on the fluidization behaviour and aerosolization performance of carrier-based dry powder inhaler formulations. AAPS PharmSciTech. 2014;15:898–909.CrossRefPubMedPubMedCentral
11.
go back to reference Ho R, Muresan AS, Hebbink GA, Heng JYY. Influence of fines on the surface energy heterogeneity of lactose for pulmonary drug delivery. Int J Pharm. 2010;388:88–94.CrossRefPubMed Ho R, Muresan AS, Hebbink GA, Heng JYY. Influence of fines on the surface energy heterogeneity of lactose for pulmonary drug delivery. Int J Pharm. 2010;388:88–94.CrossRefPubMed
12.
go back to reference Zeng XM, Martin GP, Tee SK, Ghoush AA, Marriott C. Effects of particle size and adding sequence of fine lactose on the deposition of salbutamol sulphate from a dry powder formulation. Int J Pharm. 1999;182:133–44.CrossRefPubMed Zeng XM, Martin GP, Tee SK, Ghoush AA, Marriott C. Effects of particle size and adding sequence of fine lactose on the deposition of salbutamol sulphate from a dry powder formulation. Int J Pharm. 1999;182:133–44.CrossRefPubMed
13.
go back to reference Adi H, Larson I, Chiou H, Young P, Traini D, Stewart P. Role of Agglomeration in the Dispersion of Salmeterol Xinafoate from Mixtures for Inhalation with Differing Drug to Fine Lactose Ratios. J Pharm Sci. 2008;97:3140–52.CrossRefPubMed Adi H, Larson I, Chiou H, Young P, Traini D, Stewart P. Role of Agglomeration in the Dispersion of Salmeterol Xinafoate from Mixtures for Inhalation with Differing Drug to Fine Lactose Ratios. J Pharm Sci. 2008;97:3140–52.CrossRefPubMed
14.
go back to reference Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50:1209–27.PubMed Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50:1209–27.PubMed
15.
go back to reference Weers J, Clark A. The Impact of Inspiratory Flow Rate on Drug Delivery to the Lungs with Dry Powder Inhalers. Pharm Res. United States. 2017;34:507–28. Weers J, Clark A. The Impact of Inspiratory Flow Rate on Drug Delivery to the Lungs with Dry Powder Inhalers. Pharm Res. United States. 2017;34:507–28.
16.
go back to reference Azouz W, Chrystyn H. Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice. Prim Care Respir J. 2012;21:208–13.CrossRefPubMed Azouz W, Chrystyn H. Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice. Prim Care Respir J. 2012;21:208–13.CrossRefPubMed
18.
go back to reference Malmberg LP, Everard ML, Haikarainen J, Lähelmä S. Evaluation of in vitro and in vivo flow rate dependency of budesonide/formoterol Easyhaler®. J Aerosol Med Pulm Drug Deliv. 2014;27:329–40.CrossRefPubMedPubMedCentral Malmberg LP, Everard ML, Haikarainen J, Lähelmä S. Evaluation of in vitro and in vivo flow rate dependency of budesonide/formoterol Easyhaler®. J Aerosol Med Pulm Drug Deliv. 2014;27:329–40.CrossRefPubMedPubMedCentral
19.
go back to reference Delvadia R, Hindle M, Longest PW, Byron PR. In vitro tests for aerosol deposition II: IVIVCs for different dry powder inhalers in normal adults. J Aerosol Med Pulm Drug Deliv. 2013;26:138–44.CrossRefPubMed Delvadia R, Hindle M, Longest PW, Byron PR. In vitro tests for aerosol deposition II: IVIVCs for different dry powder inhalers in normal adults. J Aerosol Med Pulm Drug Deliv. 2013;26:138–44.CrossRefPubMed
20.
go back to reference Buttini F, Brambilla G, Copelli D, Sisti V, Balducci AG, Bettini R, et al. Effect of flow rate on in vitro aerodynamic performance of NEXThaler® in comparison with diskus® and Turbohaler® dry powder inhalers. J Aerosol Med Pulm Drug Deliv. 2016;29:167–78.CrossRefPubMedPubMedCentral Buttini F, Brambilla G, Copelli D, Sisti V, Balducci AG, Bettini R, et al. Effect of flow rate on in vitro aerodynamic performance of NEXThaler® in comparison with diskus® and Turbohaler® dry powder inhalers. J Aerosol Med Pulm Drug Deliv. 2016;29:167–78.CrossRefPubMedPubMedCentral
22.
go back to reference Ghosh S, Ohar JA, Drummond MB. Peak Inspiratory Flow Rate in Chronic Obstructive Pulmonary Disease: implications for Dry Powder Inhalers. J Aerosol Med Pulm Drug Deliv. 2017;30:381–7.CrossRefPubMedPubMedCentral Ghosh S, Ohar JA, Drummond MB. Peak Inspiratory Flow Rate in Chronic Obstructive Pulmonary Disease: implications for Dry Powder Inhalers. J Aerosol Med Pulm Drug Deliv. 2017;30:381–7.CrossRefPubMedPubMedCentral
23.
go back to reference Voss A, Finlay WH. Deagglomeration of dry powder pharmaceutical aerosols. Int J Pharm. 2002;248:39–50CrossRefPubMed Voss A, Finlay WH. Deagglomeration of dry powder pharmaceutical aerosols. Int J Pharm. 2002;248:39–50CrossRefPubMed
24.
go back to reference Mäkelä M, Chrystyn H, Lavorini F, Canonica GW. Back to Basics in Asthma and COPD: optimising the Patient Journey. Eur Med J Respir. 2018;6:47–54. Mäkelä M, Chrystyn H, Lavorini F, Canonica GW. Back to Basics in Asthma and COPD: optimising the Patient Journey. Eur Med J Respir. 2018;6:47–54.
25.
go back to reference Clark AR, Hollingworth AM. The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers–implications for in vitro testing. J Aerosol Med. 1993;6:99–110.CrossRefPubMed Clark AR, Hollingworth AM. The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers–implications for in vitro testing. J Aerosol Med. 1993;6:99–110.CrossRefPubMed
26.
go back to reference Palander A, Mattila T, Karhu M, Muttonen E. In vitro Comparison of Three Salbutamol-Containing Multidose Dry Powder Inhalers. Clin Drug Investig. 2000;20:25–33.CrossRef Palander A, Mattila T, Karhu M, Muttonen E. In vitro Comparison of Three Salbutamol-Containing Multidose Dry Powder Inhalers. Clin Drug Investig. 2000;20:25–33.CrossRef
27.
go back to reference Jõgi R, Lähelmä S, Vahteristo M, Happonen A, Haikarainen J. In vitro flow rate dependency of delivered dose and fine particle dose of salmeterol/fluticasone propionate easyhaler and seretide diskus with patient flow rates collected in a randomized controlled trial. J Aerosol Med Pulm Drug Deliv. 2018;31:jamp.2018.1463. Jõgi R, Lähelmä S, Vahteristo M, Happonen A, Haikarainen J. In vitro flow rate dependency of delivered dose and fine particle dose of salmeterol/fluticasone propionate easyhaler and seretide diskus with patient flow rates collected in a randomized controlled trial. J Aerosol Med Pulm Drug Deliv. 2018;31:jamp.2018.1463.
28.
go back to reference Haidl P, Heindl S, Siemon K, Bernacka M, Cloes RM. Inhalation device requirements for patients’ inhalation maneuvers. Respir Med. 2016;118:65–75.CrossRefPubMed Haidl P, Heindl S, Siemon K, Bernacka M, Cloes RM. Inhalation device requirements for patients’ inhalation maneuvers. Respir Med. 2016;118:65–75.CrossRefPubMed
29.
go back to reference Azouz W, Chetcuti P, Hosker HSR, Saralaya D, Stephenson J, Chrystyn H. The inhalation characteristics of patients when they use different dry powder inhalers. J Aerosol Med Pulm Drug Deliv. 2015;28:35–42.CrossRefPubMed Azouz W, Chetcuti P, Hosker HSR, Saralaya D, Stephenson J, Chrystyn H. The inhalation characteristics of patients when they use different dry powder inhalers. J Aerosol Med Pulm Drug Deliv. 2015;28:35–42.CrossRefPubMed
30.
go back to reference Malmberg LP, Rytilä P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257–62.CrossRefPubMedPubMedCentral Malmberg LP, Rytilä P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257–62.CrossRefPubMedPubMedCentral
31.
go back to reference Haikarainen J, Selroos O, Löytänä T, Metsärinne S, Happonen A, Rytilä P. Budesonide/Formoterol Easyhaler®: performance under simulated real-life conditions. Pulm Ther. 2017;3:125–38.CrossRef Haikarainen J, Selroos O, Löytänä T, Metsärinne S, Happonen A, Rytilä P. Budesonide/Formoterol Easyhaler®: performance under simulated real-life conditions. Pulm Ther. 2017;3:125–38.CrossRef
32.
go back to reference Abadelah M, Hazim F, Chrystyn H, Bagherisadeghi G, Rahmoune H, Larhrib H. Effect of maximum inhalation flow and inhaled volume on formoterol drug deposition in vitro from an Easyhaler® dry powder inhaler. Eur J Pharm Sci. 2017;104:180–7.CrossRefPubMed Abadelah M, Hazim F, Chrystyn H, Bagherisadeghi G, Rahmoune H, Larhrib H. Effect of maximum inhalation flow and inhaled volume on formoterol drug deposition in vitro from an Easyhaler® dry powder inhaler. Eur J Pharm Sci. 2017;104:180–7.CrossRefPubMed
33.
go back to reference Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105:930–8.CrossRefPubMed Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105:930–8.CrossRefPubMed
34.
go back to reference Sandler N, Holländer J, Långström D, Santtila P, Saukkonen A, Torvinen S. Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler). BMJ Open Respir Res. 2016;3(1):e000119.CrossRefPubMedPubMedCentral Sandler N, Holländer J, Långström D, Santtila P, Saukkonen A, Torvinen S. Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler). BMJ Open Respir Res. 2016;3(1):e000119.CrossRefPubMedPubMedCentral
35.
go back to reference Takemura M, Kobayashi M, Kimura K, Mitsui K, Masui H, Koyama M, et al. Repeated instruction on inhalation technique improves adherence to the therapeutic regimen in asthma. J Asthma. 2010;47:202–8.CrossRefPubMed Takemura M, Kobayashi M, Kimura K, Mitsui K, Masui H, Koyama M, et al. Repeated instruction on inhalation technique improves adherence to the therapeutic regimen in asthma. J Asthma. 2010;47:202–8.CrossRefPubMed
36.
go back to reference Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:97–104.CrossRefPubMedPubMedCentral Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:97–104.CrossRefPubMedPubMedCentral
37.
go back to reference Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler Errors in the CRITIKAL Study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5:1071–81.e9.CrossRefPubMed Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler Errors in the CRITIKAL Study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5:1071–81.e9.CrossRefPubMed
38.
go back to reference Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Inhaler Error Steering Committee, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013;107:37–46.CrossRefPubMed Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Inhaler Error Steering Committee, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013;107:37–46.CrossRefPubMed
39.
go back to reference Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, et al. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim care Respir Med. 2017;27:22.CrossRefPubMedPubMedCentral Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, et al. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim care Respir Med. 2017;27:22.CrossRefPubMedPubMedCentral
40.
go back to reference Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593–604.CrossRefPubMed Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593–604.CrossRefPubMed
41.
go back to reference Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150:394–406.CrossRefPubMed Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150:394–406.CrossRefPubMed
42.
go back to reference Hancox RJ, Cowan JO, Flannery EM, Herbison GP, McLachlan CR, Taylor DR. Bronchodilator tolerance and rebound bronchoconstriction during regular inhaled beta-agonist treatment. Respir Med. 2000;94:767–71.CrossRefPubMed Hancox RJ, Cowan JO, Flannery EM, Herbison GP, McLachlan CR, Taylor DR. Bronchodilator tolerance and rebound bronchoconstriction during regular inhaled beta-agonist treatment. Respir Med. 2000;94:767–71.CrossRefPubMed
43.
go back to reference Aldridge RE, Hancox RJ, Robin Taylor D, Cowan JO, Winn MC, Frampton CM, et al. Effects of terbutaline and budesonide on sputum cells and bronchial hyperresponsiveness in asthma. Am J Respir Crit Care Med. 2000;161:1459–64.CrossRefPubMed Aldridge RE, Hancox RJ, Robin Taylor D, Cowan JO, Winn MC, Frampton CM, et al. Effects of terbutaline and budesonide on sputum cells and bronchial hyperresponsiveness in asthma. Am J Respir Crit Care Med. 2000;161:1459–64.CrossRefPubMed
44.
go back to reference Stanford RH, Shah MB, D’Souza AO, Dhamane AD, Schatz M. Short-acting beta-agonist use and its ability to predict future asthma-related outcomes. Ann Allergy Asthma Immunol. 2012;109:403–7.CrossRefPubMed Stanford RH, Shah MB, D’Souza AO, Dhamane AD, Schatz M. Short-acting beta-agonist use and its ability to predict future asthma-related outcomes. Ann Allergy Asthma Immunol. 2012;109:403–7.CrossRefPubMed
45.
go back to reference Suissa S, Ernst P, Boivin JF, Horwitz RI, Habbick B, Cockroft D, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med. 1994;149:604–10.CrossRefPubMed Suissa S, Ernst P, Boivin JF, Horwitz RI, Habbick B, Cockroft D, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med. 1994;149:604–10.CrossRefPubMed
47.
go back to reference Dusser D, Montani D, Chanez P, de Blic J, Delacourt C, Deschildre A, et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy. 2007;62:591–604.CrossRefPubMed Dusser D, Montani D, Chanez P, de Blic J, Delacourt C, Deschildre A, et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy. 2007;62:591–604.CrossRefPubMed
49.
go back to reference O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, Jorup C, Lamarca R, Ivanov S, Reddel HK. Inhaled combined budesonide–formoterol as needed in mild asthma. New Engl J Med. 2018;378(20):1865–76.CrossRefPubMed O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, Jorup C, Lamarca R, Ivanov S, Reddel HK. Inhaled combined budesonide–formoterol as needed in mild asthma. New Engl J Med. 2018;378(20):1865–76.CrossRefPubMed
50.
go back to reference Bateman E, Reddel H, O’Byrne P, Barnes P, Zhong N, Keen C, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877–87.CrossRefPubMed Bateman E, Reddel H, O’Byrne P, Barnes P, Zhong N, Keen C, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877–87.CrossRefPubMed
51.
go back to reference Beasley R, Holliday M, Reddel HK, Braithwaite I, Ebmeier S, Hancox RJ, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020–30.CrossRefPubMed Beasley R, Holliday M, Reddel HK, Braithwaite I, Ebmeier S, Hancox RJ, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020–30.CrossRefPubMed
52.
go back to reference Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim care Respir Med. 2014;24:14009.CrossRefPubMedPubMedCentral Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim care Respir Med. 2014;24:14009.CrossRefPubMedPubMedCentral
53.
go back to reference Schulz M, Krueger K, Schuessel K, Friedland K, Laufs U, Mueller WE, et al. Medication adherence and persistence according to different antihypertensive drug classes: a retrospective cohort study of 255,500 patients. Int J Cardiol. 2016;220:668–76.CrossRefPubMed Schulz M, Krueger K, Schuessel K, Friedland K, Laufs U, Mueller WE, et al. Medication adherence and persistence according to different antihypertensive drug classes: a retrospective cohort study of 255,500 patients. Int J Cardiol. 2016;220:668–76.CrossRefPubMed
54.
go back to reference Haahtela T, Herse F, Karjalainen J, Klaukka T, Linna M, Leskelä R-L, et al. The Finnish experience to save asthma costs by improving care in 1987-2013. J Allergy Clin Immunol. 2017;139(408–414):e2. Haahtela T, Herse F, Karjalainen J, Klaukka T, Linna M, Leskelä R-L, et al. The Finnish experience to save asthma costs by improving care in 1987-2013. J Allergy Clin Immunol. 2017;139(408–414):e2.
55.
56.
go back to reference Janson C, Lööf T, Telg G, Stratelis G, Nilsson F. Difference in resistance to humidity between commonly used dry powder inhalers: an in vitro study. NPJ Prim Care Respir Med. 2016;26:16053.CrossRefPubMedPubMedCentral Janson C, Lööf T, Telg G, Stratelis G, Nilsson F. Difference in resistance to humidity between commonly used dry powder inhalers: an in vitro study. NPJ Prim Care Respir Med. 2016;26:16053.CrossRefPubMedPubMedCentral
57.
go back to reference Sulaiman I, Cushen B, Greene G, Seheult J, Seow D, Rawat F, et al. Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195:1333–43.CrossRefPubMed Sulaiman I, Cushen B, Greene G, Seheult J, Seow D, Rawat F, et al. Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195:1333–43.CrossRefPubMed
58.
go back to reference Papi A, Ryan D, Soriano JB, Chrystyn H, Bjermer L, Rodriguez-Roisin R, et al. Relationship of inhaled corticosteroid adherence to asthma exacerbations in patients with moderate-to-severe asthma. J Allergy Clin Immunol Pract. 2018;6:1989–1998.e3.CrossRefPubMed Papi A, Ryan D, Soriano JB, Chrystyn H, Bjermer L, Rodriguez-Roisin R, et al. Relationship of inhaled corticosteroid adherence to asthma exacerbations in patients with moderate-to-severe asthma. J Allergy Clin Immunol Pract. 2018;6:1989–1998.e3.CrossRefPubMed
59.
go back to reference Plaza V, Giner J, Calle M, Rytilä P, Campo C, Ribó P, et al. Impact of patient satisfaction with his or her inhaler on adherence and asthma control. Allergy Asthma Proc. 2018;39:437–45.CrossRefPubMedPubMedCentral Plaza V, Giner J, Calle M, Rytilä P, Campo C, Ribó P, et al. Impact of patient satisfaction with his or her inhaler on adherence and asthma control. Allergy Asthma Proc. 2018;39:437–45.CrossRefPubMedPubMedCentral
60.
go back to reference Valero A, Ribó P, Maíz L, Barbero E, Calle M, Campo C, et al. Asthma patient satisfaction with different dry powder inhalers. Expert Rev Respir Med. 2019;13:133–8.CrossRefPubMed Valero A, Ribó P, Maíz L, Barbero E, Calle M, Campo C, et al. Asthma patient satisfaction with different dry powder inhalers. Expert Rev Respir Med. 2019;13:133–8.CrossRefPubMed
61.
go back to reference Lötvall J, Mellén A, Arvidsson P, Palmqvist M, Radielovic P, Kottakis J, et al. Similar bronchodilation with formoterol delivered by aerolizer or turbuhaler. Can Respir J. 1999;6:412–6.CrossRefPubMed Lötvall J, Mellén A, Arvidsson P, Palmqvist M, Radielovic P, Kottakis J, et al. Similar bronchodilation with formoterol delivered by aerolizer or turbuhaler. Can Respir J. 1999;6:412–6.CrossRefPubMed
62.
go back to reference Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide–formoterol Spiromax® compared to budesonide–formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med. 2016;16:42.CrossRefPubMedPubMedCentral Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide–formoterol Spiromax® compared to budesonide–formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med. 2016;16:42.CrossRefPubMedPubMedCentral
63.
go back to reference Zetterström O, Lähelmä S, Keski-Karhu J, Silvasti M, Östling-Kulling E, Ahonen A. Salbutamol via Easyhaler®is at least as effective as salbutamol via Turbuhaler®in the treatment of histamine-induced bronchoconstriction. Respir Med. 2000;94:1097–102.CrossRefPubMed Zetterström O, Lähelmä S, Keski-Karhu J, Silvasti M, Östling-Kulling E, Ahonen A. Salbutamol via Easyhaler®is at least as effective as salbutamol via Turbuhaler®in the treatment of histamine-induced bronchoconstriction. Respir Med. 2000;94:1097–102.CrossRefPubMed
64.
go back to reference Chuchalin AG, Kremer H-J, Metzenauer P, O’Keefe E, Hermann R. Clinical equivalence trial on budesonide delivered either by the novolizer® multidose dry powder inhaler or the turbuhaler® in asthmatic patients. Respiration. 2002;69:502–8.CrossRefPubMed Chuchalin AG, Kremer H-J, Metzenauer P, O’Keefe E, Hermann R. Clinical equivalence trial on budesonide delivered either by the novolizer® multidose dry powder inhaler or the turbuhaler® in asthmatic patients. Respiration. 2002;69:502–8.CrossRefPubMed
65.
go back to reference Statens legemiddelverk. Inhalasjonpulver på byttelisten – vedtak gyldig. 2018. Statens legemiddelverk. Inhalasjonpulver på byttelisten – vedtak gyldig. 2018.
Metadata
Title
Understanding Dry Powder Inhalers: Key Technical and Patient Preference Attributes
Authors
Mark L. Levy
Will Carroll
José L. Izquierdo Alonso
Claus Keller
Federico Lavorini
Lauri Lehtimäki
Publication date
01-10-2019
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 10/2019
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-019-01066-6

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