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      Inspiratory Flows and Volumes in Subjects with Cystic Fibrosis Using a New Dry Powder Inhaler Device

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          Abstract

          Introduction:

          Drug inhalation via a dry-powder inhaler (DPI) is a convenient, time efficient alternative to nebulizers in the treatment of cystic fibrosis (CF). Efficient drug administration via DPIs depends on the device resistance and adequate (≥ 45L/min) inspiratory flows and volumes generated by individuals. Dry-powder mannitol is delivered using a RS01 breath-actuated device developed by Plastiape, for Pharmaxis. The study aim was to determine in vivo if CF patients’ inspiratory flows and volumes are adequate to use the RS01 DPI device.

          Materials and Methodology:

          An open, non-interventional study; enrolled 25 CF subjects, aged ≥ 6 years with FEV1 ≥ 30 to < 90‰ predicted. Inspiratory flows and volumes were measured when subjects inhaled in a controlled manner through the RS01 device in series with a spirometer.

          Results:

          The mean inspiratory volume (IV) of CF subjects was 1.83L ± 0.97. Their achieved mean ± SD peak inspiratory flow (PIF) was 75.5 ± 27.2L/min. Twenty-three subjects (92%) achieved PIF of > 45L/min with the inhaler device; eighteen of those subjects (78%) had a baseline FEV1 of > 1L.

          Conclusion:

          Use of the RS01 DPI device allowed adequate inspiratory flow and volume for dispersion of dry-powder mannitol in CF patients.

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          Most cited references18

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          What the pulmonary specialist should know about the new inhalation therapies.

          A collaboration of multidisciplinary experts on the delivery of pharmaceutical aerosols was facilitated by the European Respiratory Society (ERS) and the International Society for Aerosols in Medicine (ISAM), in order to draw up a consensus statement with clear, up-to-date recommendations that enable the pulmonary physician to choose the type of aerosol delivery device that is most suitable for their patient. The focus of the consensus statement is the patient-use aspect of the aerosol delivery devices that are currently available. The subject was divided into different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. To achieve consensus, draft reports and recommendations were reviewed and voted on by the entire panel. Specific recommendations for use of the devices can be found throughout the statement. Healthcare providers should ensure that their patients can and will use these devices correctly. This requires that the clinician: is aware of the devices that are currently available to deliver the prescribed drugs; knows the various techniques that are appropriate for each device; is able to evaluate the patient's inhalation technique to be sure they are using the devices properly; and ensures that the inhalation method is appropriate for each patient.
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            The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers--implications for in vitro testing.

            Despite the fact that powder inhaler devices have been available for over 3 decades there is still very little fundamental information as to how powder inhaler design interacts with the airway dynamics of patients. This paper documents the results of human volunteer investigations designed to elucidate this interaction. These data indicates that if 'maximum' inhalation effort is employed the flow rate attained through an inhaler is controlled by the maximum pressure drop developed by the chest muscles. If a moderate or 'comfortable' effort is used, however, the relationship is more complex. An equation for defining the 'respirable fraction' of an inhalation aerosol cloud as a function of inhalation flow rate is also proposed.
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              Inhaled dry powder mannitol in cystic fibrosis: an efficacy and safety study.

              This international phase III study of inhaled dry powder mannitol was a randomised, double-blind, 26-week study, followed by a further 26-week, open-label (OL) extension. 324 cystic fibrosis (CF) patients were randomised, in a 3:2 ratio, to mannitol (400 mg b.i.d.) and control groups. The primary efficacy end-point was to determine the change in forced expiratory volume in 1 s (FEV₁) over the double-blind phase. Secondary end-points included changes in forced vital capacity and pulmonary exacerbations. A significant improvement in FEV₁ was seen over 26 weeks (p<0.001) and was apparent by 6 weeks, irrespective of concomitant recombinant human deoxyribonuclease (rhDNase) use. At 26 weeks, there was a significant improvement in FEV₁ of 92.9 mL for subjects receiving mannitol compared with controls (change from baseline 118.9 mL (6.5%) versus 26.0 mL (2.4%); p<0.001). Improvements in FEV₁ were maintained up to 52 weeks in the OL part of the study. There was a 35.4% reduction in the incidence of having an exacerbation on mannitol (p=0.045). The incidence of adverse events (AEs) was similar in both groups, although treatment-related AEs were higher in the mannitol compared with the control group. The most common mannitol-related AEs were cough, haemoptysis and pharyngolaryngeal pain. Mannitol showed sustained, clinically meaningful benefit in airway function in CF, irrespective of concomitant rhDNase use. Mannitol appears to have an acceptable safety profile for patients with CF.
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                Author and article information

                Journal
                Open Respir Med J
                Open Respir Med J
                TORMJ
                The Open Respiratory Medicine Journal
                Bentham Open
                1874-3064
                24 January 2014
                2014
                : 8
                : 1-7
                Affiliations
                [1 ]Royal Prince Alfred Hospital, Sydney, Australia
                [2 ]Murdock Children's Research Institute and University of Melbourne, Royal Children's Hospital, Melbourne, Australia
                [3 ]Pharmaxis Ltd, Sydney, Australia
                Author notes
                [* ]Address correspondence to this author at Pharmaxis Ltd., 20 Rodborough Road, Frenchs Forest NSW 2086, Australia; Fax: +61 2 9451 3622; E-mail: brett.charlton@ 123456pharmaxis.com.au
                Article
                TORMJ-8-1
                10.2174/1874306401408010001
                3933773
                ce9e7345-414f-4aca-8d5c-9b384f9814c0
                © Elkins et al.; Licensee Bentham Open.

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                : 18 November 2013
                : 26 November 2013
                : 26 November 2013
                Categories
                Article

                Respiratory medicine
                respiratory function tests,peak inspiratory flow.,dry powder inhaler,clinical trials,high resistance inhaler,cystic fibrosis

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