Introduction and Objectives Acceleration of inhaled flow from a DPI is important to facilitate de-aggregation of the metered dose and to ensure delivery of an appropriate dose. Patients need to inhale as fast as possible from the beginning of their inhalation manoeuvre and continue inhaling until their lungs are full.1 This study investigated inhalation characteristics when patients and healthy adults (HA) inhale through placebo Spiromax® and placebo Turbuhaler® DPIs and assessed the impact of enhanced DPI technique training.
Methods This was a randomised, open-label, crossover study involving children (6–11 years old, [CA]), adolescents (12–17 years old [AA]) and adults with asthma [ADULT], COPD patients and HA. Study participants were trained to use the Spiromax and Turbuhaler DPIs according to the Patient Information Leaflets. Inhalation characteristics were measured.
Each participant received enhanced training using an In-Check Dial™ to measure inspiratory flow (IF). Participants were encouraged to increase their IF by inhaling more quickly. Inhalation characteristics were measured in the same way as before enhanced training.
Results Before enhanced training,peak inspiratory flow (PIF) and maximum change in pressure (∆P) were significantly higher with Spiromax versus Turbuhaler (p < 0.05; all patient groups). There were also trends towards slightly higher inspiratory acceleration (ACC) with Spiromax.
Table 1 shows the pre-training inhalation characteristics. Enhanced training significantly improved PIF, ACC and ∆P (p < 0.05) in all subjects and in both inhalers except ∆P with Spiromax in patients with COPD. Percentage improvements in ∆P and ACC are shown in Table 1. Significantly greater improvements (p < 0.05) were seen with Spiromax versus Turbuhaler (post training) for PIF (all groups), ∆P in AA, ADULT and patients with COPD, and for ACC in ADULT and COPD patients.
Conclusions Patients achieved faster IF and greater positive change in pressure with Spiromax versus Turbuhaler. Enhanced training with a focus on maximising inspiratory effort produced significant improvement in inhalation parameters with both devices, and significantly greater improvements in these parameters with Spiromax versus Turbuhaler in adult patients.
Laube BL, et al. Eur Respir J 2011;37:1308–31.