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Dr Everard wrote such a wide ranging polemic against inhaled therapy that it is difficult to know where to start. While the article contains a good deal of sense, it also contains a number of inaccuracies and misperceptions. I think the record needs to be put straight.
Firstly, Dr Everard says that inhaled insulin will be in use in 2001. However, as far as I am aware, no application for delivery of insulin as an aerosol has yet been submitted to the FDA. New devices for the delivery of insulin are under trial, but the earliest they are likely to get to the market is 2002. They are likely to be relatively complex devices costing perhaps 100 times more than the current price for a salbutamol metered dose inhaler (MDI).
Secondly, Dr Everard berates the pharmaceutical industry for its efforts in moving away from chlorofluorocarbon (CFC) MDIs. In 1996, when the Montreal protocol came into force, there was a real risk that MDIs for use in asthma/COPD would no longer be available. The industry started 10 years ago to try to reformulate MDIs but the technical challenge has been enormous and complicated by intellectual property issues. Only now, more than a decade later, are a sufficient number of CFC free MDIs coming to the market so that the transition can be completed over the next 2–4 years. This has cost a huge amount of money. But where is the evidence that they prevented new chemical entities for asthma coming to the market? If such clinically efficacious compounds were available, then I am certain that they would have been commercially exploited.
Thirdly, Dr Everard is correct in stating that the MDI in some ways is a less than ideal inhalation device. The new hydrofluorocarbon (HFC) beclomethasone product (Qvar, 3M Pharmaceuticals) has …
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