BACKGROUND: The proper use of inhaler drugs is critical in the management of chronic asthma. In this study, we investigated the inhalation performance of asthmatic patients and effectiveness of the regular education of inhalation technique. METHODS: The 145 asthmatic patients who had been educated the inhaler technique for more than 3 times were enrolled. The inhalation performance of each patient was scored using a checklist form (9 items for metered dose inhaler [MDI], 4 items for dry powder inhaler [DPI]) whenever they visited the clinic. Clinical characteristics affecting inhalation performance were evaluated in the groups using each type of inhaler. RESULT: In MDI, the mean initial performance score was significantly low when the patients were female sex, aged patients (>65 years old), or had lower educational backgrounds. Some items of the checklist, which include tilting head back, placing the mouthpiece with a distance from lips, continuing deep inspiration, and holding breath after inhalation for 10 seconds, were improperly performed in about 25% of the MDI users. No significant change was observed in the final performance scores assessed after intensive repeated education for proper inhalation technique of MDI. In DPI, the mean initial performance score was significantly low in the patients with old age (>65 years old) or lower educational backgrounds. The final performance scores were significantly improved after the repeated education for proper use of DPI inhalation in contrast to MDI. CONCLUSION: For the effective management of asthma, it may be important to choose proper type of inhaler with consideration of individual characteristics of the patients. The evaluation of inhalation performance and regular education of inhalation technique could be useful to maintain and improve the effective use of inhaler, especially in DPI.
Asthma* ; Checklist ; Dry Powder Inhalers ; Education ; Female ; Head ; Humans ; Inhalation* ; Lip ; Metered Dose Inhalers ; Nebulizers and Vaporizers

PURPOSE: Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics.METHODS: We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups.RESULTS: A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, P < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, P < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups.CONCLUSION: These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.
Airway Management ; Asthma ; Dry Powder Inhalers ; Fluticasone ; Humans ; Inhalation ; Lung ; Medication Adherence ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Random Allocation

To prepare and evaluate dry powder inhalation (DPI) of extraction of Trollius chinensis Bunge (TCB). Orthodox design was employed to optimize the parameters of spray drying to prepare micronized TCB powder, the DPI was prepared by mixing micronized TCB powder and lactose. The results showed that the fine particle fraction (FPF) and emitted dose (ED) of micronized TCB powder was (21.07 +/- 1.74)%, (75.31 +/- 21.05)%, respectively, and for DPI was (56.4 +/- 2.2)%, (95.9 +/- 3.0)%, respectively. Therefore, the prepared DPI meeted requirements in the Chinese Pharmacopeia, indicating a good application prospect.
Administration, Inhalation ; Dry Powder Inhalers ; Excipients ; Plant Extracts ; administration & dosage ; isolation & purification ; Powders ; Ranunculaceae

Dry powder inhalers (DPIs) have received considerable attention because of their propellant-free composition and stability. DPIs include the DPI devices and inhalation powders. The purpose of this review is to address the development of the DPIs, including the mechanisms of absorption, the products, the devices, the preparation technology, and the characteristics.
Administration, Topical ; Drug Delivery Systems ; Dry Powder Inhalers ; Lung ; Technology, Pharmaceutical ; methods

BACKGROUND: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. METHODS: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. RESULTS: The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). CONCLUSION: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.
Animals ; Cats ; Disease Management* ; Dry Powder Inhalers ; Education* ; Humans ; Korea ; Metered Dose Inhalers ; Nebulizers and Vaporizers* ; Outpatients ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive*

To provide theoretical and practical basis for the successful formulation design of physically-mixed inhalation dry powder of proteins and peptides, related references were collected, analyzed and summarized. In this review drug micronization technology and commonly used carriers for inhalation dry powder preparation were introduced. For proteins and peptides, supercritical fluid technology and spray-drying are more suitable because of their capabilities of keeping drug activity. Being approved by U. S. Food and Drug Administration, lactose has been extensively used as carriers in many inhalation products. Formulation and process factors influencing drug deposition in the lung, including carrier properties, drug-carrier ratio, blending order, mixing methods, mixing time and the interaction between drug and carrier, were elucidated. The size, shape and surface properties of carries all influence the interaction between drug and carrier. Besides, influence of micromeritic properties of the dry powder, such as particle size, shape, density, flowability, charge, dispersibility and hygroscopicity, on drug deposition in the lung was elaborated. Among these particle size plays the most crucial role in particle deposition in the lung. Moreover, based on the mechanisms of powder dispersity, some strategies to improve drug lung deposition were put forward, such as adding carrier fines, adding adhesive-controlling materials and reprocessing micronized drug. In order to design physically-mixed inhalation dry powder for proteins and peptides with high lung deposition, it is essential to study drug-carriers interactions systematically and illustrate the potential influence of formulation, process parameters and micromeritic properties of the powder.
Administration, Inhalation ; Drug Carriers ; chemistry ; Dry Powder Inhalers ; Lactose ; chemistry ; Particle Size ; Peptides ; administration & dosage ; Powders ; administration & dosage ; Surface Properties ; Technology, Pharmaceutical

For effective inhalable dry-powder drug delivery, tetrandrine-PLGA (polylactic-co-glycolic acid) nanocomposite particles have been developed to overcome the disadvantages of nanoparticles and microparticles. The primary nanoparticles were prepared by using premix membrane emulsification method. To prepare second particles, they were spray dried. The final particles were characterized by scanning electron microscopy (SEM), dry laser particle size analysis, high performance liquid chromatography (HPLC), X-ray diffraction (XRD), differential scanning calorimetry (DSC), infrared analysis (IR) and confocal laser scanning microscope (CLSM). The average size of the primary particles was (337.5 ± 6.2) nm, while that second particles was (3.675 ± 0.16) μm which can be decomposed into primary nanoparticles in water. And the second particles were solid sphere-like with the drug dispersed as armorphous form in them. It is a reference for components delivery to lung in a new form.
Administration, Inhalation ; Benzylisoquinolines ; chemistry ; Calorimetry, Differential Scanning ; Drug Delivery Systems ; Dry Powder Inhalers ; Lactic Acid ; chemistry ; Microscopy, Electron, Scanning ; Nanocomposites ; chemistry ; Nanoparticles ; chemistry ; Particle Size ; Pharmaceutical Preparations ; Polyglycolic Acid ; chemistry ; X-Ray Diffraction

This study is to report the influence of conditions in spray drying process on physical and chemical properties and lung inhaling performance of Panax notoginseng Saponins - Tanshinone II A composite particles. According to the physical and chemical properties of the two types of components within the composite particles, three solvent systems were selected including ethanol, ethanol : acetone (9 : 1, v/v) and ethanol : acetone (4 : 1, v/v), and three inlet temperature: 110 degrees C, 120 degrees C, 130 degrees C to prepare seven different composite particle samples; each sample was characterized using laser diffraction, scanning electron microscopy (SEM), dynamic vapour sorption (DVS) and atomic force microscope (AFM), and their aerodynamic behavior was evaluated by a Next Generation Impactor (NGI). The results indicate that under the conditions of using the mixed solvent system of ethanol--acetone volume ratio of 9 : 1, and the inlet temperature of 110 degrees C, the resulting composite particles showed rough surface, with more tanshinone II A distributing in the outer layer, such composite particles have the best lung inhaling performance and the fine particle fraction (FPF) close to 60%. Finally it is concluded that by adjusting the conditions in co-spray drying process, the distribution amount and existence form of tanshinone II A in the outer layer of the particles can be changed so that to enhance lung inhaling performance of the drug composite particles.
Administration, Inhalation ; Desiccation ; Diterpenes, Abietane ; administration & dosage ; chemistry ; isolation & purification ; Drug Compounding ; methods ; Dry Powder Inhalers ; methods ; Microscopy, Electron, Scanning ; Microspheres ; Panax notoginseng ; chemistry ; Particle Size ; Plants, Medicinal ; chemistry ; Saponins ; administration & dosage ; chemistry ; isolation & purification ; Solubility ; X-Ray Diffraction