DPI Overview

/DPI Overview
DPI Overview 2018-10-22T15:33:38+00:00
Aerohaler
Aerolizer®
Breezhaler®
Clickhaler
Diskhaler
Diskus®
Duoresp-Spiromax
Easyhaler
Ellipta
Genuair®
HandiHaler®
Jethaler®
NEXThaler®
Novolizer®
Spinhaler
Turbohaler®
Twisthaler®

Inhaler devices differ in their efficiency of drug delivery to the lower respiratory tract, depending on the form of the device, formulation of medication, particle size, velocity of the aerosol cloud or plume (where applicable), and ease with which the device can be used by the majority of patients. Individual patient preference, convenience, and ease of use may influence not only the efficiency of drug delivery but also patient adherence to treatment and long-term control.

Aerohaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

N/A Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

N/A Achievable IFR (asthmatic child, severe asthma COPD)

+++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

(6) Dose metering: blister pack (maximum)

Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

N.A. Device lock.out

Reloadable

6 Max. number of doses

How to use Aerohaler

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Aerohaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Aerohaler.

DOS
DON’TS
LEGEND

Aerolizer® = Cyclohaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

N/A Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 6yrs Achievable IFR (asthmatic child, severe asthma COPD)

Device resistance

Minimum FR controlled to achieve adequate lung deposition?

N/A Overdose-secure

(1) Dose metering: blister pack (maximum)

Reservoir (maximum)

N/A  Advance warning of last dose

Protection from ambient humidity

N/A Device lock.out

N/A Reloadable

1 Max. number of doses

FORMOTEROL
BUDESONIDE
BECLOMETHASONE

How to use Aerolizer®/Cyclohaler

With a low intrinsic resistance the Aerolizer®/Cyclohaler® releases already 70% of the metered dose at an inspiratory flow of 28 l/min. However under these conditions the is fairly large with an average value of 7.9 µm. Increasing the flow to 40 l/min the average particle size decreases to 4.4 µm but further increase of flow results in only slight reduction of particle size.

The Aerolizer®/Cyclohaler® is a single dose system using gelatine capsules for drug formulation. Inhalation procedure has to be repeated several times before the capsule is completely emptied possibly leading to inaccurate dosing during inhalation. Since after each usage a new capsule needs to be inserted treatment with the Aerolizer is not very convenient for the patient.

Drugs approved for use with the Aerolizer®/Cyclohaler® include budesonide (Miflonide®), formoterol (Foradil®), beclomethasone (Becotide®, Miflasone®) and salbutamol (Sultanol®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Aerolizer/Cyclohaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Aerolizer/Cyclohaler.

DOS
DON’TS
LEGEND

Breezhaler®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

Achievable IFR (asthmatic child, severe asthma COPD)

Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

(30) Dose metering: blister pack (maximum)

Reservoir (maximum)

N/A  Advance warning of last dose

Protection from ambient humidity

N/A Device lock.out

Reloadable

30 Max. number of doses

INDACATEROL
GLYCOPYRRONIUM

How to use Breezhaler®

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Aerolizer/Cyclohaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Aerolizer/Cyclohaler.

DOS
DON’TS
LEGEND

Clickhaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 6yrs Achievable IFR (asthmatic child, severe asthma COPD)

+++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

N.A.  Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

200 Max. number of doses

SALBUTAMOL
BECLOMETHASONE

How to use Clickhaler

his section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Clickhaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Clickhaler

DOS
DON’TS
LEGEND

Diskhaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 4yrs Achievable IFR (asthmatic child, severe asthma COPD)

Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

(8) Dose metering: blister pack (maximum)

Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

4 or 8 Max. number of doses

SALMETEROL
BECLOMETHASONE

How to use Diskhaler

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Diskhaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Diskhaler

DOS
DON’TS
LEGEND

Diskus® = Accuhaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 4yrs Achievable IFR (asthmatic child, severe asthma COPD)

++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

(60) Dose metering: blister pack (maximum)

Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

60 Max. number of doses

SALBUTAMOL
SALMETEROL
FLUTICASONEPROPIONATE

How to use Diskus® = Accuhaler

The Diskus® is an inhalation device with low intrinsic resistance emitting about double the dose of fine particles at an inspiratory flow of 30 l/min compared with the Turbuhaler®. With an inspiratory flow of 60 l/min no significant difference is observed between the two devices. In-vitro formation of the fine particle fraction in the Diskus® also does not change with the inspiratory flow. Hence this device provides relatively constant intra-bronchial drug deposition independent of flow.

It also has been demonstrated that with an inspiratory flow of only 30 l/min 80% of the metered dose reached the mouthpiece. However since the prepared dosages are not completely emptied and powder is distributed all over the Diskus® after a short time of usage dose consistency appears to be uncertain.

Drugs approved for the use with the Diskus® include fluticasone (Flixotide®, Flovent®, Flutide®), salmeterol (Serevent®) and a combination of both substances (Advair®, Viani®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Diskus. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Diskus

DOS
DON’TS
LEGEND

Duoresp-Spiromax

** Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

✓/-Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

Achievable IFR (asthmatic child, severe asthma COPD)

+++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(120) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

120 Max. number of doses

FORMOTEROL
BUDESONIDE

How to use Duoresp-Spiromax

his section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Spiromax. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Spiromax.

DOS
DON’TS
LEGEND

Easyhaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 6yrs Achievable IFR (asthmatic child, severe asthma COPD)

++++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

N.A. Device lock.out

Reloadable

200 Max. number of doses

SALBUTAMOL
BECLOMETHASONE
BUDESONIDE

How to use Easyhaler®

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the pMDI. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the pMDI.

DOS
DON’TS
LEGEND

Ellipta

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 12yrs Achievable IFR (asthmatic child, severe asthma COPD)

++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(30) Reservoir (maximum)

N.A.  Advance warning of last dose

Protection from ambient humidity

N.A. Device lock.out

Reloadable

30 Max. number of doses

VILANTEROL
FLUTICASONEFUROATE

How to use Ellipta

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the flutiformo. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the flutiformo.

DOS
DON’TS
LEGEND

Genuair®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

N/A Achievable IFR (asthmatic child, severe asthma COPD)

++ Device resistance

? Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

N.A.  Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

200 Max. number of doses

How to use Genuair

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Genuair. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Genuair

DOS
DON’TS
LEGEND

Handihaler®

** Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

N/A Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

Achievable IFR (asthmatic child, severe asthma COPD)

++++ Device resistance

? Minimum FR controlled to achieve adequate lung deposition?

N/A Overdose-secure

(1) Dose metering: blister pack (maximum)

Reservoir (maximum)

N/A Advance warning of last dose

Protection from ambient humidity

N/A Device lock.out

Reloadable

1 Max. number of doses

How to use Handihaler

Handihaler® Despite a high intrinsic resistance the HandiHaler® can be successfully used by patients, who are not able to generate high inspiratory flows. In clinical studies it was shown that even patients with severe airway obstruction were able to achieve the required minimal inspiratory flow rate.

With inspiratory flow rates of 20 to 60 l/min the HandiHaler® releases consistently between 55-60% of the metered dose. The fraction of particles smaller than 5.6µm ranges from 20% at an inspiratory flow of 20 l/min to 25% at a flow of 60 l/min.

Due to the high sensitivity of tiotropiumbromide to humidity the HandiHaler® has to be loaded with a single drug capsule before each use. During inhalation the capsule vibrates which can be noticed acoustically.

The Handihaler® is approved for tiotropiumbromide (Spiriva®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the HandiHaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the HandiHaler.

DOS
DON’TS
LEGEND

Jethaler®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

Achievable IFR (asthmatic child, severe asthma COPD)

+++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

200 Max. number of doses

How to use Jethaler

The Jethaler® generates aerosol by cutting the metered dose of drug from a densely packed powder block just before inhalation. Then with an inspiratory flow rate of about 30 l/min a flow of over 100 l/min is achieved within the device. This results in the formation of very fine particles, which cannot agglomerate before released into the respiratory tract.

Thus particles small enough to reach the lungs resulting in a good lung deposition are generated even by relatively low inspiratory flow rates. With an inspiratory flow rate of 30 l/min 22% of the metered dose are deposited in the lungs increasing to 26% with a flow of 60 l/min. However coordination between release of the cutter and inhalation is necessary to attain best results. Therefore space of time while shaping the powder is marked by an acoustic signal.

The Jethaler® is approved for budesonide (Budesonid-ratiopharm®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Jethaler®. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Jethaler®.

DOS
DON’TS
LEGEND

Nexthaler®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

N.A. Achievable IFR (asthmatic child, severe asthma COPD)

++++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(120) Reservoir (maximum)

10 Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

120 Max. number of doses

FORMOTEROL
BECLOMETHASONE

How to use Nexthaler

NEXThaler® is a multidose breath-actuated medium-resistance dry powder inhaler (DPI). After activation of the breath-actuated mechanism (BAM), the full dose is released from the dosing cup within 0.35 s and this occurs consistently at a variety of inhalation flows tested (28-60 L/min).

The inhalation device incorporates a full-dose feedback system for the patient user to ensure that the complete dose is delivered and that the inhaler is handled correctly. Firstly, a click is heard on activation of the BAM when the patient inhales through the device and the internal mechanism is activated. Secondly, release of the dose is confirmed through a dose counter linked to the BAM. The dose counter does not decrement after preparation of the dose but only after delivery of the full therapeutic dose. Lastly, the formulation contains lactose as a carrier, which leaves a typical taste upon inhalation of the drug from the device. This triple feedback system allows both physicians and patients to be sure that the full therapeutic dose is taken by patients.

KEY FEATURES OF YOUR NEXTHALER INHALER

_nexthaler_key_features

DOS AND DON’TS NEXTHALER®

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the NEXThaler®. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the NEXThaler®.

DOS
DON’TS
LEGEND

Novolizer®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 6yrs Achievable IFR (asthmatic child, severe asthma COPD)

++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

200 Max. number of doses

SALBUTAMOL
FORMOTEROL
BUDESONIDE

How to use Novolizer

The Novolizer®…

  • Is a dry powder inhaler with multiple feedback mechanism to reassure the patient that the inhalation was carried out correctly.
  • Is equipped with a dosage stop system releasing the following dose only after the previous dose has been inhaled correctly.
  • Has a dose counter which moves after successful inhalation and provides so compliance measurement.
  • Is avoiding underdosing
  • Has a low-to-medium intrinsic resistance. An inspiratory flow rate of at least 35 l/min is necessary to overcome the trigger threshold. However it has been demonstrated that even children aged 4 to 5 years achieved higher peak inspiratory flow rates than required (in average 60 l/min).
  • During an inhalation manoeuvre about 90% of the metered dose is delivered at the mouthpiece with only little variability.

Compared with other devices the Novolizer® has unique features not present in any other DPI.

Drugs approved for use with the Novolizer® include budesonide (Novopulmon®, Budecort®), formoterol (Formatris®, Formotop®), and salbutamol (Ventilastin®, Salbu®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Novolizer. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Novolizer.

DOS
DON’TS
LEGEND

Spinhaler

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

Achievable IFR (asthmatic child, severe asthma COPD)

+ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

(1) Dose metering: blister pack (maximum)

Reservoir (maximum)

N/A  Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

1 Max. number of doses

How to use Spinhaler

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Spinhaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Spinhaler

DOS
DON’TS
LEGEND

Turbohaler®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 6yrs Achievable IFR (asthmatic child, severe asthma COPD)

++++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(200) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

200 Max. number of doses

TERBUTALINE
FORMOTEROL
BUDESONIDE

How to use Turbohaler

The number of studies investigating characteristics of the Turbuhaler® exceeds research on any other dry powder inhaler. It is one of the DPIs with a relatively high intrinsic resistance. Therefore formation of the fine particle fraction highly depends on the flow achieved within the system. Since highly correlates with particle size interindividual variability of efficacy must be anticipated.

With a reasonably high inspiratory flow of 60 l/min a large fraction of very small particles is generated (in average 2.5 µm). However in comparison to a low resistance DPI the same inspiratory force yields a flow of 60 l/min through the Aerolizer® and of 28 l/min through the Turbuhaler®. Under these conditions the Aerolizer® emits 82% of the metered dose with an average particle size of 4.26 µm while the Turbuhaler® releases 58% of the metered dose with an average particle size of 5.5 µm.

The Turbuhaler® is approved for the drugs budesonide (Pulmicort®, Spirocort®), formoterol (Oxis®), terbutaline (Aerodurâ®, Bricanyl®) and a combination of budesonide plus formoterol (Symbicort®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Turbohaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Turbohaler.

DOS
DON’TS
LEGEND

Twisthaler®

Patient feedback of dosen taken (visual/acoustic)

Lactose carrier (taste feedback)

Dose counter

Dose counter measuring inhalations actually taken

Accurate & consistent dose delivery

FPF air flow rate independence

> 12yrs Achievable IFR (asthmatic child, severe asthma COPD)

+++ Device resistance

Minimum FR controlled to achieve adequate lung deposition?

Overdose-secure

Dose metering: blister pack (maximum)

(120) Reservoir (maximum)

Advance warning of last dose

Protection from ambient humidity

Device lock.out

Reloadable

120 Max. number of doses

How to use Twisthaler

The Twisthaler® is an inhalation device relatively independent of flow rates. It has been demonstrated that with inspiratory flows between 28 l/min and 60 l/min 91% to 112% of the metered dose is delivered at the mouthpiece.

The fraction of particles smaller than 6.5 µm amounts up to 40% at an inspiratory flow of 60 l/min. Additionally drug doses released from the Twisthaler® only vary slightly between each dose.

The Twisthaler® is approved for mometasone furoate (Asmanex®).

This section contains a list of things you should do (DOs) and things you shouldn’t do (DON’Ts) when using the Twisthaler. This list only covers items known from practice to be the most important and most likely to be forgotten or performed incorrectly by patients; this information is in addition to the prescribing and other information provided with the Twisthaler.

DOS
DON’TS
LEGEND

THE INHALATION DEVICE PLAY A SUBSTANTIAL ROLE FOR THE TREATMENT SUCCESS

  • Incorrect use of inhalers leads to minimal therapeutic benefit [1]
  • In the future, inhaler devices are likely to become more important than the development of new drugs [2]
  • Inhaler misuse severely compromises asthma control [3]