April 2008
The Misuse of Dry Powder Inhalers in Patients with Asthma and COPD
The number of drug formulations available in Dry Powder Inhalers (DPIs) has
increased over the past few years. The size and convenience of the devices
likely contributes to the acceptance of the product, but could negatively
affect the delivery of respiratory medications in both Paediatric and
Geriatric patient groups.1,2
It has been noted that patients are more likely to feel frustrated or
overwhelmed when faced with the prospect of having multiple medications.
This can be aggravated if each drug is delivered in a different type of
device.3 Unlike pressurized Metered Dose Inhalers (pMDIs), DPIs each use a
different delivery mechanism – which means that the inspiratory flow rate
required to activate each of the devices is also different.1
Inspiratory flow rates in paediatric (<12 years) and geriatric patients (>70
years), may not be sufficient enough to generate the pressure required to
properly activate the release of the drug.1,2 When combined with patient
error, the drug delivery rates are affected even more. There is considerable
inter-patient variability in inhalation technique, inspiratory flow rate,
tidal volume, breathing frequency and even airway obstruction, in addition
to variations in other factors such as patient dexterity and ability to
self-administer the dose.
The use of a Valved Holding Chamber with pMDI is advocated across the
spectrum of patient populations, and has the ability to overcome all of the
challenges listed above. With the proper type of VHC (mask or mouthpiece),
patients are able to overcome the challenges of taking their aerosol
medication which is one of the milestones of successful asthma management.4
In addition, the exclusive Flow-Vu* Indicator and FlowSignal* Whistle
reinforce proper inhalation technique and minimize the potential for human
error by confirming inhalation is being performed correctly.
The AeroChamber* Brand of VHC offers a full range of products, including the
AeroChamber Plus* VHC with Flow-Vu* Inspiratory Flow Indicator, designed
specifically for each patient type. The devices are easy to use and provide
caregivers with peace of mind that medication has been delivered
effectively. For more information about AeroChamber* Brand of VHC and other
innovative new products, please visit our website.
1 W Janssens, P VandenBrande, E Hardeman, E De Langhe, T Philps, T Troosters
and M Decramer. Inspiratory flow rates at different levels of resistance in
elderly COPD patients. Eur Respir J. 2008; 31: 78-83
2 H Miyahara, S Korematsu, T Nagakura and T Izumi. Efficacy of fluticasone
metered-dose inhaler and dry powder inhaler for pediatric asthma. Pediatrics
International. 2008; 50: 103-108
3 P Barnes, JC Virchow, J Sanchis, T Welte and S Pedersen. Asthma
management: important issues. Eur Respir Rev 2005: 14(97): 147-151
4 Pedersen S, Frost L, Arnfred T. Errors in inhalation technique and
efficiency in inhaler use in asthmatic children. Allergy 1986; 41: 118-124.
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