Citation for published version (APA): Koning, J. P. D. (2001). Dry powder inhalation: technical and physiological aspects, prescribing and use s.n.

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1 University of Groningen Dry powder inhalation Koning, Johannes Petrus de IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2001 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Koning, J. P. D. (2001). Dry powder inhalation: technical and physiological aspects, prescribing and use s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:

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6 3DUDQLPIHQ 0DULQHOOD9LVVHU *HUD2HOHQ -3GH.RQLQJ*URQLQJHQ Printed version ISBN Electronic version ISBN x NUGI 746 The research project described in this thesis was performed within the framework of the research school GUIDE, and was supported by Groningen Centre for Drug Research (GCDR), AstraZeneca B.V, Sofotec (formally ASTA Medica), and Stichting Doelmatige Farmaceutische Zorg Drenthe / Hanzeland (DFZ). Printing of this thesis was financially supported by: Groningen University Institute for Drug Exploration (GUIDE) Rijksuniversiteit Groningen AstraZeneca B.V. Boehringer Ingelheim B.V. GlaxoSmithKline 3M Pharma Nederland B.V. Schering-Plough Printing: Stichting Drukkerij C. Regenboog, Groningen, the Netherlands

7 &RQWHQWV Preface Introduction ix xi Chapter 1 Introduction to Inhalation Therapy with Dry Powder Inhalers 3DUW 7HFKQLFDODQG3K\VLRORJLFDO$VSHFWV Chapter 2 Effect of Resistance to Airflow on the Inspiratory Flow Curve Chapter 3 Relationship between Inspiratory Flow Through Simulated Dry Powder Inhalers and Peak Maximal Inspiratory Pressure Chapter 4 Inhalation Through Dry Powder Inhalers in Chronic Obstructive Lung Disease Patients with Reduced Peak Maximal Inspiratory Pressure Chapter 5 Daily use of a Dry Powder Inhaler Increases Peak Maximal Inspiratory Pressure Chapter 6 Effect of Peak Inspiratory Flow and Flow Increase Rate on In Vitro Drug Deposition from Four Dry Powder Inhaler Devices Chapter 7 Errors in Pneumotachograph Readings Caused by an Add-on Device 3DUW $VSHFWVRI3UHVFULELQJDQG8VH Chapter 8 Choice of an Inhaler Device in the Treatment of Asthma and COPD by Chest Physicians, General Practitioners, and Pharmacists vii Chapter 9 The Use of Dry Powder Inhalers Inhalation-Instructions Chapter 10 Patient Compliance in the Treatment of Pulmonary Disease Based on Prescription Data from Pharmacies &RQFOXVLRQV Chapter 11 Final Remarks and Perspectives List of Abbreviations Summary Samenvatting Dankwoord Curriculum Vitae &217(176

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9 3UHIDFH *URQLQJHQ&HQWUHIRU'UXJ5HVHDUFK,QQRYDWLRQE\&ROODERUDWLRQ The Groningen Centre for Drug Research (GCDR), founded in 1986, is committed to the stimulation of pharmaceutical research at the University Centre for Pharmacy in Groningen, in collaboration with industrial partners. The pharmacy research groups collaborate with a large number of companies and health care organisations in many different projects. The activities range from small problem-solving projects to major research programmes running for several years. The expertise available is not only applicable for pharmaceutical companies and health care organisations, but is also very useful for other kinds of industrial research activities, especially those in the fields of food and agricultural science. The general aim of the GCDR is to carry out both fundamental and applied research into the methodologies, which are necessary for the innovative design, development and evaluation of new drugs and their dosage forms. These research areas cover the entire field of drug research, from drug design to the post-marketing surveillance of any given specific compound. In 1995 the GCDR initiated a competition for research proposals of a multidisciplinary nature for the research groups involved in the GCDR to support the GCDR mission statement innovation by collaboration. Finally, the multidisciplinary research proposal initiated by Prof. Dr. Ir. C.F. Lerk (former head of department of Pharmaceutical Technology and Biopharmacy), Prof. Dr. Th.F.J. Tromp (Pharmacy Practice), Dr. P.M.J. Coenegracht (Chemometrics), and Dr. Th.W. van der Mark (department of Pulmonology, University Hospital Groningen), was rewarded by the scientific board of the department of Pharmacy of the University of Groningen, and the GCDR with a research grant. The results obtained within this multidisciplinary research setting are presented in this thesis. ix Groningen Centre for Drug Research 35()$&(

10 Groningen centre for drugs research Hans de Koning x *521,1*(1 &(175( )25 '58* 5(6($5&+

11 ,QWURGXFWLRQ *XLGHWRWKH5HDGHU This thesis is the result of a project that was initiated by the Groningen Centre for Drug Research (GCDR). The activities were carried out in four different research groups as a combined project. The research groups were Pharmaceutical Technology and Biopharmacy (Prof. Dr. H.W. Frijlink), Pharmacy Practice (Prof. Dr Th.F.J Tromp), Chemometrics (Dr. P.M.J. Coenegracht), all three of the Groningen Research Institute of Pharmacy (GRIP), and the research group of Pulmonology (Dr. Th.W. van der Mark) from the University Hospital of Groningen. The setting of this research with input from the different research groups enabled a broad approach in investigating inhalation therapy with dry powder inhalers. This thesis is divided in a general introduction, two major experimental parts and finally some remarks and perspectives. In chapter 1, a general introduction to inhalation therapy with dry powder inhalers is presented. The aim of this chapter is to provide a brief introduction and background to all aspects investigated as presented in this thesis. Part one of this thesis deals with the technical and physiological aspects of dry powder inhalations. The aim of this section is to investigate the effects of inhalation performances on the output of fine particles from dry powder inhalers. xi Chapter 2 describes the effect of inhalation through a resistance to airflow on the inspiratory flow curve. The aim of this study is to define the essential parameters for a proper description of the inspiratory flow curve through a resistance to airflow, such as dry powder inhaler. In chapter 3 and chapter 4, the relationship between the inspiratory muscle strength and the inspiratory flow curve is investigated in healthy subjects, asthmatics, mild to moderate COPD patients and COLD patients with significantly reduced peak maximal inspiratory pressure. The aim of the study was to determine the relationship between a human performance parameter and the parameters of the inspiratory flow curve.,1752'8&7,21

12 Chapter 5 deals with the training effects of the use of high resistance to airflow dry powder inhalers. The aim of this study was to investigate the effect of daily use of a high resistance to airflow dry powder inhaler, as an inspiratory muscle training, on the peak maximal inspiratory pressure and peak inspiratory flow. In chapter 6, the results are presented from testing of the performance of four corticosteroid dry powder inhalers. The test conditions were based on previously measured inspiratory flow parameters. In this study the effects of both the peak inspiratory flow and the flow increase rate on the fine particle output from the dry powder inhalers were investigated. In chapter 7, a theoretical explanation and experimental solution of errors in pneumotachograph readings, as found during measurements with an add-on device, as described in chapter 3 and chapter 4, is presented. Part two of this thesis deals with aspects of prescribing and use of dry powder inhalers. The aim of this section is to provide knowledge about the patients use of dry powder inhalers and information about the intervention possibilities for changes in prescribing of inhaled medication. Chapter 8 deals with the evoked set for inhalation devices as applied by chest physicians, general practitioners and pharmacists. The aim of this study was to investigate which choice criteria and actual (technical) knowledge about inhaler devices is involved at the prescribing of an inhaler device in the treatment of asthma and COPD. xii Chapter 9 provides an overview of inhalation-instructions to patients for commonly used dry powder inhalers. The aim of this study is to connect technical knowledge about dry powder inhalers with an inhalation-instruction. This combined information can be used when inhalation-instruction to patients is given. In chapter 10 the patient compliance of inhaled corticosteroids is investigated, based on prescription data from pharmacies. The aim of this study is to measure differences in patient compliance in relation to the used inhaler device and age of the patient. *8,'( 72 7+( 5($'(5 Final remarks and perspectives are given in Chapter 11. Aim of this chapter is to merge the research results on dry powder inhalation as investigated from the different perspectives. The different perspectives are the result of the multidisciplinary input of the different research groups.

Citation for published version (APA): Koning, J. P. D. (2001). Dry powder inhalation: technical and physiological aspects, prescribing and use s.n.

Citation for published version (APA): Koning, J. P. D. (2001). Dry powder inhalation: technical and physiological aspects, prescribing and use s.n. University of Groningen Dry powder inhalation Koning, Johannes Petrus de IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the

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