Breakout Session # A 12:45 1:25. New Methods of Medication Delivery to the Lungs: Say Goodbye to the MDI as we know it
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1 Breakout Session # A 12:45 1:25 New Methods of Medication Delivery to the Lungs: Say Goodbye to the MDI as we know it
2 Michael J. Welch MD, FAAP, FAAAAI, CPI Co-director, Allergy & Asthma Medical Group & Research Center Member, Division of Allergy/Immunology/Rheumatology, Rady Childrens Hospital San Diego Clinical Professor, University of California, San Diego School of Medicine 5776 Ruffin Road San Diego, CA (858) office
3 Disclosures Research Center has received grants from: TEVA GSK Merck Meda Speakers bureau Merck TEVA
4 Assume everyone has poor inhaler technique!! Just ask Dr. House Video here
5 Where we going? Overview brief hx of delivery systems We ve come a long ways First MDI Newest delivery devices/systems CFC to HFA story Respimat story Latest on nebulization New DPI s Respiclick The smart MDI Future
6 , opium stramonium (Jimson weed) belladonna (deadly nightshade
7 Mudge inhaler iodine, conium (hemlock), oxygen, hydrogen, nitrogen, nitrous gas, a great variety of gums and balsamic resins, boiling tar, hydrocyanic acid, camphor, ammonia, balsam tolu, naphtha, chlorine, hyoscyamus, lactuca,, digitalis, colchium, galbanum, vinegar, nitre, lobelia inflata, ipecacuanha
8
9
10 Susie Story 1955 Susie, daughter of Geoge Maison Asthma Used hair spray President, Riker Perfume device st MDI Medihaler epi Medihaler-iso
11 1957
12 Inhaler delivery systems pmdi HFA Autohaler Respimat DPI single-dose multi-dose Nebulizer Jet Non-jet
13 Early crude devices Mudge pot, ceramics Bulb atomizers, cigarettes CFC MDI (Susie story) Medihaler-iso, Medihaler-epi Autohaler (Maxair) DPI (1st gen) (Spinhaler, Rotadisk) DPI (2 nd gen) (Diskus, Turbuhaler) DPI (3 rd gen) (Twisthaler, Ellipta, Respiclick) HFA MDI (Ventolin, Proventil, Flovent) HFA MDI (2 nd gen) (counters, solutions (Qvar, Alvesco, Aerospan), built-in spacer (Aerospan) Nebulizer (comp. air) Nebulizer (2 nd gen) Aeroecllipse, LC Jet Plus Nebulizer (3 rd gen) (eflow, Respimat)
14 CFC to HFA conversion Montreal Protocol 1987 Ban of CFC s (chloroflorocarbons) New HFA inhalers Certain HFA inhalers Solutions not suspensions Better lung deposition From 15-20% range to over 50% QVar, Aerospan, Alvesco CFC s
15 Lung deposition HFA BDP (Qvar) & fluticasone (Flovent) 29% Oropharynx deposition 78% 53% Lung deposition 13% HFA BDP fluticasone ciclesonide (Alvesco), flunisolide HFA (Aerospan ) depositions similar Leach CL, et al. Chest. 2002;122(2): Leach CL, et al. Am J Respir Crit Care Med. 2000;161(3):A34. Vanden Burgt JA, et al. J Allergy Clin Immunol. 2000;106(6): Cripps A, et al. Respir Med. 2000;94(suppl B):S3-S9. Martin RJ. J Allergy Clin Immunol. 2002;109(2 suppl):s
16 Dry Powder Devices (DPI s) Main aerosol MDI problem: coordinating actuation with inhalation Spacers help (do not solve all problems) Aerosols = powder + gas Why not just suck the powder? Various DPI s Diskus, Flexhaler, Ellipta, Handihaler Inhale fast DPI s in USA only for controller rx
17 Convenient device AND dosing Ellipta Simple device Once-a-day dosing Vilanterol Fluticasone furoate
18 1 st dry powder rescue inhaler Respiclick 1 st DPI rescue (albuterol) inhaler 1 puff DPI = 1 puff pmdi (~100 mcg) No: Shaking Coordination Spacer Built-in counter Open, click and inhale
19 Soft Mist Inhaler Respimat Very small portable nebulizer Propellant-free, multi-dose device Liquid formulation Slow moving aerosol (1/10 speed of pmdi) Lung deposition 2 to 3x of pmdi Higher patient preference over MDI & DPI Available for Spireva, Combivent, Stiolto
20 eflow technology Electronic nebulizer Vibrating mesh PARI (leaders in nebulizer technology) erapid nebulizer All nebulized medications Pulmozyme studied with erapid Nebulizer time: 2 to 3 minutes!!
21 THE SMART MDI AUTOMATIC TRACKING Easily monitors multiple medications and glows to provide dose reminders UNIVERSAL DESIGN Ergonomic design fits securely on metereddose inhalers (MDIs) WIRELESS SYNCING Wirelessly and automatically syncs to your smartphone Gecko device
22 Future Even SMARTer MDI (built-in) Faster, portable nebulization Biologics delivered by an MDI Non-respiratory drugs delivered via lungs (e.g. insulin; Afrezza)
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