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Regular Article| Volume 95, ISSUE 12, P965-968, December 2001

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Measurement of peak inhalation rates with an In-Check Meter®to identify an elderly patient's ability to use a Turbuhaler®

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      Abstract

      Dry powder inhalers are designed with resistance to airflow so that a respirable cloud of particles is generated during inhalation. Some of these devices require a certain inhalation rate to produce a consistent dose of respirable particles. The aim of the study was to determine the inhalation rate of elderly patients with chronic obstructive pulmonary disease (COPD) when they inhale through a Turbuhaler®and assess the potential of the In-Check Meter®to identify inhalation rates. Their peak inhalation rate using a normal inhalation, pre- and post-counselling, was measured using a Turbuhaler Trainer®and an In-Check Meter®. Spirometry was also measured. Seventy-four COPD patients with a mean (Math Eq) age of 79·7 (8·4) years and forced expiratory volume in 1 sec (FEV1) 41·9 (12·8)% predicted. Pre-counselling 14 obtained a rate of <30 l min−1with the Turbuhaler Trainer, 31 from 30 to 40 min−1, 23 between 40–60 l min−1and 6 >60 l min−1. The median (range) peak inhalation rates with the In-Check Meter®were 50 (50–70), 70 (50–130), 100 (60–200) and 225 (200–250) l min−1. Post-counselling 7, 16, 41 and 10 achieved the respective peak inhalation rates using the Turbuhaler Trainer®Similarly, the In-Check inhalation rates were 50 (50–60), 70 (50–130), 90 (60–200) and 250 (200–270) l min−1. The results highlight the potential of the In-Check Meter®to identify patients' inhalation rates through dry powder inhalers.

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      References

      REFERENCES

        • Clark AR
        • Hollingworth AM
        The relationship between powder inhaler resistance and peak inspiratory condition in healthy volunteers. Implications for in-vitro testing.
        J Aerosol Med. 1993; 6: 99-110
        • Richards R
        • Sanders M
        Need for a comparative performance standard for dry powder inhalers.
        Thorax. 1993; 48: 1186-1187
        • Ross DL
        • Schulz RK
        Effect of inhalation flow rate on the dosing characteristics of dry powder inhalers (DPI) and metered dose inhalers (MDI).
        J Aerosol Med. 1996; 2: 215-226
        • Malton A
        • Sumby BS
        • Dandiker Y
        A comparison of in-vitro drug delivery for salbultamol Diskus and Terbutaline Turbuhaler.
        J Pharm Med. 1996; 6: 35-48
        • Borgström L
        • Bondesson E
        • Morén E
        • Trofast E
        • Newman SP
        Lung deposition of budesonide inhaled via Turbuhaler: a comparison with terbutaline sulphate in normal subjects.
        Eur Respir J. 1994; 7: 69-73
        • Newman SP
        • Morén F
        • Trofast E
        • Talaee N
        • Clarke SW
        Terbutaline sulphate. Turbuhaler effect of inhaled flow rate on drug deposition and efficacy.
        Int J Pharm. 1991; 74: 209-213
        • Engel T
        • Scharling B
        • Skovsted B
        • Heinig JH
        Effects, side effects and plasma concentrations of terbutaline in adult asthmatics when inhaling from a dry powder inhaler device and different inhalation flows and volumes.
        Br J Clin Pharmacol. 1992; 33: 439-444
        • Engel T
        • Heinig JH
        • Malling H-J
        • Scharling B
        • Nikander K
        • Madsen F
        Clinical comparison of inhaled budesonide delivered either pressurized metered dose inhaler or Turbuhaler.
        Allergy. 1989; 44: 220-225
        • Pitcairn GR
        • Lunghetti J
        • Ventura P
        • Newman SP
        A comparison of lung deposition of salbutamol inhaled from a new dry power inhaler at two flow rates.
        Int J Pharm. 1994; 102: 11-18
        • Pitcairn GR
        • Lim J
        • Hollingworth A
        • Newman SP
        Scintigraphic assessment of drug delivery for the Ultrahaler Dry Power Inhaler.
        J Aerosol Med. 1997; 10: 295-306
        • Nielson KG
        • Skov M
        • Klug B
        • Iverson M
        • Bisgaard M
        Flow dependent effect of formoterol dry powder inhaled from the Aerolizer.
        Eur Respir J. 1997; 10: 2105-2109
        • Newman SP
        • Talaee N
        • Clarke SW
        Salbutamol aerosol delivery in man with the Rondo Spacer.
        Acta Ther. 1991; 17: 49-50
        • Johnson S
        • Miles JF
        • Weir DC
        • Hanley SP
        Turbuhaler objective assessment of patient generated flow.
        Thorax. 1996; 51: A75
        • Hawksworth GM
        • Chrystyn H
        Characterization of the inspiratory manoeuvre when asthmatics inhale through a Turbuhaler pre-and post-counselling in a community pharmacy.
        Respir Med. 2000; 94: 501-504
        • Dewar MH
        • Jamieson A
        • McLean A
        • Crompton GK
        Peak respiratory flow through a Turbuhaler in chronic obstructive airways disease.
        Respir Med. 1999; 93: 342-344
        • Borgström L
        • Derom E
        • Stahl E
        • Wahlin-Böll E
        • Pauwels R
        The inhalation device influences lung deposition and bronchodilating effect of terbutaline.
        Am J Respir Crit Care Med. 1996; 5: 1636-1640
        • Brown PH
        • Ning A CWS
        • Greening AP
        • McLean A
        • Crompton GK
        Peak inspiratory flow through Turbuhaler in acute asthma.
        Eur Respir J. 1995; 8: 1940-1941
        • Engel T
        • Heinig JH
        • Madsen F
        • Nikander K
        Peak inspiratory flow and inspiratory vital capacity of patients with asthma measured with and without a new dry powder inhaler (Turbuhaler) device.
        Eur Resp Med. 1990; 3: 1037-1041
        • Hirsch T
        • Pater-Keen M
        • Koch R
        • Leupold W
        Influence of inspiratory capacity on bronchodilation via Turbuhaler or pressurized metered dose inhaler in asthmatic children.
        Respir Med. 1997; 91: 340-341
        • Olsson B
        • Asking L
        • Borgström L
        • Bondesson E
        Effect of inlet throat on the correlation between the fine particle dose and lung deposition.
        in: Dalby RN Byron PR Farr SY Respiratory Drug Delivery V. Interpharm Press Inc, 1996: 273-281
      1. Payne, N, Beard, S, Brucklebank, D, Ram, F, Wright, J, Taylor, R, Clinical and cost-effectiveness of inhaler devices for children with chronic asthma, National Institute for Clinical Excellence, 2000, www.nice.org.uk/pdf/asthma.pdf

        • Pedersen S
        • Hansen OR
        • Fulsgang G
        Influence of inspiratory flow rate upon the effect of a Turbuhaler.
        Arch Dis Child. 1990; 65: 308-319
        • Paterson IC
        • Crompton GK
        Use of pressurised aerosols by asthmatic patients.
        BMJ. 1976; 1: 76-77
        • Crompton GK
        Problems patients have using pressurised aerosol inhalers.
        Eur J Respir Dis. 1982; 119: 101-104
        • Nimmo CJ
        • Chen D NM
        • Martinusen SM
        Assessment of patient acceptance and inhalation technique of a pressurized aerosol inhaler and two breath-activated devices.
        Ann Pharmacother. 1993; 27: 922-927
        • Selroos O
        • Pietinhalho A
        • Riska H
        Delivery devices for inhaled asthma medication: clinical implications of differences in effectiveness.
        Clin Immunother. 1996; 6: 273-299
        • Ganderton D
        General factors influencing drug delivery to the lung.
        Respir Med. 1997; 91: 13-16
        • Tarsin W
        • Hawksworth GM
        • Chrystyn H
        The intra-individual variability of inhalation rates throught two different dry powder inhalers.
        Thorax. 2000; 55: A61