Higher lung deposition with Respimat^® Soft Mist™ Inhaler than HFA-MDI in COPD patients with poor technique

Original Research

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Authors: Peter Brand, Bettina Hederer, George Austen, Helen Dewberry, Thomas Meyer

Published Date August 2008 Volume 2008:3(4) Pages 763 - 770

DOI: http://dx.doi.org/10.2147/COPD.S3930

Peter Brand¹, Bettina Hederer², George Austen³, Helen Dewberry³, Thomas Meyer⁴

¹RWTH, Aachen, Germany; ²Boehringer Ingelheim, Ingelheim, Germany; ³Boehringer Ingelheim, Bracknell, UK; ⁴Inamed Research, Gauting, Germany

Abstract: Aerosols delivered by Respimat^® Soft Mist™ Inhaler (SMI) are slower-moving and longer-lasting than those from pressurized metered-dose inhalers (pMDIs), improving the efficiency of pulmonary drug delivery to patients. In this four-way cross-over study, adults with chronic obstructive pulmonary disease (COPD) and with poor pMDI technique received radiolabelled Berodual^® (fenoterol hydrobromide 50 µg/ipratropium bromide 20 µg) via Respimat^® SMI or hydrofluoroalkane (HFA)-MDI (randomized order) on test days 1 and 2, with no inhaler technique training. The procedure was repeated on test days 3 and 4 after training. Deposition was measured by gamma scintigraphy. All 13 patients entered (9 males, mean age 62 years; FEV₁ 46% of predicted) inhaled too fast at screening (peak inspiratory flow rate [IF]: 69–161 L/min). Whole lung deposition was higher with Respimat^® SMI than with pMDI for untrained (37% of delivered dose vs 21% of metered dose) and trained patients (53% of delivered vs 21% of metered dose) (_pSign-Test = 0.15; p_ANOVA< 0.05). Training also improved inhalation profiles (slower average and peak IF as well as longer breath-hold time). Drug delivery to the lungs with Respimat^® SMI is more efficient than with pMDI, even with poor inhaler technique. Teaching patients to hold their breath as well as to inhale slowly and deeply increased further lung deposition using Respimat^® SMI.

Keywords: chronic obstructive pulmonary disease, drug delivery, inhalation, metered-dose inhaler, poor inhalation technique, training