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Inhalation is the preferred route of drug administration in asthma therapy. "We currently have very effective molecules. Despite this, we have major difficulties in treating asthma and many patients are very poorly controlled," explained Professor Peter Barnes (UK), a member of the European ADMIT group (Aerosol Drug Management Improvement Team), speaking at the Web Symposium on Asthma, Allergy and COPD in France, June 2009[1]. "Even the pMDI [pressurised metered dose inhaler], the most frequently used device worldwide, cannot be used properly by nearly half of the patients," added ADMIT member Dr. Frederico Lavorini (IT). The incorrect use of inhalers leads to insufficient drug delivery and lung deposition. Therefore, the first stage of the actions of the European ADMIT group is focused on basic therapeutic education, primarily to ensure optimal use of inhaler devices. According to Dr. Lavorini, the "ideal" inhaler is the one that delivers consistent and reliable drug doses, is easy to use and requires minimal co-operation and co-ordination. The device which best meets the requirements and recommendations of these international experts is an innovative state-of-the-art inhaler, the Novolizer®.

www.admit-online.info as an educational tool

The www.admit-online.info website has been created as a universal educational tool. It is aimed at both patients and health professionals who can use it as a means of support during consultation. According to Prof. Barnes, the measures devoted to therapeutic education vary greatly from one European country to another. "On average, we devote 70% of the consultation time to therapeutic education," explained Prof. Jean-Christophe Dubus (FR), a pneumologist and paediatrician, at the web symposium. "A GP cannot necessarily do this. Some studies show that 40% of asthmatic children have not been shown how to use inhalers." Therefore, another key goal of the ADMIT website is to provide health professionals with comprehensive documentation about inhaler devices.

The key role of inhalers in therapy

"For the inhalation of drugs, pMDIs, DPIs [dry powder inhalers] and nebulisers or ultrasound inhalers are available" explained Prof. Dubus. Nebulisers enable good bioavailability and are very easy to use, even with very young children. Conversely, however, they are not portable, they are expensive and inconvenient to use.  

In summary, more than 100 inhaler-drug combinations are available for the treatment of asthmatic patients. One of the most important factors that influence inhaler choice is the physicians` experience. According to the ADMIT group, they are much more likely to prescribe the same old inhaler they have always prescribed rather than new, improved inhalers. But the rationale for the choice of a particular inhaler should be evidence-based rather than empirical.  

According to Dr. Lavorini, asthma and chronic obstructive pulmonary disease (COPD) patients make fewer mistakes in inhalation therapy with DPIs compared to pMDIs. Metered pressurised aerosols require the patient to coordinate their breathing very closely with the release of drug from the inhaler. Some studies have shown that around 70% fail to carry out this procedure correctly. DPIs are used more successfully, with less than one fifth of patients failing to load the device properly and/or not performing a deep and forceful inhalation. To make the choice easier, the ADMIT team offers physicians a "features-based product search" on its web portal www.admit-online.info. According to the ADMIT group, an inhaler should only be prescribed with the absolute certainty that the patient can use it correctly. 

An innovative state-of-the-art DPI, the Novolizer® , best meets the requirements and recommendations of international experts. The unique inhalation control and feedback features of the Novolizer®, as well as its ease-of-use ensure better asthma and COPD treatment outcomes. Patients who have taken part in peak inspiratory flow studies were able to use the Novolizer® correctly. The drug delivery is entirely independent of the patient's inspiratory action, and the Novolizer® gives multiple feedback for successful inhalation. According to Dr. Lavorini, the old-fashioned, but still widely used, pMDI is the most complicated inhaler to handle, with poor deposition rates in the lungs.
The fact that up to approximately 70% of patients misuse their inhaler may have detrimental consequences for clinical efficacy of inhaled drugs and disease management[3,4]. After evaluation of published data, Lavorini has shown that a correct inhalation technique is more frequently associated with the use of DPIs than pMDIs[2]. DPIs are easy to use since they do not require coordination between patient's inspiration and inhaler actuation; in addition, they are characterised by a high lung deposition. 

[1] Web Symposium Asthma, Allergy and COPD, symp-on@ir.com, June 9th, 2009

[2] Lavorini, on behalf of ADMIT, ERS poster presentation 2008

[3] Crompton GK et al. Respir Med 2006; 100: 1479-1494

[4] Molimard M. Curr Med Res Opin 2005; 21: S33 - S38  

The Novolizer is a registered trademark of MEDA Group 

Further information:

www.novolizer.com

www.admit-online.info

www.meda.se

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