Spiolto Respimat System – Innovation for Easier Inhalation
Inhalation delivery is the most preferred method of drug administration in chronic obstructive pulmonary disease and bronchial asthma. The effectiveness of therapy is also conditioned by the correct inhalation technique. The aim of the following article is a brief comparison of inhalation systems, focusing on a new addition to the group of aerosol inhalers.
Introduction
Inhalation systems can generally be divided based on whether the patient inhales the active substance in the form of a powder or aerosol. Inhalers can also be evaluated based on other parameters, such as the internal resistance of the system, respirable fraction, dosage consistency, or aerodynamic parameters of the drug. Specific data that would help objectively compare all available types of inhalation devices are often not provided by the manufacturer. The choice is also largely determined by patient factors. In terms of compliance and proper operation, it is necessary to consider the patient's manual and intellectual abilities or any co-payment.
Powder Inhalation Systems
The first group consists of dry powder inhalers (DPI). The medication is released and transported to the lungs using the patient's own breath. The inhalation maneuver is slightly easier for the patient compared to an aerosol dispenser; on the other hand, it is necessary to achieve a sufficiently high inhalation (inspiratory) flow. Each inhalation system has a recommended range of peak inspiratory flow (PIF) values to ensure maximum efficacy. Generally, for DPIs, a sharp and deep inhalation is recommended to accelerate the inspiratory flow.
Aerosol Inhalers
Aerosol dispensers (MDI) can be divided into three groups: pressurized inhalers, where the aerosol is released by pressing the container, breath-actuated dispensers, known as the Easi-Breathe system, and aerosol dispensers with an integrated inhalation spacer. The latter two systems are not currently available in the Czech Republic.
The propellants in aerosol dispenser pressurized containers are hydrofluoroalkanes (HFA), which replaced the previously used freons. As an alternative to HFA, the Respimat system was developed, utilizing the energy of a tensioned spring to release the medication and a fine Uniblock nozzle to create the aerosol. The aerosol is generated independently of the peak inspiratory flow rate and appears as a fine mist. Due to this fine aerosol, visibly as a cloud, Respimat is referred to as a soft mist inhaler (SMI).
Advantages of the Spiolto Respimat System
Compared to powder inhalers, all aerosol inhalation systems place greater demands on the patient, especially in terms of coordinating the pressurization of the container and simultaneous inhalation. The mechanics of Spiolto Respimat are designed to reduce the speed and duration of the mist release. Compared to other MDIs, this gives the patient a longer timeframe to perform the proper inhalation maneuver, which should be deep and calm.
The aerosol dispenser producing the fine mist has a high value of respirable fraction (RF). This parameter, expressed as the percentage of particles measuring 4.7–2.1 µm contained in the nominal dose, is 61–81 for SMI. This is significantly higher than other inhalation systems, whose RF ranges from 16 to 64.
In addition to the aforementioned effectiveness advantage, Spiolto Respimat is equipped with a dose counter. This is crucial for the patient as it indicates the number of remaining doses, and for the last 30 doses, a slider shows on a differently colored field.
What Drives the Overall Success of Treatment
There are many requirements for an ideal inhalation system. Within the group of aerosol dispensers, Spiolto Respimat offers added value by simplifying the inhalation maneuver. However, patient compliance most significantly determines proper effectiveness. Physicians, pharmacists, and nurses can positively contribute to this by repeatedly educating and correctly training the inhalation technique with the specific inhaler.
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Sources:
1. Iwanaga T., Tohda Y., Nakamura S., Suga Y. The Respimat® soft mist inhaler: implications of drug delivery characteristics for patients. Clin Drug Invest 2019; 39 (11): 1021–1030, doi: 10.1007/s40261-019-00835-z.
2. Švihovec J. Bultas J., Anzenbacher P. et al. (eds.). Pharmacology. Grada, Prague, 2018.
3. Kašák V., Feketeová E. Respimat SMI – a new inhalation system in the treatment of COPD. Pharmacotherapy 2010; 6 (4): 369–376.
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