Using Functional Respiratory Imaging (FRI) to Compare Predicted Airway Deposition Between Pressurized Metered Dose Inhaler (pMDI) with AeroChamber Plus Flow-Vu ®️ Valved Holding Chamber (VHC) and Two Dry Powder Inhalers (DPIs) in a COPD patient
Suggett JA1, Sadafi H2 Mussche C3 & Mitchell JP4
1Trudell Medical International, 725 Baransway Drive, London, Ontario, N65 5G4, Canada
2 FLUIDDA NV, Groeningenlei 132, 2550 Kontich Belgium
3 FLUIDDA Inc., 228 East 45th Street, 9th Floor, Suite 9E, New York, NY 10017, USA
4 Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Rd., London, Ontario, N6H 2R1, Canada
Summary
Functional respiratory imaging (FRI) is a relatively recently developed in silico technique, whereby the regional lung deposition pattern can be predicted using 3-dimensional respiratory tract models from multi-slice computer tomographic scans of patients, following segmentation to extract patient-specific airway and lung structures. We used FRI to compare predicted delivery of inhaled medication from a pMDI+VHC with two commonly prescribed mid-resistance DPIs to an adult with COPD (GOLD stage-III), mimicking representative optimal and sub-optimal inhalation profiles. The pMDI with antistatic AeroChamber* Plus Flow-Vu* VHC delivered salbutamol (100μg/actuation) as model formulation inhaled at 30 (optimal) or 60 (sub-optimal) L/min. This inhaler was compared with Symbicort* Turbohaler* DPI delivering 6μg formoterol fumarate/200μg budesonide inhaling at 30 (sub-optimal) or 60 (optimal) L/min and Trelegy* Ellipta* DPI delivering fluticasone furoate (100μg); umeclidinium (62.5μg); vilanterol (25μg) inhaled at 30 (sub-optimal) or 60 (optimal) L/min. Predicted extrathoracic deposition, representing dose delivered to the oropharynx was appreciably lower for the pMDI/VHC combination compared to the two DPIs. Predicted intrathoracic deposition, representing dose delivered to the lungs, for the pMDI/VHC combination was greater than corresponding values for either of the DPIs. Regional deposition to the lung periphery under optimum inhalation, based on central/peripheral (C/P) deposition ratio, was slightly higher for the pMDI/VHC combination than for either DPI. Efficiency of inhaled medication delivery to the lungs by pMDI/VHC when inhaling either optimally or sub-optimally is likely to be greater than for either DPI.
Key Message
FRI provided insight predicting regional aerosol deposition in the airways of a COPD patient, showing a greater proportion of the labelled dose inhaled via pMDI/VHC is delivered to the lungs and correspondingly less to the oropharynx with little inhalation flow rate dependency.