Pharmacotherapeutics: Pharmacotherapuetics |

Advice for Patients Using Inhalers in Various Temperature and Altitude Conditions FREE TO VIEW

Chelsea Morin, BS; Jordan Titosky, BS; Jonathan Suderman, BS; Warren Finlay, PhD; Mary Noseworthy, MD
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University of Calgary Department of Medicine, Calgary, AB, Canada

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):972A. doi:10.1016/j.chest.2016.08.1076
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SESSION TITLE: Pharmacotherapuetics

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study was to determine the effects of pressure and temperature on inhaler performance in order to help appropriately prescribe and educate patients on proper inhaler use.

METHODS: An in vitro testing apparatus was set up using industry standard inhaler testing devices. Inhalers were actuated during simulated inhalation and particles which traveled through the throat model and reached a downstream filter were measured as the in vitro lung deposition. Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) were tested at varying altitudes from 670m to 4300m. MDIs were also tested at a range of temperature conditions including inhaler and ambient temperatures of -10°C, 0°C, 10°C, 20°C and 40°C. The inhaler and ambient temperatures were varied separately in order to simulate real patient conditions.

RESULTS: Altitude had no significant effect on the performance of MDIs. Using a constant flow rate, the Bricanyl Turbuhaler showed a decrease in deposition at higher altitudes. But when a higher flow rate was used to account for the decreased air resistance, there was no significant change in deposition. All MDIs showed a significant response to changes in temperature, with depositions of less than 60% of nominal at equilibrated temperatures of -10°C. Ventolin was susceptible to a reduction in deposition with just a reduced ambient temperature and both Ventolin and Airomir showed significant reductions in deposition when just the inhaler temperature was decreased.

CONCLUSIONS: Temperature has a significant effect on the performance of pMDIs, but altitude does not. At higher altitudes, DPIs that rely on aerodynamic forces to break up particles may require an increased inhalation flow rate to achieve nominal deposition.

CLINICAL IMPLICATIONS: It is important that patients understand that environmental conditions in which they are using their inhaler can prevent ideal drug delivery. MDIs should ideally be acclimatized to room temperature. If this is not possible, then DPIs may be a better choice for cold (subzero) temperature use.

DISCLOSURE: The following authors have nothing to disclose: Chelsea Morin, Jordan Titosky, Jonathan Suderman, Warren Finlay, Mary Noseworthy

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