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DATAMONITOR: Inhaler devices are still a major hurdle in asthma and COPD treatment
[June 03, 2008]

DATAMONITOR: Inhaler devices are still a major hurdle in asthma and COPD treatment

(M2 PressWIRE Via Acquire Media NewsEdge)

London -- Although the inhaled delivery of drugs has major advantages
over other methods of administration, inhaler devices are often
difficult to use and can indirectly have a negative impact on symptom
control. Unfortunately, in a classic catch-22 situation, those devices
that are developed to overcome the disadvantages of the majority of
inhalers often lack broad availability across different therapeutic
molecules and drug classes. Offering physicians and patients a range of
therapies in the same type of device will therefore improve proper use
of inhalers, which can indirectly have a positive impact on the control
of diseases like asthma and chronic obstructive pulmonary disease
(COPD), according to a new report* by independent market analyst

Benefits of inhalers obvious Respiratory diseases like asthma and
COPD are mostly treated with inhaled drugs in order to relieve
bronchoconstriction and target inflammation in the lungs. There are
several advantages to administering these drugs via the inhaled route
compared to oral therapy: a faster onset of action, lower drug doses
and a better efficacy-to-safety ratio. Drug delivery by inhalation is
also painless and is more convenient than injectable drugs.

Despite this impressive list of benefits, several drawbacks remain for
inhaled medicines, explains Datamonitor respiratory analyst Lisette
Oversteegen. "One of the biggest problems relates to the inhaler device
through which the drug is delivered. Every type of device is different
and requires a specific inhalation technique in order to get a
sufficient amount of drug to the lungs.

"Since there are so many different types of inhalers available, it can
be difficult for the patient to learn and remember the correct use for
each one of them. An incorrect inhalation technique is likely to have a
big impact on a patient's daily life, since their asthma or COPD
symptoms could be less well controlled than optimally possible," she

All types of inhaler devices have major disadvantages There are two
main types of portable inhaler devices used in the treatment of asthma
and COPD: metered dose inhalers (MDIs), including pressurized MDIs
(pMDIs) and breath-activated MDIs (BAIs), and dry powder inhalers
(DPIs) (including single-unit dose DPIs, multi-dose reservoir DPIs and
multi-unit dose DPIs).

Amongst the BAIs and DPIs especially, there is a wide variation in
design, making it impossible to learn only one technique to use them

The standard pMDI is the oldest and most often-used inhaler since it is
cheap and available containing many different molecules. Nonetheless, a
large proportion of patients cannot use them correctly. One of the most
common problems is a failure to co-ordinate inhalation with actuation
of the device (pressing the canister to release the drug). Patients
often actuate the inhaler before or at the end of inhalation, and some
may even hold their breath while activating the inhaler. Other errors
include failure to exhale fully before inhalation and failure to
continuously inhale slowly after actuation.

Because of the problems associated with pMDIs, attention has focused on
the improvement of inhaler devices to optimize the delivery of
medication. Breath-activated MDIs (BAIs) help to overcome the problem
of co-ordinating actuation with inhalation, thus providing the
opportunity to improve drug delivery and overall disease control.
However, the major drawback of BAIs is that there are only a few drugs
available in these devices due to the high cost involved in developing
them, Miss Oversteegen says. "Since physicians cannot offer all of the
medicines a patient needs in a BAI, they are forced to switch back to a
pMDI or combine different devices in one treatment regimen." Dry
powder inhalers offer an alternative response to the difficulties
associated with pMDIs. These devices release the drug by passing air
from the patient's inhalation effort through medication formulated as a
dry powder. Although this partially resolves the co-ordination problem
since the drug is only released when the patient inhales, there are
other disadvantages to DPIs, Miss Oversteegen says. "While the
inhalation technique for pMDIs is generally the same, the wide variety
of DPIs available means that inhalation instructions can be very

"Furthermore, to ensure that most of the drug emitted from a dry powder
inhaler reaches the lungs, it is necessary for the patient to inhale
deep and fast enough. A number of asthma and COPD patients are unable
to do so, especially the elderly, children and people with severe
airflow limitation," she says.

The ideal inhaler device does not exist Both physicians and patients
agree that there are certain characteristics to an ideal inhaler. It
should be small, easy-to-use and suitable for patients with low
inspiratory volume. It should be breath-actuated and only release the
drug when all prerequisites for successful inhalation are met. "And
most importantly", Miss Oversteegen says, "the drug delivery should be
flow-independent and multiple automatic feedback mechanisms should
exist to reassure the patient that the drug was successfully deposited

in the lungs." However, since there is no inhaler device combining
all of the above characteristics (although some characteristics are met
in different individual inhalers), physicians have to make a choice
from the range of available inhaler devices, Miss Oversteegen says.
"Clearly, physicians should recognize that patients differ and a device
that is most appropriate for their needs and circumstances should be
matched individually.

"Additionally, cost plays an increasingly important role and many
governments will ask physicians to start their patients on a cheap
pMDI, and only use a more expensive inhaler when necessary," she says.

Nevertheless, the concept of matching an inhaler to a patient becomes
redundant if inhaler availability is a problem. There can be quite a
difference in the availability of inhaler devices across treatments.
Although most molecules are available in both DPIs and pMDIs in the six
major markets**, availability within one country can be very different.

A range of molecules delivered in the same type of device could improve
treatment Obviously, when patients are on a pMDI and all the
treatments they require are available in pMDIs, there is no problem as
there is no difference between the inhalation techniques of these
devices. However, DPIs differ significantly and the availability of
certain molecules in certain DPIs may limit a physicians' choice. If,
for example, a physician recommends Symbicort (AstraZeneca's
budesonide/formoterol combination) for a patient, all the other choices
of drugs are limited to their availability in the Turbuhaler, of which
there are few.

Having a range of molecules available in the same device will allow
physicians to prescribe a complete treatment regimen in the same type
of device, minimalizing errors in inhalation technique, Miss
Oversteegen says. "This would also lead to increased convenience for
the patient, as only one technique needs to be learnt and remembered.

"Indeed, some companies market one type of inhaler device with
different molecules across drug classes, covering all the needs of a
standard asthma patient. However, these are all generic molecules and
the newer treatments are not available in the same range, leaving many
asthma and COPD patients struggling with their daily medication," she

Notes for editors

* Stakeholder Insight: Portable Inhaler Devices - Key tools to
differentiate brands and survive generic pressure ** Six major
markets: US, France, Germany, Italy, Spain and the UK.

Datamonitor's report Stakeholder Insight: Portable Inhaler Devices -
Key tools to differentiate brands and survive generic pressure provides
a comparative overview of portable inhaler devices used in the
respiratory market. Gives insight into the current market situation
based on IMS Sales Data. Assesses case studies to provide insight into
potential market strategies.

Miss Lisette Oversteegen, Datamonitor respiratory analyst and report
author is available for comment.

CONTACT: Matthew Dick, Datamonitor Press Office
Tel: +44 (0)20 7551 9387
e-mail [email protected]
Suzanna Eygabroat
Tel: +1 585 374 6326 ext 17
Denis Mason
Tel: +61 2 8705 6903

((M2 Communications Ltd disclaims all liability for information
provided within M2 PressWIRE. Data supplied by named party/parties.
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Copyright ? 2008 M2 Communications Ltd.

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