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Efficacy and safety of eco-friendly inhalers: focus on combination ipratropium bromide and albuterol in chronic obstructive pulmonary disease.

Panos RJ - Int J Chron Obstruct Pulmon Dis (2013)

Bottom Line: The adverse environmental effects of CFC-pMDIs stimulated the invention of novel delivery systems including the Respimat SMI.CFC-pMDIs contributed to the depletion of the ozone layer and the surge in disorders caused by harmful ultraviolet B radiation.The Respimat SMI is an innovative device that produces a vapor of inhalable droplets with reduced velocity and prolonged aerosol duration that enhance deposition within the lower airway and is associated with improved patient satisfaction.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, USA. ralph.panos@va.gov

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and its treatment is critical to improve quality of life, reduce symptoms, and diminish the frequency of COPD exacerbations. Due to the harmful environmental effects of pressurized metered-dose inhalers (pMDIs) containing chlorofluorocarbons (CFCs), newer systems for delivering respiratory medications have been developed.

Methods: A search of the literature in the PubMed database was undertaken using the keywords "COPD," "albuterol," "ipratropium bromide," and "Respimat® Soft Mist Inhaler™"; pertinent references within the identified citations were included. The environmental effect of CFC-pMDIs, the invention of the Respimat® Soft Mist Inhaler™ (SMI) (Boehringer Ingelheim, Ingelheim, Germany), and its use to deliver the combination of albuterol and ipratropium bromide for the treatment of COPD were reviewed.

Results: The adverse environmental effects of CFC-pMDIs stimulated the invention of novel delivery systems including the Respimat SMI. This review presents its development, internal mechanism, and use to deliver the combination of albuterol and ipratropium bromide.

Conclusion: CFC-pMDIs contributed to the depletion of the ozone layer and the surge in disorders caused by harmful ultraviolet B radiation. The banning of CFCs spurred the development of novel delivery systems for respiratory medications. The Respimat SMI is an innovative device that produces a vapor of inhalable droplets with reduced velocity and prolonged aerosol duration that enhance deposition within the lower airway and is associated with improved patient satisfaction. Clinical trials have demonstrated that the Respimat SMI can achieve effects equivalent to pMDIs but with lower medication doses. The long-term safety and efficacy remain to be determined. The Respimat SMI delivery device is a novel, efficient, and well-received system for the delivery of aerosolized albuterol and ipratropium bromide to patients with COPD; however, the presence of longer-acting, less frequently dosed respiratory medications provide patients and providers with other therapeutic options.

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Related in: MedlinePlus

Configuration of the prototype for the Respimat® Soft Mist Inhaler™. (Boehringer Ingelheim, Ingelheim, Germany).Note: Dalby RN, Eicher J, Zierenberg B. Development of Respimat(®) Soft Mist™ Inhaler and its clinical utility in respiratory disorders. Med Devices (Auckl). 2011;4:145–155.29
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f2-copd-8-221: Configuration of the prototype for the Respimat® Soft Mist Inhaler™. (Boehringer Ingelheim, Ingelheim, Germany).Note: Dalby RN, Eicher J, Zierenberg B. Development of Respimat(®) Soft Mist™ Inhaler and its clinical utility in respiratory disorders. Med Devices (Auckl). 2011;4:145–155.29

Mentions: The Respimat SMI is an alternative to pMDIs that forces a drug solution through a series of channels leading to two nozzles that focus two fluid jets into a precisely calculated convergence producing a vapor of inhalable droplets.31,32 The initial prototype for this device was constructed from a syringe containing a solution and a metal pump body (Figure 2). By pushing a lever, a measured amount of fluid was withdrawn from the syringe and a spring compressed to store mechanical energy. This energy was realized when the spring was released, pushing a piston that forced the solution through small channels forming two fluid jets that collided and produced a vapor with a mean particle mass size between 1 and 5 micrometers. Although this prototype design was effective in producing an aerosol with inhalable particles sized to be deposited in the lower airway, the fabrication of nozzles by puncture of a steel disc did not reliably create the precise angle of convergence required to produce a respirable vapor. Therefore, a novel nozzle configuration was designed from silicon-glass material with a series of channels leading to two apertures that aimed the two jets into convergent paths at a reliably reproducible angle to produce the desired aerosol. This silicon-glass configuration was constructed using dependable fabrication methods developed by the microelectronics industry. Using photolithographic techniques, a precise fluid path is etched into a silicon substrate that is then enclosed by two glass plates and sealed by anodic bonding to create the “uniblock” device that produces the aerosolized vapor31 (Figure 3).


Efficacy and safety of eco-friendly inhalers: focus on combination ipratropium bromide and albuterol in chronic obstructive pulmonary disease.

Panos RJ - Int J Chron Obstruct Pulmon Dis (2013)

Configuration of the prototype for the Respimat® Soft Mist Inhaler™. (Boehringer Ingelheim, Ingelheim, Germany).Note: Dalby RN, Eicher J, Zierenberg B. Development of Respimat(®) Soft Mist™ Inhaler and its clinical utility in respiratory disorders. Med Devices (Auckl). 2011;4:145–155.29
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3643287&req=5

f2-copd-8-221: Configuration of the prototype for the Respimat® Soft Mist Inhaler™. (Boehringer Ingelheim, Ingelheim, Germany).Note: Dalby RN, Eicher J, Zierenberg B. Development of Respimat(®) Soft Mist™ Inhaler and its clinical utility in respiratory disorders. Med Devices (Auckl). 2011;4:145–155.29
Mentions: The Respimat SMI is an alternative to pMDIs that forces a drug solution through a series of channels leading to two nozzles that focus two fluid jets into a precisely calculated convergence producing a vapor of inhalable droplets.31,32 The initial prototype for this device was constructed from a syringe containing a solution and a metal pump body (Figure 2). By pushing a lever, a measured amount of fluid was withdrawn from the syringe and a spring compressed to store mechanical energy. This energy was realized when the spring was released, pushing a piston that forced the solution through small channels forming two fluid jets that collided and produced a vapor with a mean particle mass size between 1 and 5 micrometers. Although this prototype design was effective in producing an aerosol with inhalable particles sized to be deposited in the lower airway, the fabrication of nozzles by puncture of a steel disc did not reliably create the precise angle of convergence required to produce a respirable vapor. Therefore, a novel nozzle configuration was designed from silicon-glass material with a series of channels leading to two apertures that aimed the two jets into convergent paths at a reliably reproducible angle to produce the desired aerosol. This silicon-glass configuration was constructed using dependable fabrication methods developed by the microelectronics industry. Using photolithographic techniques, a precise fluid path is etched into a silicon substrate that is then enclosed by two glass plates and sealed by anodic bonding to create the “uniblock” device that produces the aerosolized vapor31 (Figure 3).

Bottom Line: The adverse environmental effects of CFC-pMDIs stimulated the invention of novel delivery systems including the Respimat SMI.CFC-pMDIs contributed to the depletion of the ozone layer and the surge in disorders caused by harmful ultraviolet B radiation.The Respimat SMI is an innovative device that produces a vapor of inhalable droplets with reduced velocity and prolonged aerosol duration that enhance deposition within the lower airway and is associated with improved patient satisfaction.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, USA. ralph.panos@va.gov

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and its treatment is critical to improve quality of life, reduce symptoms, and diminish the frequency of COPD exacerbations. Due to the harmful environmental effects of pressurized metered-dose inhalers (pMDIs) containing chlorofluorocarbons (CFCs), newer systems for delivering respiratory medications have been developed.

Methods: A search of the literature in the PubMed database was undertaken using the keywords "COPD," "albuterol," "ipratropium bromide," and "Respimat® Soft Mist Inhaler™"; pertinent references within the identified citations were included. The environmental effect of CFC-pMDIs, the invention of the Respimat® Soft Mist Inhaler™ (SMI) (Boehringer Ingelheim, Ingelheim, Germany), and its use to deliver the combination of albuterol and ipratropium bromide for the treatment of COPD were reviewed.

Results: The adverse environmental effects of CFC-pMDIs stimulated the invention of novel delivery systems including the Respimat SMI. This review presents its development, internal mechanism, and use to deliver the combination of albuterol and ipratropium bromide.

Conclusion: CFC-pMDIs contributed to the depletion of the ozone layer and the surge in disorders caused by harmful ultraviolet B radiation. The banning of CFCs spurred the development of novel delivery systems for respiratory medications. The Respimat SMI is an innovative device that produces a vapor of inhalable droplets with reduced velocity and prolonged aerosol duration that enhance deposition within the lower airway and is associated with improved patient satisfaction. Clinical trials have demonstrated that the Respimat SMI can achieve effects equivalent to pMDIs but with lower medication doses. The long-term safety and efficacy remain to be determined. The Respimat SMI delivery device is a novel, efficient, and well-received system for the delivery of aerosolized albuterol and ipratropium bromide to patients with COPD; however, the presence of longer-acting, less frequently dosed respiratory medications provide patients and providers with other therapeutic options.

Show MeSH
Related in: MedlinePlus