RT had the opportunity to discuss market trends and the latest in aerosol delivery products with Lori Byrd, category marketing manager, respiratory, Omron Healthcare Inc, Bannockburn, Ill; Matt Conlon, director of sales and marketing, respiratory drug delivery, Respironics Inc, Murrysville, Pa; Werner Gutmann, president, PARI Respiratory Equipment Inc, Midlothian, Va; and Paul McGowen, RRT, president, Thayer Medical Corp, Tucson, Ariz.

From left to right: Lori Byrd, Matt Conlon, Werner Gutmann, Paul McGowen

Omron Healthcare Inc is a subsidiary of Omron Corp, Kyoto, Japan, a manufacturer of sensor and ultrasonic systems and technology. Omron Healthcare markets and distributes medical, home health care, and wellness products around the globe. First established in 1906, PARI Respiratory Equipment Inc began developing aerosol systems for patients with respiratory problems in the 1950s and is a now a worldwide manufacturer of aerosol delivery systems for patients with asthma, chronic lung disease, and cystic fibrosis. Respironics has been manufacturing and distributing respiratory products for more than 3 decades. Its wide range of products serves the needs of respiratory and sleep clinicians. Thayer Medical was cofounded by David Sladek and Paul McGowen, both respiratory therapists. Together, they invented several products and built the company around their clinical RT experience.

RT:  What are the latest trends/new developments in aerosol delivery products?

Byrd: As we face the growing incidence and awareness of asthma and COPD, I think we will continue to see the push for products and medications that maintain airways and reduce patient exacerbations as effectively as possible. We still have far too many patients who are not taking their medication properly and are not functioning at their best level. The requests for fast, effective, patient-friendly medication delivery devices have been heard and are being addressed by manufacturers.

Conlon: The field of aerosol drug delivery is evolving rapidly. In simple terms, aerosol therapy falls between injectable drug delivery and an oral pill. Delivery through the lung is preferable to injectables for obvious reasons, and we see more and more drug development programs moving in that direction in areas such as insulin, pain management, vaccines, and gene therapy. While a pill may seem to be the ideal, most convenient method of delivering medication, aerosol delivery is being more and more recognized as having the advantages of fewer systemic side effects and more rapid uptake. Whereas aerosol therapy has traditionally been applied for respiratory conditions such as COPD and asthma, the research is rapidly expanding for aerosol delivery of drugs to treat nonrespiratory conditions as well. It is an exciting time for clinicians and researchers in the respiratory field, as their relevance and expertise will be required as aerosol drug delivery is applied more broadly.

Within the aerosol drug delivery field, as the 2005 Chest Guidelines clearly point out, the efficacy of delivering aerosol medication via the three major modalities—nebulizers, MDIs, and DPIs—is clinically equivalent. What is emphasized in these guidelines for selecting devices is the need to consider several patient-related factors such as affordability, ease-of-use, and drug availability in specific delivery modalities. These guidelines are a significant catalyst in a paradigm shift of the way devices are and should be developed and evaluated. Historically, the emphasis has been on maximal output of drug through the device with little consideration of important, real-life, patient considerations. Clinicians are encouraged to select devices that are most appropriate for each individual patient. Device manufacturers not only must now work closely with pharmaceutical companies to ensure optimal drug delivery—and this does not necessarily mean the most amount of drug, but actually the least amount of drug to stay within the therapeutic window of the drug, and thereby reduce unwanted side effects—they also must incorporate important patient considerations into their drug and device development programs.

Gutmann: As the prevalence and diagnosis for respiratory disease states such as asthma and COPD, chronic sinusitis, and vasal allergies continue to grow, so does the demand for medications and devices used to treat these diseases via aerosol delivery. Advancements continue to focus on offering the right device with the right drug, more consistent and efficient medication delivery, and increased portability for patients. The future of effective aerosol therapies lies in the optimization of drug-to-device and device-to-drug, as providers continue to gain a better understanding of the importance of this combination to best provide effective aerosol therapies.

McGowen: Although it has always been important, I think there has been increased focus recently on containing hospital equipment costs and eliminating the risks of pathogens to patients and RTs. One of the biggest trends I’ve been seeing in the VHC [valved holding chamber] business that can have a significant impact on RTs is a push to eliminate the sterilization and reuse of holding chambers in hospitals and clinics. As an RT myself, I never really felt comfortable reusing spacers with multiple patients. It’s becoming obvious that many RTs and hospital administrators around the world feel the same way. I believe the SARS outbreaks a few years ago was a wake-up call. Since then, there has been a great deal of interest in finding a cost-effective, single-patient use alternative to plastic VHCs and spacers.

RT:  Tell us about your most recent aerosol delivery products and why they are innovative.

Byrd: Our MicroAir nebulizer operates using vibrating mesh technology (VMT) to create aerosolized drug. It operates on 2 “AA” batteries and weighs only 6 ounces with the batteries installed. It is a truly portable unit and will go with the patient anywhere so that treatments can be taken on time. Since it can run on alkaline batteries, it is an excellent option for those patients who live in areas where electrical outages can occur. VMT allows the unit to nebulize with very little medication waste at a rate faster than some compressor nebulizers. This unit makes treatments convenient, which will help the patient be more compliant with their medication, ultimately leading to better control of their disease.

Conlon: Respironics’ I-neb® is a highly sophisticated nebulizer system that uses adaptive aerosol delivery (AAD®) technology, which ensures a precise medication dose during the patient’s inhalation phase, constantly adapting to the changes in the patient’s breathing pattern. The result is precise, reproducible medication to each patient, regardless of their breathing pattern. Precise dosing is important to ensure that patients receive a safe and therapeutic dose of medication. This is especially important when delivering medications with narrow therapeutic windows such as iloprost. While this is the most advanced and sophisticated method of delivering liquid medications to the lung, such targeted and precise delivery is not required for other drugs with wider therapeutic windows such as albuterol. In the case of these more commonly used drugs, the devices need to be affordable, easy-to-use, and convenient, while enhancing patient compliance.

Respironics devices such as the OptiChamber® Advantage valved holding chamber for use with MDIs, and Sidestream® nebulizers, are ideally suited to meet these patient-related requirements. Patient convenience comes in many forms. These may include factors such as ease-of-use, portability, or speed of delivery. We recently launched the MiniElite™, a compact, battery-operated, compressor/nebulizer system to address all of those patient-related factors. It also ideally fits into the clinical and business requirements of home health care providers. Another exciting recent introduction is our line of pediatric-friendly products. Featuring Sami the Seal™ and Tucker the Turtle™, this program wraps engaging educational materials around products to encourage compliance.

Gutmann: PARI has long been the leader in offering nebulizers approved for use with a variety of FDA-approved liquid respiratory medications. The LC® Plus reusable nebulizer has been the staple of this, and the LC Sprint has recently been introduced as the next generation of reusable nebulizer geared toward delivering effective aerosol therapy. These nebulizers are offered with the most advanced PRONEB® Ultra II tabletop and Trek® S portable compressors to form nebulizer systems that provide caregivers and patients with a variety of technologically advanced aerosol delivery systems. The Trek S has become an extremely popular device that offers enhanced portability options for the patient on the go. PARI’s eFlow® is a portable electronic nebulizer that utilizes advanced technology to increase the efficiency and effectiveness of medication delivery while significantly decreasing standard treatment times. The eFlow platform can be customized and optimized for each medication formulation, and formulations can be modified or adjusted to eFlow. PARI also offers clinically supported character-style pediatric masks for use with nebulizers.

PARI’s device innovation also includes the Vortex® valved holding chamber, the first offering a nonelectrostatic material that advances aerosol delivery via MDI. Also offered now are aerosol delivery systems targeted for the upper airways and a new advanced Hydrate™ humidification system for a number of clinical applications. PARI’s device innovation and partnerships with leading pharmaceutical companies bring an unparalleled offering to the respiratory industry to address the needs of the respiratory patient and caregiver.

McGowen: One [of Thayer’s] most innovative aerosol delivery products, which I am really excited about, is the LiteAire® collapsible paperboard VHC. It is a true dual-valved MDI holding chamber that, in its collapsed state, is about the size and shape of a greeting card. When the LiteAire is popped up, it performs like a typical plastic VHC. The LiteAire actually gives a better MDI dose than most of the plastic VHCs on the market due to its material selection. Paperboard is naturally nonelectrostatic and delivers more medication to the patient. Also, the price of the LiteAire is much lower than that of plastic VHCs, which allows hospitals to use it as a single-use, disposable (environmentally friendly) product. Since the LiteAire is labeled for 1 week’s use, it can also be sent home with patients with short-term MDI needs. Thayer has been getting great feedback from hospitals, PFT laboratories, emergency departments, and pulmonary rehabilitation clinics that have switched to the LiteAire. It is a product that can benefit hospitals from a cost-savings standpoint, benefit RTs from a safety standpoint, and can encourage patient compliance with its size, convenience, portability, and easy disposability.

RT:  What about future trends/products that your companies are working on that will be introduced in the next generation?

Byrd: Omron, like other manufacturers, is constantly searching for ways to improve its products. The company will be focusing on producing nebulizers that provide a quieter, faster, more effective treatment in the future. Portability is important to today’s nebulizer users, and we will continue to make improvements in the portability of our units.

Conlon: While we cannot disclose specifics, Respironics is excited about the opportunity to play a significant role in device development in the field of aerosol science as the field evolves. We will continue to work closely with pharmaceutical companies, researchers, and respiratory therapists to identify market needs in this area and develop and introduce products that are ideally suited to those needs.

Gutmann: PARI continues to advance current and future technology platforms aimed at enhancing the effectiveness of aerosol therapies. PARI utilizes a multifunctional development program as the key to creating targeted therapies with high deposition amounts, low side-effect profiles, improved patient compliance … and happier, healthier patients. Overall, PARI’s goal is to improve compliance through technological innovations that lead to better control of symptoms and improved quality of life for patients.

McGowen: Thayer Medical’s company slogan is “Thoughtful solutions through simplicity in design.” Our philosophy drives how we design and develop aerosol delivery products. We continue to research and develop products that are simple for both patients and RTs to use and are highly effective. I am currently focused on three areas of opportunity around aerosol delivery: improving the safety of mechanical ventilation (ie, reducing contamination risks to the patient and the RT provider), improving aerosol device efficiency, and keeping overall product costs down.

RT:  Are there any misconceptions or advice to RTs about the use or care of any of your products?

Byrd: RTs should remind patients to read their nebulizers’ instruction manuals. These documents contain important information for patients regarding the use and the cleaning of their unit. Units that have not been cleaned properly may not nebulize as effectively or as quickly, which will prolong treatment times and may result in less optimal aerosol formation. Accessories, including reusable nebulizer kits, need to be replaced from time to time; and the trouble-shooting information may prevent a frustrated patient call to their favorite respiratory professional.

Conlon: In addition to offering products that are intuitively easy-to-use, Respironics invests significant resources into educational programs and tools geared toward both patients and clinicians to ensure an understanding of our products. While we do not see any particular misconceptions about our products, on a broader level, there are misconceptions about how a device should be selected. For example, many clinicians have been led to believe that the best aerosol delivery device is the one that delivers the most drug. As we have discussed, ideally, devices should meet therapeutic windows for particular drugs without overshooting those windows and potentially causing unwanted side effects. Without specific dosing information or direction from pharmaceutical companies or appropriate in vivo clinical studies, clinicians should be cautious of using maximum output as their only criterion for device selection. To assist in these areas, we’re sponsoring the new Guide to Aerosol Delivery Devices for Respiratory Therapists through an unrestricted educational grant to the American Association for Respiratory Care.This is a four CRCE contact hour program that will be available in the near future.

Visit our online Buyer’s Guide to learn where you can find aerosol delivery products.

Gutmann: I would offer advice only to continually work to understand the importance of drug and device combinations for effective aerosol delivery.

McGowen: Thayer Medical prides itself on having the clinical RT experience to develop innovative products that are designed with the RT and patient in mind. Our in-line Valved-Tee adapter and MiniSpacer® have benefited countless patients in critical care; are easy to use; and are available in adult, pediatric, and neonatal sizes. The PrimeAire® VHC and LiteAire VHC provide solutions related to safety issues, cost savings, and patient compliance. In addition, the Quake® offers a unique alternative to the current treatments used for chest physiotherapy that may benefit the RT and improve patient outcomes.

Tor Valenza is a staff writer for  RT. For further information, contact [email protected]