Bruce Rubin of VCU, discussing “The Cystic Fibrosis Explosion,” noted other challenges posed by proliferating choices, explaining that the vast number of therapies in development for CF makes it difficult to recruit patients for clinical trials and that adding more drugs to a patient’s regime decreases adherence. “We’re so busy adding on therapies,” he warned; “The more CF care that is added on, the harder it is to have adherence.” Simplifying therapy is a top priority for physicians, he said.
Combining therapies is one way to simplify, and in his talk on triple therapies, Brian Lipworth of the University of Dundee reviewed clinical studies of the currently marketed triple combination inhalers and noted the superiority of triple therapy for a subset of patients. Although choosing between triple inhalers requires choosing between types of inhaler, particle size, dosing regimen, etc., he suggested one simple rule: “I think it’s a no-brainer that if your eosinophil count is over 300, you should go on a triple inhaler.” As for ICS/LABA combinations, he said, “I think we need to consign those to the realms of history.”
In an entertaining talk, DDL committee member David Harris emphasized the counterintuitive nature of aerosol physics and stressed how poorly we understand the underlying principles. Making use of various props, including a step ladder and dozens of balloons, Harris enlisted audience members to demonstrate the physics physics behind the inspiratory maneuver, which is key to aerosolization for passive dry powder inhalers.
Reinhard Vehring of the University of Alberta, presenting the annual DDL lecture, which was titled “Mechanistic Understanding of Microparticle Formation in Respiratory Applications,” emphasized the need to understand the physico-chemical processes of particle formation and the usefulness of analytical and numerical modeling for the creation of the sophisticated particles used in many inhaled products today.
