Lavorini also cast doubt on “so-called smart inhalers,” which he pointed out has been shown to improve adherence but not asthma control and which he said are “not a panacea.” Asserting that “Adherence is the biggest obstacle to efficient inhaled therapy,” he suggested that OINDP developers need a better understanding of patient requirements. In response to a question about whether the device is more important than the drug, Lavorini acknowledged that “one size does not fit all” and that the best inhaler is one that patients can use correctly and that they will continue to use over time.
One innovation Lavorini highlighted as a benefit to improved control was the ability to delivery extra fine particles in products, which he called “a great achievement,” citing data showing that extra fine ICS is more likely to achieve asthma control than standard sized particles.
Another speaker who presented a look at inhaled drug delivery past and future was Hugh Smyth, who delivered the Annual DDL Lecture on the subject of “Overcoming barriers in drug delivery to the lung, what have we learnt and where are we going?” At the beginning of his talk, Smyth observed that dry powder inhalation systems are basically the same as they have been for the past 50 years but that a number of innovations are in the works.
One challenge Smyth noted is that batch-to-batch variability in DPI formulations can greatly affect how much patients benefit from a particular inhaler in real world use. Reducing that variability using innovations such as continuous processing might lessen the need for physicians to improve their knowledge of devices; however, he acknowledged, “I think we are a long way away from reaching that goal. He also pointed out later that, “The patient’s variability is many orders of magnitude greater than the device.”
Among the innovations he cited in addition to continuous processing were improved aerosolization in formulations that use larger carrier particles; higher dose therapies for conditions such as cystic fibrosis and pulmonary infections; and inhaled delivery of biologics.
In his talk titled “What happened to nebuliser innovation?”, Wilbur de Kruijf of Resyca cited the increasing need for delivery of inhaled biologics as one reason why “nebulizers will be essential” over the next five years and why innovation in nebulizer and SMI design is underway. He foresees a greater use of nebulizers/SMIs for systemic delivery and for vaccination, citing the use of Aerogen nebulizers for delivery of CanSinoBIO’s COVID-19 vaccine. Among the other trends that he foresees for nebulizer development include making smaller, smarter devices; disposable nebulizers/SMIs; controlled release formulations for nebulization; and reduced waste.
