Drug delivery from inhaler devicesBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7062.895 (Published 12 October 1996) Cite this as: BMJ 1996;313:895
- Hans Bisgaard, Associate professor
- Pulmonary Service, Department of Paediatrics, Rigshospitalet, National University Hospital, DK-2100 Copenhagen, Denmark
Lung deposition, clinical effect, and cost-effectiveness vary
The current treatment strategy in asthma, which emphasises the early introduction of inhaled anti-inflammatory treatment,1 2 is associated with considerable additional treatment costs. The cost effectiveness of such treatment is therefore an important consideration. The purchase price of inhaled drugs is usually related to the nominal dose delivered by the inhaler, but the therapeutic effect is related to the proportion of the nominal dose deposited in the lungs. This proportion is now known to vary widely for different combinations of drugs and inhalers.
Increased delivery of the inhaled drug to the lungs increases the therapeutic effect until the plateau of the dose-response curve is reached. This principle is the basis of adjusting doses of all inhaled drugs, including corticosteroids. However, as has been shown with the β2 agonist terbutaline, a defined clinical effect can be obtained by a certain nominal dose from one device or a by a reduced dose from a device that achieves a higher lung delivery.3 This study investigated the Turbohaler device, which delivered about twice as much of …