Turbuhaler ® and Spiromax ® empty devices were used for this study. Turbuhaler ® (AstraZeneca, Sweden) is a multidose DPI consisting of a protective cover, mouthpiece, drug reservoir with dose indicator, and a rotating grip at the base; dose preparation requires holding the device in the upright position and a full rotation of the grip [18] . Spiromax ® (Teva Pharmaceutical Industries, Petach Tikva, Israel) is a multidose DPI with design similar to a pressurised metered-dose inhaler (pMDI) but uses an X-ACT ® technology for drug delivery [19] . Dose preparation consists in opening the cap until one click is heard while holding the device with the mouthpiece cover at the bottom [20] . For both devices, we compiled a checklist of errors potentially impairing drug delivery to the lungs. These errors were identified a priori based on the manufacturer's instructions included in the patient information leaflet [18, 20] and on expert steering committee advice [21] . The checklists include errors associated with dose preparation, position of the inhaler, inhalation manoeuvre, and general knowledge of device use (Table S1).
Turbuhaler
Manufactured by AstraZeneca
Sourced in Sweden, United Kingdom
The Turbuhaler is a dry powder inhaler device used to deliver medication directly to the lungs. It is a breath-actuated device, requiring the user to inhale through the mouthpiece to activate the release of the medication. The Turbuhaler is designed to deliver a consistent, pre-measured dose of medication with each inhalation.
Automatically generated - may contain errors
Lab products found in correlation
Diskhaler, by GlaxoSmithKline (1 mentions)
Ventolin, by GlaxoSmithKline (1 mentions)
Symbicort turbuhaler, by AstraZeneca (1 mentions)
Pulmicort turbuhaler, by AstraZeneca (1 mentions)
Ellipta, by GlaxoSmithKline (1 mentions)
Breezhaler, by Novartis (1 mentions)
Evohaler, by GlaxoSmithKline (1 mentions)
Handihaler, by Boehringer Ingelheim (1 mentions)
Respimat, by Boehringer Ingelheim (1 mentions)
8 protocols using turbuhaler
1
Evaluation of Inhaler Device Errors
2
Open-label Budesonide ICS Trial
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Participants were enrolled in an open-label ICS trial if they had received no oral or inhaled steroids in the last 90 days. Participants self-administered 400 mg of budesonide twice daily through a Turbuhaler (AstraZeneca Limited, Auckland, New Zealand) for 12 weeks before repeat testing. Investigators and participants were blind to cluster allocation at the time of testing.
3
Randomized Asthma Rescue Medication Trial
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Patients were randomised to receive either formoterol (Oxis® Turbuhaler®; AstraZeneca, Lund, Sweden; 4.5 μg per delivered dose) or salbutamol (pressurised metered-dose inhaler [pMDI]/dry powder inhaler [DPI]; Diskhaler® [200 μg per dose; Ventolin™, GlaxoSmithKline, Uxbridge, UK], Diskus® [200 μg per dose; Ventolin™, GlaxoSmithKline, Uxbridge, UK] or Turbuhaler® [100 μg per dose; Inspiryl®, AstraZeneca, Lund, Sweden]), treatment was available to patients on the first day of the study immediately after randomization. Since these therapies were provided on an as-needed basis, compliance was not measured.
4
Efficacy of Budesonide/Formoterol in Asthma Treatment
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This retrospective, post-hoc analysis included data from double-blind, randomized, parallel-group studies of 6 [10 (link)] and 12 [11 (link), 12 (link)] months’ duration. The detailed methodologies have been published elsewhere [10 (link)–12 (link)]. Briefly, the clinical studies investigated the efficacy of BUD/FORM 160–320/9 μg/day MRT (Symbicort SMART™; AstraZeneca, Lund, Sweden) compared with fixed-dose BUD 320–640 μg/day as maintenance therapy and the SABA, terbutaline 0.4 mg, as needed. A fixed dose of BUD/FORM 160/9 μg maintenance therapy plus terbutaline 0.4 mg as-needed treatment arm was investigated as a comparator only in one [12 (link)] of three studies and was not included in the present analysis for this reason. All study drugs were administered using Turbuhaler® (AstraZeneca, Lund, Sweden) dry powder inhaler as delivered doses. Patients were permitted to take a maximum of 10 as-needed occasions/day of BUD/FORM or terbutaline before contacting the investigator for reassessment. The studies were performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Approval from regulatory agencies and ethics committees was obtained at all centres. All patients gave written informed consent.
5
Comparing Asthma Reliever Therapies
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The Canadian Thoracic Society guidelines recommend the use of SABA as a reliever in individuals with mild asthma on ICS monotherapy [16 (link)], which is the same as the comparator group in the SYGMA studies. The treatment groups in SYGMA 1 and SYGMA 2 from which clinical data were sourced for this analysis were the as-needed budesonide-formoterol 200–6 μg (Symbicort® Turbuhaler®, AstraZeneca) group, with 1277 patients in SYGMA 1 and 2089 in SYGMA 2, and the twice-daily budesonide 200 μg maintenance therapy (low-dose ICS; Pulmicort® Turbuhaler®, AstraZeneca) plus as-needed terbutaline 0.5 mg (SABA; Turbuhaler®, AstraZeneca) group, with 1282 patients in SYGMA 1 and 2087 in SYGMA 2 [18 (link), 19 (link)].
6
COPD Management Program in Vietnam
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The study was conducted in Bach Mai Hospital in Hanoi where a national program for management of COPD has been running for 7 years. All patients recorded in the list of COPD outpatients attending the COPD program from January to December 2016 were invited to participate in the study during their monthly medical consultation. To be eligible, the patients needed to satisfy the study inclusion criteria that include the following: had a diagnosis of COPD by the physician, attended the COPD program at least once per month and had at least one inhaler medication including metered-dose inhaler (MDI) and/or Turbuhaler® (AstraZeneca plc, London, UK) prescribed for COPD. The exclusion criteria included patients with serious visual, hearing and communication problems; deficit of mental function; at end stage of serious diseases such as cancer; attending other programs related to pulmonary diseases and unable or unwilling to provide written informed consent. All eligible patients provided signed consent forms before enrolling in the study.
7
Comparing Inhaler Device Usability
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We compared five types of inhalers. The primary outcome was differences in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction after training, most common step of misuse, and factors affecting the accuracy of inhaler use. Further, we surveyed patient satisfaction with each device and found the most frequently error-prone steps. In this study, six inhaler device types were used by participants: Evohaler (GlaxoSmithKline, London, UK/Chiesi, Parma, Italy), Respimat (Boehringer Ingelheim, Ingelheim am Rhein, Germany), Turbuhaler (AstraZeneca, Lund, Sweden), Ellipta (GlaxoSmithKline), Breezhaler (Novartis, Basel, Switzerland), and Handihaler (Boehringer Ingelheim). However, Breezhaler and Handihaler were analyzed in the same group because of the similarities. Finally, five device types were compared.
8
Dry Powder Inhalation of AZD9164
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The investigational product was formulated at AstraZeneca R&D, Södertälje, Sweden and supplied as fully prepared individual Turbuhaler™s, requiring only priming prior to use. The dry powder for inhalation within each Turbuhaler™ was a mixture of AZD9164 and lactose monohydrate for inhalation. The placebo Turbuhaler™ was identical in appearance but contained lactose monohydrate powder only.
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