Emitted dose estimates from Seretide® Diskus® and Symbicort® Turbuhaler® following inhalation by severe asthmatics
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The dose emitted from dry powder inhalers may be inhalation flow-dependent. Using an ex vivo method, the Electronic Lung™, we have measured the aerodynamic characteristics of the emitted dose for both active constituents from Seretide&#xae; Diskus&#xae; (salmeterol xinafoate 50 mcg; fluticasone propionate 500 mcg) and Symbicort&#xae; Turbuhaler&#xae; (formoterol 6 mcg; budesonide 200 mcg).1 Electronic inhalation profiles were collected from 20 severe asthmatics (mean PEFR 53 % predicted) when they inhaled using a placebo Seretide&#xae; Diskus&#xae; and a placebo Symbicort&#xae; Turbuhaler&#xae;. These were replayed in the Electronic Lung™ with the respective active inhaler in situ. Mean(S.D.) peak inhalation flow rates (PIFR) through the Diskus&#xae; and Turbuhaler&#xae; were 94.7(32.9) and 76.8(26.2) l min−1, respectively. From the Electronic Lung™ the Diskus&#xae; inhalation profiles provided a mean(S.D.) fine particle dose (FPD) for fluticasone propionate and salmeterol of 20.4(4.8) and 18.4(4.4) % labelled dose. For Turbuhaler&#xae; inhalation profiles the FPD was 23.1(12.9) and 20.7(11.1) % labelled dose for budesonide and formoterol, respectively. The linear (p < 0.001) relationships between FPD against PIFR for budesonide and formoterol were 3 (p = 0.002) and 2.8 (p = 0.007) times steeper than fluticasone propionate and salmeterol, respectively. The results highlight a more significant effect of inspiratory flow on variable dosage emission when using the Symbicort&#xae; Turbuhaler&#xae; compared with the Seretide&#xae; Diskus&#xae;.

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