title: Clinically Relevant In Vitro Testing of Orally Inhaled Products-Bridging the Gap Between the Lab and the Patient.
abstract: Current pharmacopeial methods for in vitro orally inhaled product (OIP) performance testing were developed primarily to support requirements for drug product registration and quality control. In addition, separate clinical studies are undertaken in order to quantify safety and efficacy in the hands of the patient. However, both laboratory and clinical studies are time-consuming and expensive and generally do not investigate either the effects of misuse or the severity of the respiratory disease being treated. The following modifications to laboratory evaluation methodologies can be incorporated without difficulty to provide a better linkage from in vitro testing to clinical reality: (1) examine all types of OIP with patient-representative breathing profiles which represent normal inhaler operation in accordance with the instructions for use (IFU); (2) evaluate OIP misuse, prioritizing the importance of such testing on the basis of (a) probability of occurrence and (b) consequential impact in terms of drug delivery in accordance with the label claim; and (3) use age-appropriate patient-simulated face and upper airway models for the evaluation of OIPs with a facemask. Although it is not necessarily foreseen that these suggestions would form part of future routine quality control testing of inhalers, they should provide a closer approximation to the clinical setting and therefore be useful in the preparation for in vivo studies and in improving guidance for correct use.
authors.affiliation: Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Road, London, Ontario, N6H 2R1, Canada. mitchelljolyon@gmail.com.
authors.forename: Jolyon P
authors.initials: JP
authors.lastname: Mitchell
authors.affiliation: Trudell Medical International, London, Ontario, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Suggett
authors.affiliation: Trudell Medical International, London, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Nagel
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D016503:Drug Delivery Systems / Q000379:methods*; D004867:Equipment Design / Q000379:methods; D006801:Humans; D009330:Nebulizers and Vaporizers; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011786:Quality Control
chemical_list: D004364:Pharmaceutical Preparations
keywords: delayed inhalation; face models; inhaler testing; poor coordination