Evaluation of the Importance of Capsule Transparency in Dry Powder Inhalation Devices

Rocío Reinoso Arija; Rosario Ruiz-Serrano de la Espada; Mª Dolores Núñez Ollero; Laura Carrasco Hernandez; Esther Quintana Gallego; Jose Luis López-Campos

doi:10.1370/afm.3147

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Figure 1.
Differences in chamber weight before and after inhalation in the 2 types of capsules.

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Table 1.

Characteristics of Patients Included

Variable	Total Sample (n = 91)	Opaque Capsule (n = 28)	Transparent Capsule (n = 63)	P Value^{^a}
Age, y	68.0 (15.0)	68.0 (13.0)	66.0 (15.0)	0.627
Sex, male	61 (67.0%)	19 (67.9%)	42 (66.7%)	0.556
Active smokers, n	25 (27.5%)	8 (28.6%)	17 (27.0%)	0.533
Tobacco history, pack-year	40.0 (25.0)	35.0 (21.0)	40.0 (24.0)	0.097
BMI, kg/m²	27.0 (7.5)	27.0 (9.0)	27.0 (9.0)	0.986
FVC, %	82.0 (27.0)	82.0 (26.5)	82.0 (28.0)	0.452
FEV1, %	65.0 (34.0)	66.0 (37.2)	64.0 (33.0)	0.786
Time of inhaler use, mon	22.0 (73.0)	48.0 (82.0)	12.0 (61)	0.010
Diagnosis, (%)				0.054
Pre-COPD	21 (23.1)	11 (39.3)	10 (15.9)
COPD	67 (73.6)	16 (57.1)	51 (81.0)
Other	3 (3.3)	1 (3.6)	2 (3.2)
COPD obstruction severity,^{^b} (%)				0.203
Mild	11 (16.4)	3 (18.8)	8 (15.7)
Moderate	34 (50.7)	6 (37.5)	28 (54.9)
Severe	17 (25.4)	7 (43.8)	10 (19.6)
Very severe	5 (7.5)	0 (0.0)	5 (9.8)

BMI = body mass index; COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in the first second; FVC: forced vital capacity.
Note: Values expressed as median (interquartile range) or as absolute frequencies (relative) depending on the nature of the variable. Relative frequencies referred to the total number of cases per group, unless otherwise specified. The other diagnoses included cases of interstitial involvement, thromboembolic disease, and sequelae of pneumonia.
↵a Calculated by the Mann-Whitney U or by the chi-square tests according to the variables.
↵b Percentages calculated on the total number of COPD patients in each group.

SUPPLEMENTAL DATA IN PDF FILE BELOW

Supplemental Figure 1. Inhalers included in the analysis

Supplemental Figure 2. Differences in basal weights of capsules of different inhalers

Supplemental Figure 3. Changes in capsule weight depending on severity of COPD

Supplemental Figure 4. Changes in capsule weight between COPD and pre-COPD

Supplemental Table 1. Weights of the capsules in each device according to drug information leaflet

Lopez-Campos_Supp.pdf -
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PLAIN LANGUAGE ARTICLE SUMMARY

Research Brief

Transparent Capsules in Dry Powder Inhalers Significantly Improve Medication Delivery

Background and Goal:This study examined whether using a transparent capsule in single-dose dry powder inhalers for patients with non-reversible chronic airway disease affects the amount of medication delivered. The goal was to determine if patients who use transparent capsules, which allow them to see if the medication has been fully inhaled, have better inhalation results compared to those using opaque capsules.

Study Approach:Researchers conducted an observational cross-sectional study at a tertiary university hospital. The study involved 91 patients using long-acting bronchodilators with single-dose dry powder inhalers for chronic airway disease. Patients were asked to use their inhalers under supervision, and the weight of the capsule was measured before and after inhalation to assess how much of the medication was delivered. The study was conducted between October 2020 and October 2022.

Main Results:

    •    Patients using transparent capsules had a significant decrease in capsule weight after inhalation, with a 30.1% reduction compared to an 8.6% reduction for opaque capsules, indicating more medication was delivered.

    •    The change in capsule weight was consistent regardless of the severity of the patient’s airway disease.

Why It Matters:The findings suggest that using transparent capsules in dry powder inhalers could improve medication delivery by providing patients with visual feedback on their inhalation technique. This could lead to better management of chronic airway diseases by ensuring that patients receive their full dose of medication. Given the high importance patients place on verifying correct medication intake, these results reinforce the need for inhalation devices that support effective use.

Evaluation of the Importance of Capsule Transparency in Dry Powder Inhalation Devices

Jose Luis López-Campos, MD, et al

Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/ Universidad de Sevilla, Seville, Spain

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain