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By: Dong Gao

Pressurized metered dose inhalers (pMDIs) have long been used to treat asthma and chronic obstructive pulmonary disease (COPD) in in adults, children and infants and have markedly improved the ease, speed, and reliability of aerosol therapy for reversible airflow obstructions. Users or patients essentially rely on coordinated actuation of the pMDI device and their own inhalation capabilities to achieve good disease symptom control. As most pMDIs are formulated as suspensions or solutions, the device needs to be shaken thoroughly before use to ensure effective aerosol drug delivery. Failure to shake before actuation or any delays between shaking and actuation could have clinical consequences such as uncontrolled asthma maintenance and poor aerosol drug delivery to the lungs.

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No-shaking and shake-fire delays affect respirable dose for suspension but not solution pMDIs

This paper published in International Journal of Pharmaceutics by Davide D’Angelo et al. investigate the importance and the effect of shaking pMDIs formulated as suspensions on the quality of the aerosol plume in terms of respirable dose and aerodynamic particle size distribution. The study found that the aerodynamic parameters in terms of respirability of pMDIs formulated as solutions, are unaffected by no-shaking or by the delay of 60 s in actuation after cap removal. Hence, pMDI solution-based formulations could be more suitable in reducing the occurrence of one of the most common errors in pMDI misuse. They also highlight the importance of properly training the patient on the use of pMDI devices for efficient aerosol drug delivery to the lungs.

Read more in the literature:

Chierici V, Cavalieri L, Piraino A, Paleari D, Quarta E, Sonvico F, Melani AS, Buttini F. “Consequences of not-shaking and shake-fire delays on the emitted dose of some commercial solution and suspension pressurized metered dose inhalers”. Expert Opin Drug Deliv. 2020 Jul;17(7):1025-1039. doi: 10.1080/17425247.2020.1767066.