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The earliest reference to therapeutic dry powder inhalation may also be the earliest reference to “engineered particles,” dating from 1849, in London. An initial article looks at the history of dry powder inhalers, including devices and formulations, and discusses considerations for future DPIs. Then an interview takes a new look at current challenges and opportunities for DPIs. 22 OctOber 2022 Inhalation Dry powder inhalers: A new look at what may be next An interview with Mark Sanders on current challenges and opportunities for DPIs Over the past several years, Inhalation has been delighted to publish a series of articles on the histor- ical development of the four major classes of inhal- ers: dry powder inhalers (DPIs), pressurized metered dose inhalers (pMDIs), nasal inhalers and nebulizers. Here, we republish—and update part of—the DPI history article, through an interview in which author Mark Sanders provides his new perspectives on cur- rent challenges and opportunities for DPIs. Vicki Schuman, Editor and Publisher, Inhalation: Mark, how could dry powder inhalers (DPIs) be improved to facilitate better patient technique? Mark Sanders, Founder and Curator of the Inhalatorium: Improving usability has to be key. For instance, I started my career with Fisons in the 1970s when their Spinhaler ® dry powder inhaler was changing patient treatment for asthma. I was impressed with the way adding the Spin-whistle ® to the Spinhaler enabled patients to achieve correct inhaler technique by providing audible feedback when a patient inhaled properly. Since then, we've seen training whistles in various formats, mostly on placebo-type devices, but seldom on devices that treat patients. We know many patients have problems achieving correct inhaler technique. So whistle guidance could have a useful role to play in improving inhaler tech- nique, particularly now that smartphone apps can detect whistle guidance tones and provide confirma- tion of correct use or tips to improve. We know from recent pMDI-based studies [1, 2] that audible and visual guidance can help improve duration of inhalation, and that this metric correlates well with lung deposition and symptom control. Improving the use of existing, familiar devices could be a much more economical approach to solving the ever-increasing costs of managing patients with uncontrolled respiratory disease. Inhalation: Isn't patient adherence also a major concern? Mark: It certainly is. I've been intrigued that oral tablets offer calendar packs with days clearly spec- ified to aid patient adherence. Yet with inhalers, at best, we have dose counters. Perhaps I can lay down a challenge to device designers to develop an improve- ment to dose counting that facilitates adherence, in the same way as a tablet calendar pack. Inhalation: What role can smart inhalers play? Mark: We definitely have heard a great deal about the adherence improvements that electronic smart inhal- ers could bring, but there are some major hurdles to overcome. Apart from the cost of the electronics, envi- ronmental issues concerning batteries and rare earth metals in the circuitry need to be addressed. In addi- A variety of dry powder inhalers (DPIs) and patient training devices.

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