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The novel adaptor aims to ensure consistent and adequate drug delivery for patients with suboptimal inspiratory flow. Asthma is a chronic inflammatory disease affecting four million children in the United States [1]. Current treatments primarily rely on anti-inflammatory medications delivered directly to the lungs, often through various types of inhalers. Among the most common are pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). Inhalation February 2026 29 Enhancing pediatric asthma treatment: A new DPI adaptor for improved drug delivery The novel adaptor aims to ensure consistent and adequate drug delivery for patients with suboptimal inspiratory flow Lily Zhu, BS; Punthitra Arpornsuksant, MD; Maxwell A. Xu, MS; Isaree Pitaktong, BS; Varun Kedia, MSE; Syed Yusuf Ali, MS; George L. Coles, MS; Yunong Bai, BS; Damali Egyen-Davis, BS; Mandeep Jassal, MD, MPH and Carlton K. K. Lee, PharmD, MPH Johns Hopkins University Introduction Asthma is a chronic inflammatory disease affect- ing four million children in the United States [1]. Current treatments primarily rely on anti-inflam- matory medications delivered directly to the lungs, often through various types of inhalers. Among the most common are pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). pMDIs use an aerosol spray to deliver medication. Patients must coordinate actuation of the inhaler to release the medication with their inhalation to deliver the medication to their lungs [2, 3]. To facilitate the dos- age delivery, a spacer device is commonly used with pMDIs [3, 4]. e spacer holds the medication as an aerosol, allowing the propellant drops to evaporate and decrease in velocity until the patient inhales it entirely [3]. In contrast, DPIs remove the actuation step, allowing the patient to simply inhale to draw the powdered dose of medication into the lungs [5]. A significant challenge for pediatric asthma patients lies in generating the proper inspiratory flow required for effective drug delivery from DPIs. While DPIs are designed for adults with an inspiratory flow rate of 60-90 L/min, children typically only achieve a flow rate of 25-40 L/min [6, 7]. Furthermore, since spac- ers are incompatible with DPIs, there are currently no devices available to assist patients who have sub- optimal inspiratory flow [8]. Improper technique— such as insufficient inspiratory flow and failure to complete the full inhalation—can lead to inade- quate dose delivery, with poor drug deposition in the lower airways, reducing the effectiveness of anti- inflammatory medications. As a result, some children who use DPIs are more likely to experience frequent asthma exacerbations, increased emergency depart- ment visits, hospitalizations and missed school days, which place both medical and economic burdens on families [9, 10]. Repeated exacerbations are also asso- ciated with long-term structural changes in the lungs, such as airway remodeling and reduced pulmonary function, potentially impacting respiratory health into adulthood [11]. To address the issue of high inspiratory flow require- ments, active DPIs have been developed [12, 13]. ese devices utilize external energy sources to enhance aerosol dispersion and dislodge the drug from the powder bed or canister, and rely on mech- anisms such as motor-driven impellers, hand pis- tons or electrical impulses [8, 14]. However, some of these devices have faced challenges, including high cost, complexity and vulnerability to failure [15]. Several of these devices have since been removed from the market. To overcome these limitations, we propose a novel device named the FlowMate ® , which features a delay- and-release mechanism. is design aims to ensure consistent and adequate drug delivery to the lungs, addressing the needs of pediatric patients with sub- optimal inspiratory flow. Methods Concept and prototype development To address the limitations of DPIs in pediatric asthma patients, we established several key design criteria focused on the needs of both patients and caregivers. ese include enhancing drug deposition to deliver the full nominal dose, ensuring ease of use to accom-