Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 1

<p>Schematic diagrams of inspiratory flow rate and the pressure drop monitoring system (a), typical inhalation flow pattern and parameters (b), and Schematic diagrams of attachment orifice (c).</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 4

<p><b>Typical inspiratory flow profiles of a dry powder inhaler (Diskus</b>^<b>®</b><b>, a) and soft mist inhaler (b).</b> Dashed and solid lines represent before and after inhalation instruction, respectively.</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 5

<p><b>Participants’ peak inspiratory flow rate (a) and duration time (b) via soft mist inhaler, before/after inhalation instruction.</b> Black bars represent mean ± SD. Asterisk (*) indicates statistical significance (P < 0.05).</p

Inhalation devices commercially available in Japan.

<p>a, Breezhaler^® (Novartis Pharma AG, Switzerland.); b, Clickhaler^® (Otsuka Pharmaceutical Co., Ltd., Japan); c, Diskhaler^® (GlaxoSmithKline, UK); d, Diskus^® (GlaxoSmithKline, UK); e, Ellipta^® (GlaxoSmithKline, UK); f, Handihaler^® (Boehringer Ingelheim GmbH, Germany); g, Jenuair^® (KYORIN Pharmaceutical Co., Ltd., Japan); h, pMDI (3M, USA); i, Respimat^® (Boehringer Ingelheim GmbH, Germany); j, Swinghaler^® (Otsuka Pharmaceutical Co., Ltd., Japan); k, Turbuhaler^® (AstraZeneca plc, UK); l, Twincaps^® (Daiichi Sankyo co., Ltd., Japan); and m, Twisthaler^® (Merck and Co., USA).</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 3

<p>Relationships between inspiratory flow rate and pressure drop of commercial inhalers (filled points) and simple attachment orifices (open points) (a). Relationships of pressure drops between commercial inhalers and orifices (b). Gray and red lines represent y = x and approximated line (y = 1.024 x + 0.003, R² = 0.9851), respectively. Bland-Altman plot for relationship of pressure drops between commercial inhalers and orifices (c). Gray solid and dotted lines represent bias and 95% limit of agreement interval of difference of pressure drop between commercial inhalers and orifices (-0.10, -1.38 to 1.18), respectively.</p

Lower limit of peak inhalation flow rates for commercial dry powder inhalers.

<p>Lower limit of peak inhalation flow rates for commercial dry powder inhalers.</p

Device-specific resistance and orifice diameters.

<p>Device-specific resistance and orifice diameters.</p

Relationship between peak inspiratory flow rate and duration time.

<p>Data including both of before and after inhalation instruction. Filled and open circles represent dry powder inhaler and soft mist inhaler, respectively.</p

Participant characteristics.

<p>Participant characteristics.</p