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3/21/2001

Zanamivir Inhaler May Not Deliver to Elderly

Kate Traynor

A study published in the March 10 BMJ (PDF) found that hospitalized seniors have trouble using the dry-powder inhaler intended for administering zanamivir, an anti-influenza drug.

Half of the study participants were unable to load a placebo disk and prime the Diskhaler immediately after being trained on how to use the GlaxoSmithKline device, making this the most difficult process for the seniors to master. A day later, 65 percent of the seniors were unable to load and prime their Diskhalers.

Loading and priming turned out to be significantly easier for a control group of seniors who used a placebo disk with the Turbohaler, a dry-powder inhaler by AstraZeneca L.P. Ninety-four percent of the seniors successfully loaded and primed their Turbohalers immediately after training, as did 97 percent of the participants who were tested after 24 hours.

The research team concluded that seniors are unlikely to benefit from using zanamivir unless its delivery system is improved.

The study involved 20 men and 53 women ages 71 to 99 years who were nearing their date of discharge from a British hospital. Patients who had used an inhaler in the past and seniors with a mental or physical condition that might make inhaler use difficult were ineligible for the trial.

Use of the devices was assigned by randomization—35 to the Turbohaler group, and 38 to the Diskhaler. Each study participant was given 15 minutes of training and then assessed for the ability to master five aspects of inhaler use. Seniors earned up to two points in each equally weighted scoring category, with 10 points comprising a perfect score.

The assessment was repeated after 24 hours. All but three patients in the Turbohaler group and one in the Diskhaler group completed the second assessment.

Average total scores in the Turbohaler group were significantly higher than in the Diskhaler group immediately after training and at 24 hours. Seniors in the Diskhaler group were much less aware of their device being empty than were patients in the Turbohaler group at both time points. The seniors’ ability to exhale or hold their breath was comparable in both treatment groups.

The Turbohaler, available in the United States under the name Turbuhaler, is sold as a delivery device for AstraZeneca’s Pulmicort brand of budesonide. In a commentary posted to the BMJ Web site after publication of the article, two of the study authors said that they have "no competing interests" with dry-powder device manufacturers. The article itself declared no funding and no competing interests by the authors.