The fast-track introductions of the various vaccines during the Covid-19 crisis has highlighted how the pace of drug development has increased significantly in recent years. Today pharmaceutical and healthcare companies are able to bring many types of treatments to market more quickly.
At the same time, the drugs that are now being developed are becoming ever more sophisticated, in terms of both their overall effectiveness and how they can be closely targeted to different patient groups. This enables more individualised care to be provided for individuals, tailored to their specific needs and medical history. According to a Euromonitor report on the future of personalised healthcare1, this patient-tailored approach is expected to reduce trial-and-error treatments and improve outcomes and healthcare cost-effectiveness.
The report also identifies how personalised healthcare systems are being driven by strong biotech and R&D sectors that are helping to speed up the development of these new solutions, combined with the experience of the pharmaceutical industry which brings them quickly to manufacture commercialisation.
Alongside this, the introduction of these precision medicines has been supported by the move to eHealth, telemedicine and remote diagnostics, a trend that was accelerated by the pandemic. Through the use of information management and information and communication technology (ICT), diagnoses can be carried out remotely, and the care and treatment integrated into patients’ daily lives. Carers are also able more easily to share relevant information, and data can be analysed as part of disease management or a clinical trial.
In this way, patient engagement can be enhanced and improved, encouraging positive behaviour and ensuring greater adherence and compliance to treatments.
Such sophistication brings with it additional challenges as to how these treatments are packaged, dispensed and administered. Each format needs to meet the precise requirements of the particular drug while also delivering the appropriate patient experience so that the drug can be taken easily and intuitively to maximise its effectiveness.
The medical device sector is no stranger to innovation in its ongoing development of solutions that effectively deliver drugs to the lungs. The first pressurized metered dose inhaler (pMDI) was introduced in 1956 and since then we have seen continual enhancements and improvements to the technology, as well as the introduction of dry powder inhalers (DPI).
Much of the success of today’s inhalers is thanks to the advanced manufacturing techniques that have been introduced over the years. High precision moulding and assembly are required for the complex and technical parts, some of which are micro dimensional. Internal coatings have to deliver product protection and stability.
It is therefore quite sobering to learn that despite these many advances since 1956, the number of inhaler errors caused by inadequate inherence and technique has hardly changed at all during this time. Specifically, up to 94% of patients still make critical mistakes using their inhalers2. Another study found that adherence to asthma and COPD treatments was as low as 32 percent, meaning two out of three people were taking their medicine incorrectly.3
It is this problem that the latest technical inhaler innovation is seeking to overcome. A new generation of models, which incorporate digital technology, is able to improve adherence and more effectively monitor treatments in order to greatly enhance patient outcomes.
The new inhalers incorporate built-in sensors with digital capabilities that allow them to track inhaler use. This information is shared with a companion app which then provides personalised guidance to each patient. The use of the app reminds patients when to take a dose and provides tips to help them self-medicate more effectively. Patients can also share their data with healthcare providers, either remotely or in person, to enable data-driven treatment adjustments.
A typical app is able to track when and how a patient inhales a dose and provide an alert if a dose is missed. It can monitor inhaler orientation during inhalation and capture estimates of inhalation parameters. Through this, personalized learning content can be prepared with health forecasts and insights. Patients can build better inhalation techniques, learn to identify and avoid what triggers their symptoms, and track their breathing to identify signs of improvement or worsening of their condition.
For one app already on the market, the Amiko Respiro™, a seven-month randomised control trial generated a 43 per cent improvement in medication adherence, a 61 per cent reduction in inhaler technique errors, and a +5.9 improvement in asthma control (ACT).
Importantly, these digital features can be introduced without compromising on the technical design and intricate manufacture of the inhalers. This ensures that they retain both their ability to dispense the medicine accurately and their user-friendly features, particularly in terms of being suitable for all age groups.
While these benefits are primarily focused on improving patients’ quality of life, they have equally important financial implications. A recent study by York Health Economics Consortium and The University of London’s School of Pharmacy estimated that the resulting net benefit associated with greater compliance for asthma treatment was £2,250 per patient, leading to savings of between £90 – 130m per year4.
Similarly, Health-monitoring.com estimated that the costs associated with imprecise dosing of medicines to be around $765 billion, which represents some 30 percent of total spend on healthcare5.
Alongside these continual improvements in design and technology, the drive for more sustainable solutions is also becoming a critical factor in inhaler design.
This is not to say that this is something completely new to medical devices. The lightweighting of products in order to reduce the amount of material required to produce them has long been a key factor in new inhaler designs. Here the critical consideration has been to lower the weight of the dispenser while ensuring that it remains fully functional and user-friendly and continues to deliver the best patient experience.
Another important consideration for any product design has been to improve its recyclability. This has led to the development of more mono-material solutions, made in materials such as PE (polyethylene) and PP (polypropylene), both of which are now widely recyclable.
Alongside this has been the introduction for pharmaceutical and healthcare applications of ISCC Plus certified packaging and plastic components that contribute to a circular economy approach.
ISCC is a globally applicable sustainability certification system, covering all sustainable feedstocks, including agricultural and forestry biomass, circular materials and renewables, based on advanced recycling mass balance. Mass balance is an accepted and certified protocol that documents and tracks recycled content from supplier through to final delivery to customers.
The availability of this advanced recycled resin in both circular PP and PE, which is free from harmful contaminants and therefore suitable for food and pharmaceutical applications, provides the opportunity for the development of solutions for drug delivery applications that contain a high percentage of recycled material, from 30 to 100 percent. Crucially these can be for products where this has previously been difficult to achieve.
Increased consumer spending on healthcare, demand for customised services and an aging population are all driving demand for personalised healthcare services. For inhalation treatments, the transition to precision medicine and to outcome-based care provides great opportunities to improve patient technique and adherence through the adoption of digital technologies, and the health and financial benefits that this can bring are plain to see. And by focusing on both human and environmental centred design, the medical device industry can devise solutions that benefit both people and the planet.
1. https://www.euromonitor.com/future-of-personalised-healthcare/report
2. https://pubmed.ncbi.nlm.nih.gov/18083019/
3. National Library of Medicines, Patient characteristics associated with medication adherence, Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ
4. https://www.hmsinc.com/news/blog/entry/visualizing-the-cost-of-health-care