Aerosol Delivery Differences and Cost Analysis of Wasted Medication Under Clinically Relevant Test Methods Using a Valved Holding Chamber With Facemask and Fluticasone Propionate
Bibliographic record
Abstract
Abstract Rationale: Global asthma guidelines highlight the importance of using a valved holding chamber (VHC) with documented efficacy in young children, specifically noting the fact that the dose delivered may vary considerably between VHCs used. The recent transition of fluticasone propionate (FP) to an authorized generic has significant cost implications for patients who rely on this inhaler for disease management. The objective of this study was to evaluate the performance of four different VHCs available in the US market and to assess delivery differences to the carina and estimate potential cost impact. Methods: 4 different VHCs were evaluated by breathing simulator (tidal volume=155-mL, I:E ratio=1:2, rate=25 cycles/min). The facemask of each spacer (n=3) was attached to the ADAM III, an anatomically realistic oro-naso-pharynx model of a 4-year-old child and the airway coupled to a breathing simulator via a filter to capture drug particles that penetrated as far as the carina. 5-actuations of fluticasone propionate HFA (44μg, Prasco Laboratories) were delivered at 30-s intervals and recovered from specific locations in the aerosol pathway by HPLC. Comparisons were then made on drug delivery data looking at potential dose to the lungs for each pMDI/VHC. This potential delivery was then equated to an estimated savings using the most efficient VHC based upon published costs [1] that Prasco fluticasone propionate HFA 44 has a cost of $90.61 per inhaler. Results: Recovered FP from each type of VHC and associated implications are summarized in the table. Conclusion: The choice of pMDI/VHC system can significantly impact medication delivery, which in turn affects the overall cost efficiency of therapy. In this case, using the AeroChamber Plus® Flow-Vu® VHC may improve medication cost efficiency by up to five times compared to other VHC options. By enhancing the amount of medication that reaches the lungs with each puff, patients may experience better disease control and require less reliever medication. [1] Accessed 30th Oct,2024 https://www.goodrx.com/flovent?form=hfa-inhaler&dosage=44mcg&quantity=1&label_override=fluticasone-propionate-hfa
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".