The aim of this study was to analyse the effect of breathing parameters, age, gender and disease status on the lung doses of the two ICS+LABA fixed combination dry powder drugs. Breathing parameters of 113 COPD patients were measured while inhaling through emptied NEXThaler® and Ellipta® inhalers and the corresponding lung doses were calculated. Lung dose of Foster® NEXThaler® was superior to the lung dose of Relvar® Ellipta® in around 85% of the patients. The average value of the ratio of bronchiolar to bronchial deposition fractions was 5.0 for Foster® NEXThaler® and 2.6 for Relvar® Ellipta®. Lung dose was sensitive to the inhalation parameters, such as peak inhalation flow, inhaled volume and breath-hold time. For both studied drugs the dose to the lungs was relatively high for moderate PIF values, but it declined for low (< 35 L/min) and high (> 95 L/min) PIFs. The lung dose increased by the increase of the inhaled volume, but saturated over 1.0 L of inhaled air. Longer breath-hold time led to higher lung deposition, but the dependence was drug-specific. FEV(%) and FEV/FVC (%) did not influence the lung dose significantly (p=0.05). Exacerbating patients had lower lung doses (28.8±5.8% for Foster® NEXThaler® and 23.7±3.8% for Relvar® Ellipta®) than their non-exacerbating counterparts (33.7±6.1% for Foster® NEXThaler® and for 24.9±3.9% for Relvar® Ellipta®). The exact clinical consequences of the differences between the deposition distributions of the two drugs could be assessed only by systematic clinical trials.

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