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Anomatic Pharma will exhibit at the coming CPHI China at InnoPack area .InnoPack China is the flagship exhibitions of pharmaceutical packaging and drug delivery system industry in Asia-Pacific region. It presents a comprehensive look at Asia`s pharmaceutical packaging and drug delivery innovations and new impetus for business success. We will be showcasing Metered-dose Inhaler (MDI ) canisters and its other components . Visit us at : E6G32 Look forward to seeing you all , 20-22 Dec ,Shang Hai . China .

Clinical Context Since 2017, medical cannabis (MC) has been legally approved in Germany to treat severe Parkinson disease (PD) symptoms when previous therapies failed or were not tolerated. Cannabinoids modulate basal ganglia function particularly relevant for levodopa-induced dyskinesia. Study Synopsis and Perspective There is high patient interest in MC to help alleviate motor and nonmotor symptoms of PD, yet few avail themselves of this treatment, new research shows. In what investigators say is the largest "real-world" survey of MC in this patient population, researchers in Germany found more than 50% were aware of MC for PD, but less than 10% of patients with PD used it. In addition, MC users reported significant reductions in PD symptoms including motor and nonmotor symptoms. "Results suggest that MC might be helpful for selected PD patients with insufficient symptom relief despite their usual anti-parkinsonian medication," the researchers, led by Carsten Buhmann, MD, head of the outpatient center for neurology at University Hospital Hamburg-Eppendorf in Germany, write. The study was published online November 11 in the Journal of Parkinson's Disease. Largest Survey To-Date The increasing availability of MC in many countries has fueled interest in the drug's potential ability to alleviate symptoms for many disorders. In Germany, cannabis has been legal since 2017 as a therapeutic option for patients with severe, treatment-resistant symptoms of PD. However, the investigators note, little is known about PD patients' view of MC. To assess the community's perception of MC and patients' experience with it, the investigators conducted a national mail-in survey to patients with PD who received the journal of the German Parkinson Association and locally to patients attending their movement disorders clinic who responded to the questionnaire on-site. The researchers analyzed data from a total of 1348 survey responses (1123 nationwide and 225 local). The study cohort was 54% male with a mean age of 71.6 years and a mean disease duration of 11.6 years. "With 1348 participants, this study is the largest survey in [PD] patients that assesses knowledge about and experience with application of cannabinoids to treat disease-related motor and nonmotor symptoms," Dr Buhmann told Medscape Medical News. Just more than half (51%) of respondents were aware that MC was legal to help treat PD symptoms. More than a quarter (28.3%) knew about the various available routes of administration and 8.8% understood the difference between cannabidiol (CBD) and tetrahydrocannabinol (THC). Overall, 15% of all respondents had tried cannabis. Of this group, 13.9% were regular users, 32.2% used it occasionally, and 42.6% tried it only once. PD-related cannabis use was reported by 8.4% of patients and was associated with younger age, living in large cities, and better knowledge about the legal and clinical aspects of MC. Of those who used MC for PD symptoms, 9.7% reported using THC only, 39.8% used CBD only, and 20.4% used both. About 18% did not know which type of cannabis they had used and 12.4% did not provide this information. Among non-MC users, 65.4% reported interest in it. Of this group, 44% said they would prefer it in capsule form and 31% said that they would prefer liquids or drops. Better Than Standard Treatment? A total of 54% of MC users reported clinical benefit with the success rate correlated with more frequent use. When MC treatment was successful, 50.8% of patients rated it as superior to levodopa or dopamine agonists and 23.0% reported an equal effect. Among MC users, 40% reported a reduction in pain and muscle cramps. In addition, 20% reported improvement in anxiety stiffness/akinesia, freezing, tremor, depression, and restless legs. Results also showed that compared with CBD, inhaled THC was more frequently reported to reduce akinesia and stiffness (50% vs 15.4%; P < .03). Most (85%) users reported MC was generally tolerable. More than one third (36.3%) reported adverse effects such as fatigue, dizziness, and increased appetite. Tolerability was lower for smoking THC (81.8%) than ingestion of CBD (91.9%), but this difference was not statistically significant. Smoking THC was significantly more likely to provoke adverse effects (54.5%) vs oral ingestion of CBD (18.9%). Dr Buhmann said he was surprised by participants' relatively low level of knowledge about the clinically important difference between psychotropic THC and nonpsychotropic CBD. He added that his team is planning a prospective, controlled, 3-arm study to compare the efficacy and tolerability of THC, CBD, and placebo applied as drops in patients with PD. Bias at Play? Commenting on the findings for Medscape Medical News, Peter A. LeWitt, MD, professor of neurology at Wayne State University School of Medicine in Detroit, Michigan, said "it seems likely that patients who went to the effort of obtaining [MC] would manifest some bias towards benefit from a drug that has, for many, a pleasant psychotropic effect and a reputation for helping with a variety of medical problems." A clinical trial would collect data on frequency of use, dose, and targeted symptoms to determine whether MC is effective or not. However, Dr LeWitt added, this information was not collected in the current study. "The authors have adequately discussed limitations they recognize in their study, but readers will have to do the same in examining the range and magnitude of claimed benefits offered by cannabis vis-à-vis [PD]," he said. Half of cannabis users who reported symptomatic relief rated the efficiency of cannabis more highly than that of levodopa or dopaminergic agonists. "This level of enthusiasm for antiparkinsonian action is not congruent with what is known from other experience and may represent the curious status of a drug once thought to be dangerous that now has been elevated to [the status of] a broadly effective adjunctive therapy," said Dr LeWitt. "While a careful study of cannabis's effects on unmet needs of [PD] would be of interest, the information in this report isn't compelling enough to justify such a study," he concluded. The National German Parkinson Association provided support for the study. Dr Buhmann has received compensation for participating on advisory boards for UCB Pharma and Zambon. He has received lecture fees from AbbVie Pharma, BIAL Pharma, Desitin, GE Healthcare, Grunenthal Pharma, Licher, Medtronic, Novartis, TAD Pharma, UCB Pharma, and Zambon Pharma. Dr LeWitt has disclosed no relevant financial relationships. J Parkinsons Dis. 2021;1:309-21.[1] Study Highlights Questionnaires (n=1348 analyzed) were distributed nationwide via the GPA membership journal (n=1123) and locally in the investigators' clinic (n=225) to control for report bias. 51% of participants were aware of the legality of MC application, 28% of routes of administration, and 9% of differences between Δ9-THC and CBD. 8.4% of patients reported PD-related cannabis use, which was associated with younger age, living in large cities, and better knowledge of legal and clinical aspects of MC. Nearly two thirds of MC users ingested it orally as oily liquid (CBD) and one quarter inhaled it as hashish/marijuana (THC). More than 40% of cannabis users reported reduced pain and muscle cramps; more than 20% reported subjectively improved stiffness/akinesia, freezing, tremor, depression, anxiety and restless legs syndrome. Overall tolerability was good (85%), but was slightly better for pure oral CBD than for inhaled THC. One third reported adverse effects, mostly fatigue, dizziness, and ravenous appetite, but only 8.0% discontinued MC because of intolerance. 54% of oral CBD users and 68% of those inhaling THC-containing cannabis reported symptom improvement. Among patients reporting symptom improvement, 50.8% rated MC as superior to levodopa or dopamine agonists and 23% as equal. THC inhalation was more frequently reported to reduce akinesia and stiffness than CBD ingestion (50.0% vs 35.4%; P <.05). 65% of nonusers reported interest in MC use. The investigators concluded that many patients with PD consider MC to be a therapeutic option, and nearly 10% use MC for motor and nonmotor symptoms, but efficacy and different routes of administration should be studied further. Findings from this "real-life" study suggest that MC might benefit selected patients with PD with insufficient symptom relief from typical antiparkinsonian medication and warrant controlled clinical studies of the efficiency, tolerability, and best routes of administration of MC treatment in PD. Limited knowledge about various routes of administration or differences between THC and CBD, and a possible accompanying fear of these substances, could discourage patients from considering MC as a therapeutic option. Although two thirds of nonusers were interested in MC, nearly half were concerned about addiction. The high perceived efficacy of MC relative to levodopa or dopamine agonists might be related to a relevant placebo effect because of high patient expectations. There are only limited, inconclusive data regarding efficacy of cannabis products for PD motor and nonmotor symptoms, particularly as cannabinoid composition of MC products varies widely. Study limitations include questionnaire return rate of only 4.7% nationwide and possible response bias. An expert consulted by Medscape urged interpreting the results with caution. Clinical Implications Many patients with PD consider MC use, but few use it; those who do find it effective. Efficacy and different routes of administration of MC products need further study. Implications for the Health Care Team: There are only limited, inconclusive data regarding MC efficacy for PD symptoms, particularly as cannabinoid composition of MC products varies widely. Members of the healthcare team should be aware of the growing interest in MC and be prepared to educate patients about the potential side effects of MD and difference between psychotropic and non-psychotropic MC. please find on https://www.medscape.org/viewarticle/948268?src=wnl_tpal_210403_mscpedu&impID=3290296

Practice Essentials Metered dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers are modes of aerosol drug delivery that are used to treat respiratory disorders (eg, asthma, obstructive lung disorders, cystic fibrosis, pulmonary arterial hypertension, infectious pulmonary disease). [1] A spacer is an external device that is attached to an MDI to allow for better drug delivery by enhanced actuation and inhalation coordination. A diagram of an MDI is shown in the image below. Cross-sectional diagram of metered dose inhaler (MDI). View Media Gallery Metered dose inhalers (MDIs) An MDI is a handheld aerosol device that uses a propellant to deliver the therapeutic agent. Advantages of MDIs are as follows: Portability Multidose delivery capability Lower risk of bacterial contamination [2] Disadvantages of MDIs are as follows: Need for correct actuation and inhalation coordination [3, 4] Oropharyngeal drug deposition [2] Dry powder inhalers (DPIs) A DPI is a breath-actuated device that delivers the drug in the form of particles contained in a capsule or blister that is punctured before use. Advantages of DPIs include the following: Breath-actuated Spacer not necessary No need to hold breath after inhalation Portable No propellant Disadvantages of DPIs include the following: Adequate inspiratory flow required for medication delivery May result in high pharyngeal deposition Humidity potentially causes powder clumping and reduced dispersal of fine particle mass Inhalation accessory devices (IADs) Inhalation accessory devices (IADs) generally fall into 2 categories: spacers and holding chambers. A spacer is an extension add-on device that permits the aerosol plume from the MDI to expand and slow down, turning it into a very fine mist instead of a high-pressure actuation spray. Valved holding chambers allow for a fine cloud of medication to stay in the spacer until the patient breathes it in through a one-way valve, drawing the dose of medication into the lungs. Advantages of IADs are as follows: Enhanced drug delivery Compensation for poor technique/coordination with MDI Reduced oropharyngeal deposition Disadvantages of IADs are as follows: Large size and volume of device Bacterial contamination is possible; device needs to be cleaned periodically Electrostatic charges may reduce drug delivery to the lungs Nebulizers Nebulizers are devices that transform solutions or suspensions of medications into aerosols that are optimal for deposition in the lower airway. The following are advantages of nebulizers: Provide therapy for patients who cannot use other inhalation modalities (eg, MDI, DPI) Allow administration of large doses of medicine Patient coordination not required The following are disadvantages of nebulizers: Decreased portability Longer set-up and administration time Higher cost May need source of compressed air or oxygen (jet nebulizer)

As a cost-savings measure, some respiratory therapy departments have been using a single metered dose inhaler (MDI) canister to administer medication to multiple patients. This practice, first described more than a decade ago,[1,2,3] employs a protocol in which the MDI nozzle (mouthpiece) is wiped with an alcohol prep pad and then inserted into a patient-specific aerosol cloud enhancer (ACE) spacer with a one-way valve before delivering the medication (see Figure 1 in the PDF version of the newsletter). Most protocols also call for disinfecting the nozzle using an alcohol prep pad after the medication has been delivered. The MDI remains with the respiratory therapist and is used to deliver subsequent doses to other patients prescribed the same drug. The spacer remains with each patient and is not shared. This process, referred to as a common MDI canister protocol, is not used for patients on isolation precautions and is rarely used for patients being mechanically ventilated. Proponents of this practice cite significant cost savings, staff efficiency, and fewer treatment delays, while advocating that cross-contamination among multiple users of the MDI is unlikely if the above-cited protocol is followed. Eliminating the need to retrieve and return each patient's MDI from patient-specific or unit medication supplies-particularly automated dispensing cabinets-has increased staff efficiency. Annual cost savings up to 55% have been documented, and the shared MDIs allow patients to be charged per puff of medication.[1,2,3] Treatment delays associated with pharmacy distribution of MDIs have been eliminated in many cases, and improvements in patient education have also been reported due to one-on-one time with respiratory therapists. Opponents of allowing multiple patients to use the same MDI canister are not convinced that these benefits outweigh even a minimal risk of cross-contamination, particularly if the protocol for disinfecting the nozzle is not followed. Early findings from several hospitals that adopted the practice showed varying results. In one hospital, microbiological sampling of the canisters used to administer treatments showed no growth of organisms cultured from the mouthpiece after being swabbed with alcohol.[1] But cross-contamination was documented in two other cases.[2,3] In one case, cultures were taken of the MDI nozzle before and after disinfection with an alcohol prep pad, as well as after treatments were administered. Growth of Staphylo-coccus epidermidis occurred in at least 5% of the cultures with all three types of specimens, including those taken after the nozzle was disinfected with an alcohol prep pad.[2] In another case, the hospital assessed the failure to wipe the canister nozzle with an alcohol prep pad prior to patient use; 1 of 18 (5.5%) cultures resulted in growth of Streptococci Group D (Enterococci).[3] Two more recent studies showed no adverse effects after implementing a common MDI canister protocol.[4,5] In 2000, a study of 17 patients showed no contamination at 24, 48, or 72 hours when cultures were taken from the MDI mouthpiece after swabbing with an alcohol pad, after actuation and removal from the spacer, and after removing it from the spacer and swabbing it with alcohol.[4] A similarly designed 2001 study also showed no growth in cultured samples from the MDIs after use with 50 patients.[5] Contamination that might occur from a common MDI canister protocol would seem to come from the surface of the canister, not the medication itself. This risk could be mitigated by good hand washing, along with wiping down the canisters with alcohol swabs. But if staff are not compliant with hand hygiene between patients-and many are not-how compliant will they be with cleaning the mouthpiece after every patient use? The problem is less with the common MDI canister protocol itself and more so with the potential lack of carrying out proper infection control practices. Hospitals that have successfully implemented the common MDI canister protocol state that compliance with disinfecting the MDI nozzle is key. But we know practitioners don't always follow proper procedures. In one of our recent newsletters, we mentioned reports of transmitting blood-borne infections after reusing insulin pens, even after the needle was changed between patients.[6] In 2008, the Centers for Disease Control and Prevention (CDC) found that more than 60,000 patients in the US during the last decade were at risk for blood-borne diseases due to multiple lapses in infection control practices, including the failure to clean shared glucometers.[7] More than 400 patients acquired Hepatitis B or C infections in patient-to-patient transmission due to a failure to follow fundamental infection control principles.[7] Failure to properly disinfect stethoscopes between patient use has also been linked to nosocomial infections.[8] The CDC and the American Medical Association recommend disinfecting stethoscopes between patient use,[8] but as a practical matter, it does not happen. Deciding whether to implement a common MDI canister protocol requires thoughtful analysis and deliberation. If the results of earlier studies[2,3] hold true, a 5% rate of potential cross-contamination may not be acceptable given the high-volume use of MDIs, frequency of repeated exposure to patients who use MDIs several times a day, and the heightened risk to immunocompromised patients. With shrinking reimbursements for care associated with nosocomial infections, cost-containment gains from employing a common MDI canister protocol may be quickly lost if an infection occurs. If a decision is made to move forward with a common MDI canister protocol, the Association for Professionals in Infection Control and Epidemiology (APIC) recommends carefully analyzing your processes to ensure handoffs between patients are not inadvertent sources of contact transmission, and emphasizing in the protocol the importance of hand hygiene and canister disinfection with alcohol after each use and prior to the next use.[9] For hospitals that choose to dispense individual MDIs to patients, we encourage all manufacturers to provide smaller [institutional" containers of MDIs to prevent unnecessary costs and waste. ISMP also suggests further research involving larger and more diverse patient samples from varied settings to better demonstrate any risks associated with cross-contamination among patients. Studies that show the level of staff compliance with the common MDI canister protocol over time and describe facilitators and detractors related to compliance would also be useful.

Anomatic Pharma will be exhibiting at Respiratory Drug Delivery - RDD 2020, taking place at JW Marriott Desert Springs, Palm Desert, California on 26 - 30 April 2020. RDD 2020 conference offers attendees a great opportunity to participate in the best international conference of its kind, features in-depth presentation and discussion of pioneering respiratory drug delivery science; Most of participants use RDD to expand the opportunity for networking , to enlighten their ideas and meet new business partner . The exhition is main events of RDD. Devices and equipment designers and components suppliers will present their latest development along with sientific poster in the drug delivery area . Anomatic Pharma is showcasing its respiratory drug delivery components mainly for Metered-dose Inhaler (MDI) canisters . Please come to discuss with us and find out a solution for your inhalation products . Look forward to seeing you in California USA .

Research in pulmonary drug delivery has become increasingly active in the Asia/Pacific region. With this comes a need for a forum that caters for the interests of Asian researchers and industry. Inhalation Asia is a non-commercial conference that aims to provide an opportunity for people who work on inhalation MDI ,DPI and SMI in Asia to network and showcase their research, products and services. Anomatic , as a world-leading manufacturer , is providing MDI aluminum canister which is the key component of MDI system requesting sophisticated technology , With our over 50 years of experience of deep draw and surface treatment technology , We are hoping to assist you for your Inhalation drug research and development and to be your partner supplier. Please find us and MDI Plain/Anodized/Plasma coated canisters at Anomatic exhibition area during Inhalation Asia conference . Look forward to seeing you all . Research in pulmonary drug delivery has become increasingly active in the Asia/Pacific region. With this comes a need for a forum that caters for the interests of Asian researchers and industry. Inhalation Asia is a non-commercial conference that aims to provide an opportunity for people who work on inhalation MDI ,DPI and SMI in Asia to network and showcase their research, products and services. Anomatic , as a world-leading manufacturer , is providing MDI aluminum canister which is the key component of MDI system requesting sophisticated technology , With our over 50 years of experience of deep draw and surface treatment technology , We are hoping to assist you for your Inhalation drug research and development and to be your partner supplier. Please find us and MDI Plain/Anodized/Plasma coated canisters at Anomatic exhibition area during Inhalation Asia conference . Look forward to seeing you all . Research in pulmonary drug delivery has become increasingly active in the Asia/Pacific region. With this comes a need for a forum that caters for the interests of Asian researchers and industry. Inhalation Asia is a non-commercial conference that aims to provide an opportunity for people who work on inhalation MDI ,DPI and SMI in Asia to network and showcase their research, products and services. Anomatic , as a world-leading manufacturer , is providing MDI aluminum canister which is the key component of MDI system requesting sophisticated technology , With our over 50 years of experience of deep draw and surface treatment technology , We are hoping to assist you for your Inhalation drug research and development and to be your partner supplier. Please find us and MDI Plain/Anodized/Plasma coated canisters at Anomatic exhibition area during Inhalation Asia conference . Look forward to seeing you all during 13th to 15th November 2019 in Hong Kong .