On Friday, December 10, just as the snow was beginning to melt in Edinburgh, DDL 21 concluded with one last podium session. Delegates also had a chance to spend some additional time at the exhibition.
The day began with a talk by Karen Pickering, MBE, a 4-time Olympic swimmer, winner of 4 Commonwealth Games gold medals, and an ambassador for Asthma UK. Pickering recounted her history of overcoming asthma, from her diagnosis at age 7 to her struggles to balance her need for appropriate medications with the need to maintain her eligibility to compete.
Among other observations, she noted that dry powder inhalers and swimming pools don’t mix, that wheezing can be much scarier for others than for the asthmatic, and that she obtained a much higher quality of life by training so hard that she gave herself asthma attacks than if she had restricted her activities to avoid exacerbations.
Pickering expressed the opinion that schools and parents need to allow children to continue activities, and that children need access to their inhalers. She was horrified to discover, she says, that many schoolchildren are required to leave their inhalers with a school nurse.
Following Pickering’s talk, the last session on "Increasing chances of success in early inhaled developments" began with a presentation by David Harris of Sagentia titled "How does Airflow Resistance Affect Inspiratory Characteristics as a Child grows into an Adult?" The presentation included some very interesting data, including a finding of a strong correlation between height and inspiratory energy and survey results showing a preference for much lower resistance devices than those currently marketed.
Harris also presented data showing that even small children generate a great deal more inspiratory energy than is necessary to aerosolize powder and conducted a demonstration that got the audience’s full attention by dropping an apple from a height of almost 15 feet onto a cymbal. He was the first of several speakers who called for the design of specific inhalers for specific patient groups.
Like Harris, Omar Usmani advocated for specialized inhalers and also called for a reconsideration of tests required by regulatory agencies, in this case the requirement for FEV1 testing, which he showed fails to accurately reflect the effectiveness of bronchodilators delivered to the small airways. He presented several alternative physiological tests to differentiate responses from conducting airwarys from those of the acinar zones, where the small air sacs are located.
The last presentation in the "What on Earth" series of talks, on topics which did not fit into major sessions, was given by Rod Hall of Mucokinetica on "Mucociliary Transport & the "Unusually Thick" Paradox." Hall argues that focusing on the "thickness" of mucus in cystic fibrosis patients is mistaken and that the use of mucolytics to thin the mucus is counterproductive.
Instead, he says, data show that the speed of mucociliary clearance is a surface characteristic independent of the viscoelastic characteristics of the bulk of the gel, and that the real determining factor of clearance speed is osmolarity, as has been demonstrated by clinical trials using inhaled dry powder mannitol and inhaled saline.
Ben Forbes of King’s College London gave the final talk of the conference, presenting the goals of a new group called "Drugs in the Lungs" designed to facilitate collaboration between researchers working to understand pulmonary disposition and pulmonary pharmacokinetics.
As the conference closed, chair Georgina Fradley announced the dates for DDL 22: December 7-9, 2011. The committee also announced a call for papers, with details to follow.
