Q: Do you see a lot of interest from developing nations?
A: There is obviously a lot of economic growth in the BRIC countries as well as other territories such as countries in south-east Asia and South America excluding Brazil. In some instances, a lot of the development of drug products and devices for inhalation therapy will be indigenous, too. As an example, Brazil already has its own suppliers for inhaled products such as spacers and valved holding chambers; we see them at TMI as part of our customer awareness work.
A few years ago, Dr Heather Zar, a clinician practicing in South Africa, pioneered the idea of local solutions for patients with limited financial resources. Her approach is if you can’t afford a commercially available valved holding chamber, you can use a soft-drink bottle as an alternative expansion chamber to contain the aerosol from a metered dose inhaler.
Clearly this approach is not to the advantage of first-world manufacturers of these products. However, the reality is that people out in the townships in South Africa can’t afford the sort of products that the first world is making, so they have no choice but to go without or use what is available to them.
Another example is in sub-Saharan Africa where there’s almost no income per capita. Not only do solutions that are workable without mains-powered electricity and therefore with little or no control of environmental conditions have to be provided, ideally the community needs to take ownership for compliance with prescribed therapy to be maintained.
Although this example is not related to inhalation, it serves to illustrate the point I just made. I’ve been involved with a group called SODIS, which is solar disinfection of drinking water. The SODIS organization encourages communities in low-income developing countries, particularly in Africa and Latin America, to take ownership of a simple-to-do method in which clear PET drinking bottles filled with local water, which is contaminated with micro-organisms, are disinfected by the ultra-violet rays from several hours in the sun on exposure trays made from locally available, low cost materials.
Moving back to our field of endeavor, the World Health Organization with the support of the Bill and Melinda Gates Foundation is doing some great work with the delivery of measles vaccine by inhalation in these locations. There’s also multi-drug resistant tuberculosis; Professor Tony Hickey, amongst others, is working in that area to find a practical solution that can be implemented in locations with limited resources that are often the reservoirs of this bacillus (see for example: Misra, A. et al., Tuberculosis (Edinburgh), 2011; 91(1):71-81).
