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contents

Summary of Design.............................. 2 Background............................................. 4 Project Partners...................................... 6 Primary Research................................... 8 How the MDI works.............................. 14 Concept development........................ 16 User feedback......................................... 18 Julia Clapp................................................ 19 The Concept............................................ 22 Next Steps................................................ 28


summary of design

This project is based on the brief from the RSA 2011; “Double Duty Devices”. The brief was to re-design a medical device to reduce plastic waste. I chose the inhaler, a device which is crucial to the 5.4 million asthmatics in th UK. As well as trying to reduce plstic waste I wanted to design a solution which asthmatics wanted to use. Talking to asthma specalists as well as asthmatics themselves it was revealed that there is a stigma attached to the use of an inhaler, with particular effect on younger asthmatics:

it’s functional part which can them be slotted into a custom case, giving asthmatics choice and control over the look and feel of their device. Secondily the inhaler is a device which may be needed at any time in any situation, however a person with asthma might have very different needs from an inhaler when going out for a night in the town or when sitting at home watching the TV. The second aspect of my concept is to allow flexiblity of use, so inderviduals change choose how their inhaler looks and functions depending on which case they use, hard customisable case or soft compact case.

““The worst complication is amongst young people, it is often the want to avoid the stigma of using an inhaler, anything that makes them different”.

Key Points:

One of the issues revealed was that patients had very little choice over the inhaler device they would receive, it is all dependant on which drug manufacturer is currenty stocked or wiether it is picked up from a high street pharmacy or a surgery. My concept reduces the device down to

- Re-design of the standard MDI (metered dose inhaler) - Reduce Plastic Waste. - Giving users more choice. - Providing a solution which can alter to fit with the users chosen situation.

Julia Clapp asthma specialist

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Current MDI product

Re-design featuring interchangable cases

3


background

Asthma currently affects 1 in 11 children and 1 in 12 adults in the UK, thats currently 5.4 million people.

Combination (purple) - this is a mix of both long acting reliever and preventer.

Asthma is allergen based condition, where the contact with an allergen or “asthma trigger� irriates a persons airways; the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways.

Asthma is a wide affected condition which can affect anyone regardless of age or situation, and it effects people differently in varying serverity, some may only have a mild reaction meaning they only need a reliever inhaler, whereas others will need to have several inhaler types with them.

There is no cure but there is a range of medications to treat and manage the symptoms. these medications come in four varieties: Reliever (blue) - provides instant relief by relaxing the muscles around the windpipe Preventer (brown) - reduces the mucus and inflammation around the windpipe Long Acting Reliever (green) - as the name suggests it is a long acting version of the reliever lasting 12hrs instead of 4.

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Key Points: - 5.4 million people affected - Alligen based condition - Affects the lungs and airways - Can be very mild or extremely severe - Range of medications to control and treat the condition.


insert; Rhinnanon with inhalers herself and others have had which are color coded depending on the type of drug each dispenses

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project partners

I would like to thank the following for their help during this project: Heather Pascow (asthma nurse) Julia Clapp (asthma specialist) Nichole (Chiesi) Heather Pascow is an asthma nurse based at Penryn surgery who has helped my to understand more about the condition and the available treatments, and the role of the asthma nurse. Julia Clapp is a asthma specialist based at carnon downs surgery, she teaches and trains others about asthma so was a really valuable source of information. She also provided feedback on my designs with some key insights. I contacted many of the major pharmaceutical companies who are invovled in the supply of inhalers to pharmacies, Chiesi for who nicole

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works for sent me training inhaler devices as well as several white papers and information on inhalers and the medication. (see secondary research).


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primary research

The initial step in my primary research process was using survey monkey to create an online survey which was distributed via social network sites as well as the universities internal email system. The survey results show that the average person has 0.85 inhalers with them when out and about and 1.86 in the home. It can be assumed from this therefore that the majority of asthmatics will carry around one inhaler when out and will have several at home. In regards to the disposal of the inhaler after use, no one recycled their inhaler device. The questionnaire has revealed some interesting results in terms of use: Generally people found inhalers easy to use, you can see from the pie charts there is always a high proportion of of red and blue (easy and veryeasy), there is however a clear in increase in difficultly as the user moves from relaxed to a social space or becomes panicked.

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Out of those asked 80% preferd the MDI other the other choices, however it is the case that some of the people asked had only ever used one type. The full results are available in the primary research file.

Key Points: - The majority of people carry around at least one inhaler with them - Most people have more than one inhaler at home. -The appearance of the inhalers are not seen as an issue, but people still feel there is a stigma attached and want more discrete devices. - The use of an inhaler becomes less easy when in a social space or panicked.


If it's been in my bag sometimes crumbs/other small object fall into the canister holder and there have been times when I've been too panicked to check if it's clean and inhaled them.

7. How easy do you find it to use inhalers when...

At any one time how many inhalers do you have to...

Which of the above inhalers do you most prefer?

carry around with you

keep in your house

A B

none

C

one

D

two

none one two three

E

four

“i would rather have something which is more discreet”

8. Do you find the appearance of your inhaler an Issue?

How easy do you find inhalers to use when... in a social space

relaxed

panicked/ stressed

very easy

very easy

very easy

easy

easy

easy

average

average

average

difficult

difficult

difficult

very difficult

very difficult

very difficult

“Only issue is bulk - can’t easily keep in the pocket of your jeans. Can look a bit odd.”

8. Do you find the appearance of your inhaler an Issue?

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primary research

Heather Pascow is a nurse based in Penryn Surgery. She is a trained asthma nurse, this basically means that her role is to make sure that a patient knows how to use their inhaler and that they have the right type of inhaler. One of the most important parts of treating asthma, heather pointed out, is the correct use of the inhaler to properly take the asthma medication. There are a range of different inhaler types, which can be placed in two catergories; dry powder (Dpi) and metered dose (Mdi). With in each catergory there are a range of different devices, to figure out which device is best for an indervidual the nurses have a Inspiratory flow meter which simulates the inspiratory draw required for each device. Where possible patients will normally be prescribed the standard MDI, this is because they are generally the easiest to use (require a lower inspiratory flow) and are the cost effective option; Salbutamol: Dry Powder (turbohaler) - approx ÂŁ4.85

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Easy Breathe - approx ÂŁ6.16 Mdi - approx ÂŁ1.97 Another key consideration of prescription is that the standard Mdi fits a volumatic spacer. A volumiser basically allows the drug to be inhaled a slow and steady rate. This is particularly good for the young or elderly who might struggle with the timing of the regular device.It is also the way to get the optimum amount amount of drug dispersion.

Key Points: - Technique for using inhalers is important - Range of different inhalers for both dry - powder and metered dose types. - Standard MDI is the preferred type for a range of reasons including usability and price


Expiratory peak flow meter Volumatic spacer

Turbohaler Training Inhaler

MDI placebo inhaler

Inspiratory peak flow meter easy breathe “placebo�

insert ; a selection of asthma equipement and training aids that Heather has at her disposal as an asthma nurse

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primary research

As well as talking to professionals a key part of the primary research involved users of inhaler devices. The images opposite are examples of asthmatics taking part in exercises designed to extract information about how asthmatics feel they are perceived, how good current inhalers are and what they what from their inhalers. A. “Capability” Users place common inhaler types on a grid based on there capabilty B.“It’s all about perception” An exercise looking at how people with asthma feel they are perceived C. “Rate your Inhaler” Getting users to rate inhalers on aesthetics, useability and size D. “The Ideal inhaler” Asking users what their ideal inhaler would be like in various situations

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Key Points: - Stigma attached to public use of inhalers - Use in a sport, health setting perceived as poor fitness - Use on a night out means in trouble - Use on a public bus indicates attantion seaking - Best for use: MDI - Best for Aesthetics: Accuhaler - Best for size: Turbohaler -Users want different things from their inhaler in different situations i.e. in the home situation they wanted a inhaler device that was really useable but weren’t concerned with appearance or size, whereas when going out they want a inhaler with is more compact/ discrete.


A

B

C

D

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how the MDI works

It is relevant at this stage to look in detail at the workings of a MDI inhaler as research has revealed this inhaler type to be most prevelent, it is the metered dose inhaler I will be redesigning with the aim to reduce plastic waste and meet user needs as revealed in primary research.

The propellant used in the canister used to be CFS but has been replaced with HFA (hydrofluoroalkane) due to corncern of ozone damage.

The metered dose inhaler comprises of two parts; - Actuator Plastic sleave which includes a mouth piece and dispencing nozzel. - Canister Contains prescribed medication in liquid form When wanting to use the inhaler users press down the canister into the actuator, which forces the end of the canster back inside itself, this allows a measured amount of drug and propellant out of the canister, now in aerosol form. As the drug comes out of the canister it is forced through the dispencing nozzle of the actuator creating the “plume” which is taken into the lungs by the patient.

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Key Points: - Canister pressed down - Releases medication - Forced through orifice creating a “plume” - Plume is important for good dissemination of medication into patient


drug canister

metered dose inhaler

plume

mouth piece

dispencing nozzle

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concept development

Based on the research and user input I started to design a solution starting of with sketches, turning those sketches into CAD models and using rapid prototyping to test out size, shape and fittings.

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From these I came up with three concepts that I would take back to the users for feedback. (see opposite)


Concept One This first concept retains the same shape as the standard MDI inhaler with one key difference; the mouth piece is replacable meaning that at the end of use only the mouth piece is discarded, the casing can be kept and used with the next prescription, meaning the casing now is perminent so can feature a custom pattern or surface graphic.

Concept Two The second design takes a different approach getting rid of the plastic casing altogether, instead the mouth piece also acts as a lid which protects the canister ans stops any crumbs or dust being inhaled by the patient when in use.

Concept Three The third concept takes the same ideal as concept two but includes the possibilty of a hard case which is used much like concept one. The main idea behind this concept is the ability for patients to chose how they will use their inhaler.

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user feedback

I presented users with three concept designs as well as an example of a current device. Users where asked to choose there favourite, provide their thoughts and opinion for a chance to win a £10 play.com voucher. Below is the response from the 25 people who took part: “I like this because it is a changeable case and its like a big pen”.

“I like how it is discrete, compact and functional. The way it keeps clean is a big deal for me, as I keep my inhaler in my bag; which picks up the c*** at the bottom of it” “some form of protection for the canister”

“looks a bit clunky, needs to look more sleek” Concept Two 36%

“it doesn’t look like an inhaler so people may not be so imbassed about using it”. “like the idea that it is compact and fits in my handbag. The first thing I sacrifice on a night out is my inhaler vs. lipstick”

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“Having a distinctive design helps you identify your inhaler and adds personalization”

Concept Three 8%

Concept One 56%

“being showed examples of designs” “trendy and colourful people are more likely to use it”. “maybe could be a smaller version but works just the same”.

“I would do a whole selection of different patterns for different groups”


Images from feedback event held in the Universities Canteen during a busy lunch time

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Julia Clapp

Julia Clapp an Asthma specalist from carnon downs surgery, she teaches asthma nurses about asthma, she knows asthma!

able spacer, which has a rubber flange so can fit any shape mouth piece, but it has less volume than the volumizer.

Carnon downs surgery is a dispensing practise which means patients can get their medication from the surgery. The medication that is available to asthmatics comes in either branded or generic types, each make comes with it’s own inhaler and slighlty different canister style meaning that branded canisters cannot fit generic types and vi sa versa. Medication is available to patients in a range of places from a dispensing surgery to a high street pharmacy each can carry a different make of drug which can change with time.

Familarity is another important aspect mentioned, especially amongst the elderly, Julia told me that some older patients have been known to try and use Autohalers or breathe easy inhalers like a MDI, taking the top off and pressing the canister down.

One thing that is very important when considering inhaler devices is the “plume�, the cloud of medication that comes out of the inhaler. The plume can affect the level of dissemination, and therefore how much of the medication gets into the body. The best way to absorb the medication is through the use of a volumizer, which is only compatible which a certain mouth piece shape. There is however a

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Key Points: - Brand of medication depends on location of of prescription pick up. - Each brand has a different style canister each with a slightly different orifice size so inhalers are not transferable between brands. - Familiarity is important, people need to be able to be familiar with the technology and feel comfortable. - Design could be improved by making it suitable for volumizer.


“The worst compliance is amongst young people, it is often the want to avoid the stigma of using an inhaler, anything that makes them different�. 21


final concept

The Final design concept is the Lidhaler, essentially a mouth piece with the dispecer nozzel placed in a lid like shell. This part uses approx 60% less plastic than the standard MDI (based on volume). Lidhaler is HDPE injection moulded and therefore recyclable.

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Available in four colour spectums to represent each drug type just as current MDI’s are coloured. Patients would get the Lidhaler and canister with their prescription and use with their own cases.


Fits into a personal hard case which is kept and reused by the patient each time they need a new prescription meaning less plastic waste and can feature a custom surface graphic.

Alternatively the patient can choose to use it with a soft silicone case, where the lidhaler acts as a lid to the drugs canister, making it more compact and stopping any dust inhalation. Patients can switch between the two cases to fit their needs.

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final concept

Ø23.26 Ø24.00 Ø27.00

24.00

3.00

24.00

O24.00 O23.50 O21.50 O21.00

69.00

50.00

O0.50

10.00

16.70

17.70

9.00

19.00

13.00

35.70

10.00

8.00 6.52

O4.10 O3.10 O6.00

5.00

20.38 23.26

1.00∞

1.97 21.00 24.00

1.50

7.00 10.00

27.00

23.26 27.00

1.50

Lidhaler and Hard case

Scale. 1:1 All Dimensions in mm

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Patient collects prescription: - Lidhaler - medication canister

Cansister is disposed of and Lidhaler is recycled. The two cases are kept by patient for use with next prescription

Patient is given a hard and soft case when first diagnosed.

Patient fits mouth piece and canister into choosen case

During use patient can switch between cases to suit their need

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how it compares

Current MDI - No recycling or reuse just 100% waste at end of Life - Patient is given whatever is provided by the brand of medication, no choice over look or size of device which can vary between brands - Effective - Easy to use - Dust/ crumbs can get caught in device and inhaled by user if carried around in a bag

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Lidhaler - 100% recyclable mouth piece, both the soft and hard case are reusable. - Regardless of the brand of medication given to patient at point of prescription, personal cases means they can dictate the look and feel of their inhaler. - Patients change the way their inhaler looks and the way it is used to suit their need. - The ability to have a custom suface graphic on a permanent case creates a strong user attachment - When using the inhaler with the silcone case, the lidhaler stops the chance of users inhaling dust from their bag

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next steps

This Design solution is simply a design concept, which requires further user feed back and development to make the product viable. In order to do that there are some key issues to address as well as possible avenues to explore. One of the biggest issues with this design is the mouth piece, the cylindrical shape means that although it can fit a able spacer (a small, compact volumizer) it cannot fit a volumatic spacer which according to the professionals is the optimum way to disseminate the drug into the body, and is important in the use of inhalers with young children and the elderly. This means that either the mouth piece needs to alter to fit an volumiser or the volumizer attachment needs to alter to fit the mouth piece. Because the main part of this concept is a interchangeable mouth piece , their is much more exploration into the range of hard covers to fit it into. Currently I have only shown the possibility to have different surface graphics to make them personal to the owner, but potentially the hard cases could have built in functionality, such as a dose counter on the

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back. The actual shape of the case could be different as long as it fits the mouth piece and protects the canister there could be a range of shapes and sizes and materials. This concept could led on to further concepts which reduce the amount of plastic used again, and give the user even more choices in the look and feel of the inhaler

Key Points: - Design needs to be compatible with volumizer, either change mouth piece shape or adapt the volumizer. -Explore further the possibilties of having interchangeable cases. - Add functionality like a dose counter to hard case. - Evolve concept to further decrease plastic use, and increase user choice.


next step? how can added functionality like dose counters be designed into the solution?

next step? Can the part that needs to be detached for recycling be reduced even further?

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phil-merrifield-arthritus-medical-opt  

Summary of Design.............................. 2 Primary Research................................... 8 User feedback..........................

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