Optimizing Respiratory Care with NEXThaler: Bridging Technology and Treatment

Omar Usmani,1,2 Fulvio Braido,3,4 Daiana Stolz,5,6 Anh Tuan Dinh-Xuan,7 Borja G Cosio,8 Laura Franzini,9 Alessio Piraino,9 Ulrica Scaffidi Argentina9 1National Heart and Lung Institute (NHLI), Royal Brompton Hospital (RBH) and St Mary’s Hospital London, Imperial College London, London, UK; 2The Royal Brompton & Harefield Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 3Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy; 4IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 5Clinic of Respiratory Medicine, University of Freiburg, Freiburg, Germany; 6Faculty of Medicine, University of Freiburg, Freiburg, Germany; 7Department of Respiratory and Sleep Medicine, Cochin Hospital, University Paris Cité, Paris, France; 8Son Espases University Hospital, Idisba, Ciberes, Mallorca, Spain; 9Global Medical Affairs – AIR, Chiesi Farmaceutici S.p.A, Parma, ItalyCorrespondence: Laura Franzini, Global Medical Affairs – AIR, Chiesi Farmaceutici S.p.A, via Palermo 26/A, Parma, 43100, Italy, Email [email protected]: Inhaled therapy is central in the management of asthma and chronic obstructive pulmonary disease, with inhaler device selection significantly influencing treatment efficacy and patient adherence. NEXThaler is a breath-actuated dry powder inhaler (DPI) designed to deliver extrafine formulations of inhaled corticosteroids (ICS) and bronchodilators, ensuring consistent drug deposition across both central and peripheral airways. This review provides a clinically oriented overview of inhaler technologies, focusing on the design features and clinical performance of this breath-actuated DPI. Notably, this narrative review is based on a comprehensive analysis of peer-reviewed clinical and preclinical studies on the NEXThaler DPI. Most evidence presented is derived from non-comparative studies, modeling approaches, or sponsor-supported trials. Key features of the NEXThaler DPI include a breath-actuated mechanism, flow-independent dosing, a dose counter and a triple feedback system that enhances correct usage, and a simplified open-inhale-close mechanism. The delivery of extrafine particles (< 2 μm) facilitates deeper lung penetration, improving small airway targeting and potentially allowing for lower ICS doses with maintained efficacy. Lung deposition studies demonstrate superior peripheral distribution and consistent dosing across varying inspiratory flow rates. Clinical trials and real-world studies confirm the efficacy and safety of bronchodilators and ICS combinations delivered via the NEXThaler DPI in both asthma and chronic obstructive pulmonary disease populations, showing noninferiority to pressurized metered-dose inhalers and improved outcomes in lung function, symptom control, and adherence. The device’s usability and patient satisfaction further support its role in respiratory care. Additionally, its propellant-free design contributes to reducing the environmental impact of inhaler therapy. Overall, thanks to its technological innovations, the NEXThaler DPI represents a clinically validated and patient-friendly option for the delivery of inhaled therapies in chronic respiratory diseases.Keywords: NEXThaler, dry powder inhaler, extrafine formulation, asthma, chronic obstructive pulmonary disease