Enhanced medical product TECHNICAL FIELD The present invention relates to a method and a medical product for enclosing a metered, dry powder medication dose together with a dose of an excipient in a common dose container intended for insertion and use in a dry- powder inhaler device (DPI), resulting in an improved emitted medication dose upon inhalation. In a further aspect the invention is directed to simplifying dose forming and adapting doses for high performance inhalation.

BACKGROUND Within health care today administration of medicaments by inhalation for distributing dry powder medicaments directly to the airways and lungs of a user is becoming more and more popular, because inhalation offers an efficient, fast, and user friendly delivery of the specific medication substance.

Dry powder inhalers (DPIs) have become accepted in the medical service, because they deliver an effective dose in a single inhalation, they are reliable, often quite small in size and easy to operate for a user. Two types are common, multi-dose dry powder inhalers and single dose dry powder inhalers. Multi-dose devices have the advantage that a quantity of medicament powder, enough for a large number of doses, is stored inside the inhaler and a dose is metered from the store shortly before it is supposed to be inhaled. Single dose inhalers use pre-metered doses and such inhalers are loaded with a limited number of individually packaged pre-metered doses, where each dose package or container is opened shortly before inhalation of the enclosed dose is supposed to take place.

Dry powder medicaments may be in a pure formulation consisting of only active pharmaceutical ingredient (API), or the formulation may comprise other substances for different purposes, e.g. enhancing agents for increasing the bio-availability and/ or bio-activity of the API. Pharmacologically inert excipients may be included for diluting a potent API, in order to act as carrier of the API or to improve the flowability of the formulation to enhance metering and filling properties of the powder.

Powders with a particle size suitable for inhalation, i.e. particles having an aerodynamic diameter, AD, in a range 0.5 - 5 μm, have a tendency of aggregating, in other words to form smaller or larger aggregates, which then have to be de-aggregated before the particles enter into the airways of the user. De-aggregation is defined as breaking up aggregated powder by introducing energy e.g. electrical, mechanical, pneumatic or aerodynamic energy. The aerodynamic diameter of a particle of any shape is defined as the diameter of a spherical particle having a density of 1 g/cm3 that has the same inertial properties in air as the particle of interest. If primary" particles form aggregates, the aggregates will aerodynamically behave like one big particle in air.

The tendency to form aggregates is aggravated in the presence of water and some powders are sensitive to very small amounts of water. Under the influence of moisture the formed aggregates require very high inputs of energy to break up in order to get the primary particles separated from each other. Another problem afflicting fine medication powders is electro- static charging of particles, which leads to difficulties in handling the powder during dose forming and packaging.

Methods of dose forming of powder formulations in prior art include conventional mass, gravimetric or volumetric metering and devices and machine equipment well known to the pharmaceutical industry for filling blister packs and gelatin capsules, for example. See WO 03/66437 Al, WO 03/66436 Al, WO 03/26965 Al3 WO 02/44669 Al, DE 100 46 127 Al and WO 97/41031 for examples of prior art in volumetric and/or mass methods and devices for producing metered doses of medicaments in powder form. Electrostatic forming methods may also be used, for example disclosed in US 6,007,630 and US 5,699,649.

Gelatin or plastic capsules and blisters made of aluminum or plastic, or laminates comprising aluminum and plastic foil are common prior art containers for metered single doses of dry powder medicaments. Typically, the user has to open the inhaler, insert at least one container into the inhaler, close it, push a button to force one or more sharp instrument(s) to penetrate a selected container, such that the dose may be accessed by streaming air when the user at leisure decides to inhale the dose. Besides a method of breaking the container open inside the inhaler and pour out the dose in a chamber first, the most common methods of opening the container are to punch one or more holes in the container itself or in a foil sealing the container or peel off the sealing foil. In the first case the powder is poured onto a surface inside the inhaler and made available for inhalation from there. In the second case the dose is aerosolized by inhalation air being forced through the container or the dose being shaken out of the container and immediately aerosolized by streaming air on the outside of the container.

However, there is still a need for improved efficacy of dry powder medicament doses being part of medical products intended for delivery by inhalation using a DPI.

SUMMARY The present invention relates to a method for enclosing 1) a metered, dry powder medication dose comprising at least one active pharmaceutical ingredient (API) and 2) a metered, dry powder dose of at least one excipient in 3) a common space of a common dose container. The medication formulation is a dry powder formulation adapted for inhalation and the excipient or excipients are biologically acceptable dry powders that are in all respects compatible with the medication powder. The invention teaches that the respective formulations are metered and filled into a common space of the dose container. According to the invention, the deposited doses in the common dose container constitute a medical product. The method and the medical product are effective in raising the emitted medication dose output loo when the doses are delivered together by inhalation from a dry powder inhaler. The therapeutic efficacy of the metered medication dose is thereby improved. According to the invention, the improvement in emitted medication dose is not influenced by intentional or unintentional mixing of the doses of API and excipient after filling into the dose container, as long as 105 the two doses are aerosolized together during inhalation. Nevertheless, arranging a somewhat random disorder of API and excipient particles by agitating the doses may be a way of raising the emitted API dose figure. Many kinds of medical dry powder formulations for inhalation benefit from the invention, such as pure API formulations, formulations comprising no particles consisting of API and other ingredients and formulations of porous particles - e.g. Technospheres® and microspheres In particular, the present invention is useful where the dry powder medication formulation in the dose is sticky and where particles of the medicament tend to attach themselves to surfaces with which they come in contact, such that they are difficult to set 115 free. The present method may be advantageously applied to naturally sticky substances and medication formulations, but also to powders sensitive to ambient conditions such as elevated temperature and humidity.

DESCRIPTION OF THE DRAWINGS 120 The invention will be described in the form of a preferred and illustrative embodiment and by means of the attached drawings, wherein like reference numbers indicate like or corresponding elements and wherein:

FIG. 1 illustrates in perspective (Fig. Ia), top (Fig. Ib) and side (Fig. Ic) 125 views a particular embodiment of a sealed dose container filled with a dose of a medicament and a dose of an excipient; FIG. 2 illustrates a sealed dose container filled with a dose of a medicament consisting of two deposits and a dose of an excipient consisting 130 of three deposits.

FIG. 3 illustrates a sealed dose container after agitation filled with a dose of a medicament consisting of two deposits and a dose of an excipient consisting of three deposits where the doses have become partly mixed. 135 FIG. 4 illustrates in a graph results of a climate test showing the drop in fine particle dose, FPD, of Atrovent® with active substance being ipratropium bromide.

140 FIG. 5 illustrates in a flow diagram the steps of the invention for joining a metered medication dose and an excipient dose in a common dose container.

DESCRIPTION OF AN ILLUSTRATIVE EMBODIMENT 145 The present invention relates to a method for joining a metered, dry powder medication dose and a dry powder dose of a biologically acceptable excipient in a common dose container. Surprisingly, we have found that a medical product, based on the present method, improves the emitted dose, i.e. the output mass of the active ingredient of the medication powder dose, when 150 the joined doses are inhaled from a dry powder inhaler device. The present invention improves the emitted dose by minimizing the powder retention inside the DPI. Surprisingly, we have found that the invention is advantageously applied to many types of dry powder medicament formulations intended for inhalation, particularly sticky dry powders stand 155 to benefit. Examples of medical dry powders suitable for the present method are formulations comprising proteins, including peptides, lipids, water- soluble excipients, pure API formulations, formulations of APIs and other substances and powders of porous particles, e.g. Techno spheres® and microspheres. The addition of the excipient dose acts as a cleaning agent 160 and helps to release the medication dose and entrain it into inspiration air when the doses are inhaled by use of a dry powder inhaler device. Moreover, the quantity of excipient acting as a cleaning agent in the joined doses is much less compared to what is necessary in an ordered mixture containing an API formulation and an excipient acting as diluent and carrier. 165 In a further aspect, it is well known in the art that many important medicaments in dry powder formulations are sensitive to high levels of humidity, such that the emitted particle dose out of an inhaler device drops drastically as the relative humidity in the air increases. This sensitivity to 170 ambient conditions is especially noticeable among the new protein-based medicaments for inhalation under development or recently introduced into the marketplace, e.g. medicaments directed towards treatment of systemic disorders. In recent years, the pharmaceutical industry, having interests in inhalable medicaments, has directed most development resources to the 175 formulation side of product development and the delivery systems, i.e. dose packaging and the inhaler devices, have been less in focus. Thus, the teachings herein concern how to join separate formulations of a medicament and an excipient in a medical product, which provides improvements in drug delivery performance by inhalation and thereby improved therapeutic 180 efficacy.

A successful formulation of an API for inhalation needs to be inter alia chemically and biologically stable under storage and in-use conditions, it needs to have a high bio-availability and bio-activity, a suitability for a filling 185 process and a narrow particle size distribution. There are a number of well- known techniques for obtaining a suitable primary particle size distribution that will ensure correct lung deposition for a high percentage of the dose mass. Such techniques include jet-milling, spray-drying and super-critical crystallization. There are also a number of well-known techniques for 190 modifying the forces between the particles and thereby obtaining a powder with suitable adhesive forces. Such methods include modification of the shape and surface properties of the particles, e.g. porous particles and controlled forming of powder pellets, as well as addition of an inert carrier with a larger average particle size (so called ordered mixture). A simpler 195 method of producing a finely divided powder is milling, which produces crystalline particles, while spray-drying etc produces generally more amorphous particles. Novel drugs, both for local and systemic delivery, often include biological macromolecules, which do add completely new demands on the formulation and the production process. Examples of problems, 200 which need to be addressed when developing a formulation for inhalation comprising an API and optionally other substances, are: • API stability • Absorption of the API in the lung • Solubility of the API 205 • Particle size distribution • Dilution of API potency • Elimination of unpleasant taste • Powder flowability

210 When a working formulation has been developed and regulatorily approved together with a chosen packaging and dose delivery system, the threshold of improving the formulation chemically or biologically is very high, because the whole regulatory process must be repeated. Besides the time and cost involved in developing a new formulation, most time and money will be spent 215 on regulatory work. From this aspect, the present invention may provide a fast road to higher medical efficacy by making a switch to a different technical platform possible. Technically, it is very straightforward to implement the present invention and to switch the packaging and dose delivery systems. A new dose container may be developed or an existing one 220 may be chosen capable of accepting a dose of the original formulation and a dose of a selected excipient, thereby constituting a medical product according to the invention. Examples of suitable DPIs3 which may be used with the present invention are described in our publications US 6,622,723 and US 6,422,236. Regulatorily, combining a well-known, proven 225 formulation with a biologically acceptable excipient does not require extensive development and clinical studies to aquire an approval. The regulatory process is normally in such cases uncomplicated and quick in comparison.

230 Preferably, the de-aggregating system should be as insensitive as possible to variations in the inhalation effort produced by the user, such that the delivered aerodynamic particle size distribution in the inhaled air is largely independent of the inhalation effort over a certain minimum level. A very high degree of de-aggregation presumes the following necessary steps: 235 • a suitable formulation of the powder (particle size distribution, particle shape, adhesive forces, density, etc) • a suitably formed dose of the powder adapted to the capabilities of a selected inhaler device • an inhaler device providing shear forces of sufficient strength in the 240 dose to release and de-aggregate the powder (e.g. turbulence) A method and a device for de-aggregating a powder is disclosed in our US patent No. 6,513,663 Bl .

Dose forming 245 An advantage of the present invention is that prior art methods of dose forming of medication and excipient powder formulations for inhalation are easily applied, such as conventional mass, gravimetric or volumetric dose metering. Filling devices and machine equipment well known to the pharmaceutical industry for filling blister packs and gelatin capsules, for 250 example, may be used. Electrostatic forming methods may also be used, for example as disclosed in our publication WO 02/ 11803 (US 6,696,090) disclosing a method and a process of preparing a so called electro-powder, suitable for forming doses by an electro-dynamic method, further described in our publication US 6, 868,853, which both are incorporated hereby in this 255 document in their entirety by reference. These disclosures stress the importance of controlling the electrical properties of a medication powder and points to the problem of moisture in the powder and the need of low relative humidity in the atmosphere during dose forming.

260 Suitable dose sizes for inhalation are typically in a total mass range from 1 mg to 20 mg. Smaller doses than 1 mg are difficult to meter and fill consistently and doses having a mass exceeding 20 mg may be difficult to release and de-aggregate completely in the DPI. Many of the new protein- based active substances require a metered mass of the API in the order of 1 - 265 5 mg to give the desired therapeutic effect when inhaled. If the medicament comprising the API is a candidate for being included in a mixture, further comprising an excipient of bigger particles, typically of average size between 20 and 200 μm, acting as carriers of the medicament, one must keep in mind that a stable, homogenous, ordered mixture in bulk quantity that does 270 not begin to segregate when used in a repetitive, filling operation, cannot hold more than 4 - 5 % by weight (w/w) of the medicament. Segregation means that small drug particles separate from the big excipient ones, leading to different concentrations of the API in different parts of the bulk powder store. Given that the medicament mass is in the range 1 - 5 mg, i.e. pure API 275 having a therapeutic effect, a metered dose of an ordered mixture will be in a range from 20 to 125 mg. A dose mass in this range is not suitable for inhalation. APIs for systemic absorption by pulmonary delivery must have particles in a range 1 - 3 μm, which makes it difficult to make a homogenous, ordered mixture which does not segregate when later used in a 280 filling process. Anyone will realize that if the concentration of API varies in the bulk powder mixture and if segregation occurs during handling and in the filling process, it will be impossible to know how much API drug that is filled each time. A particular aspect of the present invention presents a solution to this problem by using far less excipient, not in an ordered 85 mixture with the medicament as in prior art, but separately dosed into the same dose container as the medicament dose. The present invention uses ratios API/excipient in a range 1/20 - 20/ 1. In fact, the present invention simplifies the dose filling in many cases, because 290 the complexity of making a stable mixture of the API formulation and a suitable excipient is eliminated. A first dose of the formulation containing the API is metered and filled into a dose container and a second dose of at least one excipient is also filled into the same dose container. The order of filling the two doses is irrelevant to the invention. A best mode of filling 295 depends e.g. on the formulations, the selected mass ratio, the dose container and the DPI, which will receive the medical product containing the doses to be inhaled. If the medication dose and the excipient dose are deposited separately in a common container, which is then sealed, agitating the container indefinitely will not result in a homogenous mixture, as samples 300 will show. Nevertheless, in a particular embodiment, agitating the dose container after filling with API and excipient doses will create a non-uniform mixture, which will boost the emitted dose of the API . However, agitating the dose container may be preferred, but is not necessary, in order to implement the invention, provided the doses are arranged to be inhaled simultaneously 305 together. An advantage of the invention is that the road to regulatory approval may be considerably shorter compared to taking a new formulation through the necessary, regulatory steps. A further advantage of the disclosure is that metering and filling of the medicament dose may become simpler compared to filling an ordered mixture. Both the cleaning excipient 310 and the medicament are often more easily separately metered.

Generally, dry powder medicament doses need to be protected by an enclosure not only during storage, but also when inserted in an inhaler, e.g. a single dose DPI, where the dose and its enclosure are kept in a ready state 315 before delivery in an inhalation at a point in time decided by the user. New types of dry powder medicaments, not least for systemic treatment, have a rather short expiry date and they are generally quite sensitive to ambient conditions, especially moisture during storage and in use. Hence, the demands put on dose protection and inhaler devices in handling sensitive .,20 doses are therefore much higher than for prior art devices as used e.g. for administering traditional medicaments against respiratory disorders.

In, the development of new and improved types of single dose dry powder inhalers, see our U.S. Patent No's 6,622,723, 6,422,236, 6,868,853, 325 6,571,793 and 6,840,239, we have also developed dose filling methods, see our U.S. Patent No. 6,592,930 and WO 04/ 110539, all of which are incorporated in this document in their entirety by reference. In the development work, particular attention has been devoted to sticky substances per se, i.e. such dry powders which are inclined to leave a high 330 percentage of the active substance, the active pharmaceutical ingredient(s), retained on the inner surfaces of the dose container or aerosolization chamber and on the internal walls of the air channels inside the inhaler device, through which the airflow passes carrying the released dose into' the airways of the user. Besides stickiness in the active substance, i.e. the API, 335 stickiness may be experienced when using easily water-soluble excipients in the formulation or when the powder formulation consists of porous particles where the surface area of a particle is very large relative the particle's mass. Stickiness in a powder may also be a result of particles disposed to form large particles, which sometimes also are difficult to de-aggregate. Not 340 surprisingly, if the humidity of the surrounding air is high, we've found that medical powders in general are more inclined to stick to any surface with which they come in contact. What degree of air humidity is deemed to be high depends on the sensitivity to humidity of the powder. The retention effect for a sticky powder depends, inter alia, on the structure of surfaces in 345 contact with the powder, the surface areas, the materials concerned, the design of the inhaler device and the aerosolization and de-aggregation forces provided by the DPI, to name a few important factors. Time is another factor e.g. when stickiness is due to high moisture. Different powders adsorb more or less humidity and at different rates. However, many medical powders are 350 affected within milliseconds of being exposed to humidity in the ambient air. Other powders adsorb water more slowly. In any case, it is not satisfactory having an inhaler designed such that the user may open a dose container first, allowing the ambient atmosphere access to the dose therein for an undefined time period of seconds or even minutes before an inhalation 355 commences.

Surprisingly, we have found that a low figure of emitted dose from a DPI may be drastically improved by introducing a suitable, biologically inert excipient in dry powder form into the dose container or chamber at the dose metering 360 and filling stage, thereby joining a dose of the medication in question to a dose of the excipient. Naturally, the excipient or excipients must be compatible in all respects with the medication powder. For best accuracy, the invention teaches that the respective formulations are to be separately metered and filled into the same dose container, where they intentionally or 365 unintentionally may or may not be mixed after filling. The doses must, however, be so arranged in the dose container that they will be aerosolized simultaneously together. The improvement in emitted dose as a percentage of the metered dose is very significant. Particularly sticky powders may benefit from the present invention, because the relative improvement in 370 emitted dose may be more significant than for more easily aerosolized powders. Powders may be naturally sticky or conditionally sticky or both, e.g. if affected by humidity. The excipient may be separately filled into the dose container before or after filling of the medicament dose. Surprisingly, we have found that even a small amount of a selected, suitable excipient 375 powder, which is used to coat the inner surfaces of the container prior to dose filling, may be sufficient to raise the emitted dose figure of the active pharmaceutical ingredient, API. From a filling point of view, however, a coating of the container internal surfaces presents many problems, such as the risk of unintentional spreading of excipient particles onto sealing 380 surfaces of the container, thereby risking the sealing quality. It is preferred to fill the container with doses of the medicament and the excipient, where each dose consists of at least one metered deposit of the formulation in question. When the dose container later is opened and the doses aerosolized during an inhalation, the particles of the excipient dose act as cleaning 385 agents for the container and the internal parts of the inhaler, whereby a high share of the medication powder particles that stick to the interior surfaces are forcibly released and entrained in the streaming inhalation air. The clensing effect is very obvious whether or not the medication dose has been mixed with the excipient dose prior to an inhalation, provided the doses are 390 released simultaneously together. However, a best mode of filling the API and the excipient in a selected dose container and what mass ratio to use between medicament and excipient must be decided during development of the particular medical product. Different formulations do not necessarily benefit from the same filling method and the optimum quantity of excipient 395 dose to be deposited into the dose container together with the medication dose depends on the formulation of the API, among other things. In a particular embodiment a dose comprising at least one powder deposit of the medicament is deposited in the dose container and deposits of the excipient are deposited on diametrically opposed sides of the medication deposits. The 400 deposits of the excipient are preferably of approximately the same mass and the deposits added together constitute the excipient dose. Typically, the dose mass of the excipient is roughly the same as the mass of the medication dose. The deposition sequence and pattern of the deposits making up the respective doses in the dose container depend on how the DPI aerosolizes the 405 powder in the dose container. The deposited excipient dose must be properly aerosolized like the medication dose, or else the cleaning effect of the excipient may be less efficient.

In another embodiment of the invention, a dose comprising at least one API 410 and a dose comprising at least one biologically acceptable excipient are separately metered, whereupon the metered doses are filled together into a dose container, optionally first being at least partly mixed prior to filling.

In a further particular embodiment, a dose of excipient is filled into the 415 container in a first step, but not spread out inside. Then, in a second step the medicament is filled into the container, optionally on top of the excipient. Optionally, a further amount of excipient is deposited on top of the dose. A further option is to agitate by e.g. shaking or vibrating the dose container after filling and optionally after sealing of the container, whereby the 420 excipient(s) become roughly mixed with the medicament powder. The non¬ uniform mixture is characterized in that it does not constitute an ordered mixture. We have surprisingly found that even if the excipient, acting as a cleaning agent, does not isolate the dose from contacting the internal surfaces of the container, still the excipient manages to clean out the dose 425 from the container. When the powder in the container or aerosolization chamber is attacked by a sufficiently turbulent air-stream, the medicament powder dose is released, de-aggregated and entrained into the air-stream that flows through the inhaler air channels and further into the airways of a user. Besides acting as carriers of small particles, it is assumed that mainly 430 the coarse excipient particles act similarly to a sandblasting device, i.e. to physically set medicament particles free by sheer impaction power. Which combination of excipients, particle sizes and methods of depositing amounts of excipients depends on the excipient(s) and the medicament. What degree of agitation to use, if at all, must also be investigated in each individual 435 application.

The excipient may comprise fine particles <10 μm, particles >10 μm or the excipient may comprise fine particles <10 μm and coarse particles >10 μm. The excipient particles having an aerodynamic diameter (AD) of 10 μm or 440 more are deposited by impaction in the mouth, throat and upper airways upon inhalation, because the mass of these excipient particles is generally too big to follow the inspiration air into the lung. Therefore, excipients are selected inter alia with a view to be harmless when deposited in the areas concerned. However, a formulation of excipient(s) may comprise more than 445 one excipient. For instance it is often advantageous to include an excipient consisting of small particles <10 μm in a mixture with an excipient consisting of big particles >10 μm, more typically >25 μm. This mixture flows easily and a metered dose of the mixture holds together when lightly- compacted and makes the filling process simple. The mass ratio between 450 small particles and big ones is in a range 0.01 - 0.1 and typically 0.02 - 0.05 for best operation. The excipients used may or may not be of the same substance.

Suitable excipients for inclusion in a dose container are to be found among 455 the groups of monosaccarides, disaccarides, polylactides, oligo- and polysaccarides, polyalcohols, polymers, salts or mixtures from these groups, e.g. glucose, arabinose, lactose, lactose monohydrate, lactose anhydrous [i.e., no crystalline water present in lactose molecule], saccharose, maltose, dextrane, sorbitol, mannitol, xylitol, sodium chloride, calcium carbonate. A 460 particular excipient is lactose. Lactose in a dry powder form, so called Respitose® from DMV International having 95 % of particles larger than 32 μm, has been successfully used as a cleaning excipient in many inhalation experiments of ours.

465 The moisture properties of any proposed excipient must be checked before it is chosen to be used as a cleaning agent. If an excipient gives off water, after dose forming, it may negatively affect the API in the medicament dose, such that the fine particle dose, FPD, deteriorates rapidly after sealing of the dose container. Therefore, excipients to be in contact with or to be mixed with the 470 medicament are to be selected among acceptable excipients, which have good moisture properties in the sense that the excipient will not adversely affect the FPD of the API(s) for the shelf life of the product, regardless of normal changes in ambient conditions during transportation and storage. Suitable "dry" excipients are to be found in the above-mentioned groups. In a 475 particular embodiment of the present invention, lactose is selected as the preferred dry excipient and preferably lactose monohydrate. A reason for selecting lactose as excipient, is its inherent property of having a low and constant water sorption isotherm. Excipients having a similar or lower sorption isotherm can also be considered for use, provided other required 480 qualities are met.

Ambient conditions during dose metering, filling and container sealing should be closely controlled. The ambient temperature is preferably limited to 25 0C maximum and relative humidity preferably limited to 15 % Rh 485 maximum, but the actual permissible relative humidity depends on the specific formulation and some cases may require much less than 15 % Rh, even less than 5 % Rh. The powder formulation is also to be kept as dry as possible during the dose forming process. Further, it is very important to control the electric properties of the powders and to apply electric charging 490 and discharging as needed, regardless of which method of dose forming is to be used. Fine powders pick up static electric charges extremely easily, which can be advantageously used in dose forming, if the charging and discharging is under proper control. Keeping the ambient relative humidity low ensures that only a very small, acceptable amount of water is enclosed in the dose 495 container together with the dose and not enough to present a threat to the stability of a moisture sensitive substance and the FPD of the dose.

The disclosed method counteracts as far as possible any adverse influence that e.g. humidity in the air may have on the fine particles in the dose. 500 Minimizing the dose exposure to the atmosphere may preferably be done by implementing a breath actuation mechanism coupled to opening of the dose container in the inhaler. But the present invention may be advantageously used to boost performance from a dry powder inhaler device. Examples of problems in prior art dry powder inhaler devices, having negative effects on 505 the emitted dose are: • Inhaler design provides too low airflow turbulence close to dose during inhalation; • Selected dose container is bigger than necessary and provides too much internal surface area for powder to stick to; 510 • Inhaler and dose container present high sticking effects between dose particles and internal surfaces of dose container and inhaler; • User interface of the inhaler gives ambient humid air access to the dose for a long time before an inhalation actually takes place; Such failings in prior art DPI devices may be rendered less detrimental and 515 the emitted dose is improved by the adoption of the present invention. Most preferably, however, the present invention is applied in an inhaler incorporating an Air-razor device for a gradual dose release in a prolonged dose delivery period, as described in our U.S. Patent No. 6,840,239.

520 Example 1 : Mixtures of API and Excipient In the course of developing methods and products according to the present invention different APIs were mixed with excipients in different ratios. The objectives were to find inter alia suitable formulations and methods of filling doses, but also to optimize inhaler techniques and interaction between 525 inhaler and dose container. Table 1 below discloses some examples of volume trically dosed mixtures API/ excipient and the resulting emitted dose when delivered by a proprietary DPI.

Table 1 530

Conclusions As shown in Table 1 , mixtures with far more micronized API (insulin) than 5 535 % were used in these tests. The objective was to find suitable excipients and to see how different mixing ratios affected the emitted dose. The mixtures were produced under laboratory conditions in small quantities and remained quasi-stable under the run of tests. The emitted dose as percentage of total recovered dose was measured and the results were used in the development 540 of the current invention.

Example 2: Ipratropium climate stability tests This test was made in order to find out how sensitive ipratropium bromide is to moisture. Commercially available Atrovent® capsules containing 545 ipratropium bromide and excipient were bought in from our local pharmacy and introduced into the laboratory together with the HandiHaler® dry powder inhaler device. The powder was withdrawn from the originator's capsules and transferred to the capsules again after climate storage. The aerodynamic fine particle fraction (FPF) in the emitted dose from the HandiHaler® was 550 measured using Andersen impactors according to European Pharmacopoeia (EP) and US Pharmacopoeia (USP). All analytical work then was performed according to standardized methods using a state of the art High Performance Liquid Chromatograph (HPLC) system.

555 Test Sl Aerodynamic fine particle fraction of metered and delivered dose out of Handihaler® using Atrovent® formulation powder was analyzed. Transfer of powder from and back into originator capsules was performed in relative humidity below 10 %. The test was performed with 4 kPa pressure drop over 560 the HandiHaler® at room temperature and laboratory ambient conditions.

Test S2 An in-use stability test was carried out of the aerodynamic fine particle fraction of metered and delivered dose out of Handihaler®. From the blister 565 holding the Atrovent® capsules the powder was transferred to a medium moisture barrier container and sealed. The containers were put for 1 month in 25 0C and 60 % Rh. The container holding the powder was then put in an exicator for 2 h before tests were performed. The inhaler test was performed with 4 kPa pressure drop over the HandiHaler® at room temperature and 570 laboratory ambient conditions.

Test S3 The same test as in S2 was carried out except that the containers were put for 1 month in 40 °C and 75 % Rh. 575 Conclusions It is obvious from the graph in Figure 4 showing the drop in fine particle dose, FPD, that ipratropium bromide is a very moisture sensitive substance.

580 Example 3 In order to illustrate the positive effect on emitted dose, i.e. the mass of the medicament powder entrained in inspiration air leaving a typical DPI, the following tests were carried out in our laboratory.

585 A pure, micronized, recombinant, human insulin in dry powder form was selected as the medicament test substance. Lactose in a dry powder form, so called Respitose® from DMV International having 95 % of particles larger than 32 μm, was selected as a cleaning excipient.

590 Four dose containers, aluminum blisters constituting so called pods, were filled in a dry climate with nominally 2.5 mg insulin. The filled containers were designated 'A'.

Four further containers, identical to the first four, were filled in the same, 595 dry climate with nominally 2.5 mg insulin and 2.5 mg Respitose®, in separate filling steps, making a total dose of 5 mg and a mass ratio of 50/50 between insulin and Respitose®. The filled containers were designated 'B'.

The containers were adapted for insertion into a proprietary, single dose DPI, 600 called E-flex.

Two containers of type 'A' and two containers of type 'B' were put for an hour before testing in a climate cabinet set at room temperature and approximately 90 % relative humidity and the remaining containers were 605 stored in the laboratory under normal ambient conditions.

The emitted doses were measured using a total of four DPI test devices, pne per type of filling ('A' and 'B') and climate. Emitted dose was measured using a HPLC analyzer. Retention in the containers and in the suction tube and 610 mouthpiece of the inhalers were also measured using the HPLC analyzer. Results are presented in Table 2 below.

Table 2

615 Conclusions from climate testing The tests show conclusively that the cleaning excipient Respitose® boosts the emitted dose (ED) leaving the inhaler. This is especially noticable under ambient conditions where the ED increases from 87 to 93 % of the metered 620 dose and retention is reduced by almost 50 % from 13 to 7 %. In the humid case a 3 % improvement is seen , retention is reduced by approximately 10 - 15 %, from 24 to 21 %. It is also interesting to note that the efficacy of the test DPI system is very high even under extremely humid conditions.

The disclosed method must be adapted to the particular type of dose container, which has been selected for insertion into a particular, adapted dry powder inhaler. As already pointed out, different types of dose containers are advantageously used in the present invention. Examples of containers are aluminum or plastic single dose blisters of varying size and design and also capsules of gelatin, cellulose or plastics.

Prior art blister packages for dry powder medicaments, intended for inhaler use, often have a fairly thin polymeric seal, which can be easily ripped or punched open before the dose is supposed to be inhaled. Another common seal is a peelable foil such that the blister is peeled open prior to inhalation of the enclosed dose. Yet another type of prior art dose container is the capsule. Capsules are often made of gelatin, but polymers and cellulose and other materials are also used. A common problem for prior art blisters and capsules used for dry powder doses for inhalation is that the primary package does not protect sensitive substances from moisture well enough during storage and in use. Minimizing the time the primary package is exposed to the atmosphere and minimizing the time during which the dose is subjected to the ambient atmosphere after opening of the container are therefore important aspects of inhaler and dose container design.

Using a new type of blister pack, a so-called pod (patent pending), as a particular embodiment of a sealed dose container, is to be preferred in an application where the present invention is to be put to use. A pod container may be made as a high barrier seal container offering a very high level of moisture protection and which is in itself dry, i.e. it does not contain water. See Figure 1 illustrating a pod carrying a sealed container in a perspective drawing. Figure Ia shows a sealed container 33 (seal 31) put into a protective casing 41 adapted for insertion into a dry powder inhaler. Figure Ib shows a top view of the carrier/ container and indicates a dose of a dry 655 powder medicament 22 and a dose of a dry powder excipient consisting of two depositions 21 inside the container 33 under a seal 31. Figure Ic illustrates a side view of the carrier/ container in Figure Ib. Figure 2 illustrates a similar container to Figure 1, but the medicament dose consists of two deposits 22 and the excipient dose consists of three deposits 21. 660 Figure 3 illustrates the dose container in Figure 2 after agitation of the container, whereby the deposits 21 and 22 have become partly mixed in a load 23. Figure 5 illustrates in a flow diagram the steps of the present invention for joining a metered medication dose and an excipient dose in a common dose container. 665 The invention teaches that the addition of an excipient dose to a medication dose at the inhalation stage improves the release of the API of the medication powder dose, such that the emitted API dose increases and the retention in the dose container and in the down stream airflow channels decreases. It is 670 not necessary to arrange a mixing of the doses, as long as the excipient dose generally is aerosolized simultaneously together with the medication dose. The excipient dose mass is not critical to achieve an improvement in the quantity of the emitted API dose. The big excipient particles will impact and stick in the mouth and throat and become swallowed and will have no 675 detrimental effect on the efficacy of the emitted dose.

It will be understood by those skilled in the art that various modifications and changes may be made to the present invention without departing from the scope thereof, which is defined by the appended claims.