In a report on medication compliance,¹ the World Health Organization (WHO) reported, “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” Among patients with chronic illness, approximately 50% do not take medications as prescribed.

Within the healthcare products universe, compliance is king. After all, a product not taken as intended stands to be a potentially ineffective treatment. Within this article, we will discuss various aerosols and pressurized dispensing systems and how these product forms are playing well beyond their traditional role of convenience into the greater critical role of healthcare compliance and increasing the efficacy of traditional over-the-counter (O-T-C) pharmaceuticals.

Over the years, some market segments have developed easy-to understand packaging approaches to help signal intended use/consumption regimens. Take for example, oral contraceptives. Prior to 1962, such products were sold in 100-count pill bottles, with no obvious or intuitive signal of the ideal consumption compliance procedures. Then the dial pack was introduced, which was designed to help users remember to take them accurately and as intended. Later, Norinyl introduced an improved package format that took the original sequential design and then added several features that enhanced compliance, including a row of placebo pills allowing users to take a pill every day of the month, making them less likely to forget to start a new pack.²

It was the combination of package innovation (dial pack) and product innovation (addition of placebo to complete a 28-day compliance schedule) that brought clarity to compliance. In a similar vein, pressurized packaging formats stand to help many healthcare users in their pursuit of effective self-care regimens by lowering the boundaries to regular, prescribed use.

The benefits of pressurized package formats are well documented; targeted application, high product evacuation rates and the ability to create a wide range of unique dispensing forms are but a few examples. Increasingly, such formats are being recognized as irreplaceable in the healthcare field, where enhanced product preservation needs, comfort of application and pharmacoeconomics factors (such as caregiver labor rates and patient compliance) are being scrutinized with ever increasing rigor.

Dr. Smith’s 10% Zinc Oxide Adult Barrier Spray, for the treatment of symptoms associated with adult incontinence, is a benchmark example of how creation of a pressurized dispensing system, geared toward increasing enhanced medical benefits, has helped to transform the patient/caregiver experience while also reducing overall pharmacoeconomic costs for healthcare facilities.

Within the nursing home industry, zinc oxide creams are commonly used to help fight the onset and symptoms of incontinence associated dermatitis (IAD). The direct, manual application of such products to potentially sensitive areas can cause patient discomfort and embarrassment, and comes with the increased risk of product cross-contamination.

In an effort to simplify the treatment process and enhance the overall caregiver/patient experience, Dr. Smith’s established an in-field usage study of an innovative zinc oxide bag-on-valve (BOV) spray system that allows the caregiver to administer a protective skin barrier coating via a touch-free spray-on application process. The goal of the study was to evaluate a new product form designed to reduce patient contact, eliminate the mechanical friction of standard applications and help preserve the dignity of the patient.

The usage study was conducted at a longterm care facility and a protocol was established to collect responses, analyze and report findings of qualitative and quantitative results with the use of the product. The current protocol for IAD prevention was replaced with the use of Dr. Smith’s Adult Barrier Spray for a period of 30 days, during which data was collected on the number of brief changes and uses of the spray, the incidence of severity of IAD, the incidence of urinary tract infections (UTI) and the number of uses per can (see chart on page 24).

At the conclusion of the study, encompassing more than 10,000 treatments, the results were found to be nothing short of remarkable. With significant increases in patient and caregiver satisfaction and overall reduction in the onset and duration of IAD, 82% of caregivers felt that the test product improved their facility’s quality of patient care. As a further testament, 80% said they preferred the test barrier treatment to the previously used product and 88% said they would recommend it. Since the completion of the study, it has also been noted that occurrences of UTIs have decreased appreciably. This is truly a great example of how a pressurized package format has helped to transform a mature market by increasing ease-of-use, improving therapeutic efficacy and increasing overall user and patient satisfaction.

Patient/user compliance also extends into the area of O-T-C self-care products including sunscreens and antifungal treatments, both of which now have spray formats that substantially aid user compliance.

Sunscreens are an important drug in the prevention of skin cancer and the signs of aging. The American Cancer Society reports one person dies of melanoma every 54 minutes³ with a UK study reporting that about 86% of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.⁴ Despite these risks, in a 2010 study, only one third of adults reported regularly applying a sunscreen of SPF 15 OR higher⁵ with more than one third of the population reporting experiencing sunburns in the previous year.⁶ With these types of statistics, it is easy to see that consumers are in ongoing need of new approaches to sun care and for products that are easy to use and well-suited to their individual lifestyles.

Almost two decades ago, the introduction of sunscreen sprays changed the sun care market in highly substantive ways, creating a new array of consumer-friendly formats (mousse, lotion sprays and whipped lotion) with new product benefits (cooling, low grease skin feel aesthetics, wet skin application and more). Since then, these products have been formulated for increasingly segmented consumer groupings, with the expressed intent of increasing consumer application and reapplication. Today, spray sunscreens account for 50% of the global sunscreen market as a leading form for speed, convenience and ease-of-use and continues to grow in market share as a lead sunscreen form. Growth in this segment signals the importance of spray sunscreens and their acceptance as a key tool in consumer-driven, UV-related skin protection.

Within the healthcare products universe, compliance is king. After all, a product not taken as intended stands to be a potentially ineffective treatment.

Product compliance is also an issue for the antifungals market, where effective treatment commonly extends well beyond the subsidence of symptoms. In a market where almost one quarter of the population suffers from nail fungus^7,8, athletes foot⁹ or both, effective and easy-to-use product forms are essential for productive self-care. Standard product treatment forms such as antifungal powders can be messy and embarrassing and creams can be difficult to administer, especially for the elderly, diabetics and those with generally limited mobility. The introduction of spray treatments has dramatically improved the product experience, increasing patient application “reach” by projecting the product toward the infected area, while concurrently eliminating the telltale signs of antifungal powder residue on clothing, shoes and hosiery. Additional relief of pain and discomfort is also realized through the cooling attributes many spray antifungals offer, further demonstrating the benefits that aerosols can play in lowering the boundaries to use and compliance.

The list of other healthcare aerosols delivering high consumer value is plentiful and includes other examples such as monoxidil foam, which allows deep penetration of actives into the hairline in an easy-to-apply foam. Topical analgesic sprays offer continuous, spray-any-angle, targeted application of product, even in hard to reach places; nasal spray, which, with its gentle BOV mist, can be formulated preservative free and sterilized in a hermetically sealed package, helping to alleviate preservative resistance in users. Examples such as these demonstrate that aerosols and pressurized package systems can play a key role in product innovation and have meaningful impact on ease-of-use, leading to lower barriers to product compliance.

The consumer value associated with aerosols has been understood for over 70 years. In an age where consumers are increasingly taking a selfcare approach to health care, aerosols and other pressurized package innovations can offer a host of benefits that aid the user in overcoming the obstacles to effective compliance while increasing overall satisfaction and desirability.

What does the future hold for aerosols in healthcare? Imagine applications that include gentle mist moisturizing sprays for ocular applications, low drag ultra-cooling products for hemorrhoids, mediated haircare for deep penetration of actives without the need for water, and luxurious, fast rub-in whipped lotions for enhanced derma applications. The opportunities are endless. SPRAY

^1. Sabaté E, editor., ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003
^2. https://thesocietypages.org/socimages/2012/02/21/the-development-of-oral-contraceptive-packaging/
^3. Cancer Facts and Figures 2017. American Cancer Society. http://www.cancer.org/ acs/groups/content/@editorial/documents/document/acspc-048738.pdf. Accessed January 10, 2017.
^4. Parkin DM, Mesher D, Sasieni P. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer 2011; 105:S66-S69.
^5. National Cancer Institute. Cancer Trends Progress Report: UV Exposure and Sun Protective Practices. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human
^6. Holman DM, Berkowitz Z, Guy GP Jr, Hartman AM, Perna FM. The association between demographic and behavioral characteristics and sunburn among U.S. adults—National Health Interview Survey, 2010. Preventive Medicine 2014;63:6–12. Services.
^7. Haneke E, Roseeuw D (1999) The scope of onychomycosis: epidemiology and clinical features. Int J Dermatol 38Suppl 2: 7–12
^8. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, et al. (2000) A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 43: 641–648
^9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907807/