1. Determination of the preferred tongue position for optimal inhaler use
Takahiko Horiguchi, MD, PhD, Rieko Kondo, MD, PhD 
The Journal of Allergy and Clinical Immunology: In Practice 
Volume 6, Issue 3, Pages e3 (May 2018)
DOI: /j.jaip
Copyright © 2018 The Authors Terms and Conditions

2. Figure 1
Effect of lowering the tongue on tracheal drug deposition using a DPI. With the tongue lowered (upper-right panel), a larger proportion of the powder was carried toward the trachea and beyond (lower-right panel). DPI, Dry powder inhaler.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

3. Figure 2
Quantitative analysis of drug deposition in the pharyngeal region when the tongue is lowered during pMDI use. Areas proximal to the larynx with a homogeneous background were selected (closed boxes). After grayscale conversion, the mean pixel intensity was analyzed using Image J. The selected region appeared significantly whiter when the tongue was lowered, indicating increased aerosol deposition. pMDI, Pressurized metered dose inhaler.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

4. Figure E1
Endoscopic positioning. The endoscope was inserted immediately in front of the pharynx.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

5. Figure E2
Peak powder appearance images of drug deposition using a DPI. The left panel shows deposition without the tongue lowered. A large amount of powder is deposited on the tongue. With the tongue lowered (right panel), a larger proportion of the powder reached the pharyngeal region (NB, the tongue is not visible in this image). DPI, Dry powder inhaler.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

6. Figure E3
Quantitative analysis of peak powder appearance images of drug deposition using a DPI. With the tongue lowered, the proportion of areas covered with the powder was significantly higher. DPI, Dry powder inhaler.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

7. Figure E4
Peak aerosol appearance images of drug deposition using a pMDI. With the tongue lowered, a larger proportion of the aerosol reached the pharynx (right panel). pMDI, Pressurized metered dose inhaler.
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions

8. Figure E5
Flow of medication to the pharyngeal region using 2 different tongue positions (Flutiform training inhaler).
The Journal of Allergy and Clinical Immunology: In Practice 2018 6, e3DOI: ( /j.jaip )
Copyright © 2018 The Authors Terms and Conditions