Figure 1.

The exhalation delivery system (EDS).Source: Palmer JN, Jacobson KW, Messina JC, Kosik-Gonzalez C, Djupesland PG, Mahmoud RA. EXHANCE-12: 1-year study of the exhalation delivery system with fluticasone (EDS-FLU) in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018;00:1–8.

• The EDS has a flexible mouthpiece and a nosepiece. The sealing nosepiece is shaped to transfer pressure from the mouth, to avoid compression of soft tissue in a way that could obstruct air flow, and to “stent” the nasal valve, particularly superiorly.
• Exhalation through the EDS (1) creates an airtight seal of the soft-palate, isolating the nose from the mouth and lungs, (2) transfers proportional air pressure into the nose, and (3) helps “float” medication around obstructions to high/deep sites in the nasal labyrinth, such as the OMC.
• The transferred intranasal pressure is proportional, across various exhalation forces, to oral pressure, counterbalancing pressure on the soft palate. This assures a patent communication behind the nasal septum and allows air to escape through the opposite nostril. “Positive-pressure” expands passages narrowed by inflammation (versus negative pressure delivery, “sniffing”).
• Use is simple and quick. A patient inserts the nosepiece into one nostril and starts blowing through the mouthpiece. This elevates and seals the soft palate, as with inflating a balloon, separating the oral and nasal cavities. The patient completes use by pressing the bottle to actuate. This causes a coordination-reducing valve to release the exhaled breath concurrently with aerosol spray in a “burst” of naturally humidified air.
• Additional information related to the EDS device can be found at https://www.optinose.com/exhalation-delivery-systems/technical-overview.