Ability of using different dry powder inhalers during COPD exacerbations

Papaioannou, Andriana Ι.; Herodotou, Yiolanda; Tomos, Ioannis; Apollonatou, Vasiliki; Verykokou, Galateia; Papathanasiou, Efthymia; Manali, Effrosyni D.; Loukides, Stelios; Papiris, Spyros

doi:10.1016/j.pupt.2017.12.007

Cited by 5 publications

(15 citation statements)

References 31 publications

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“…A study evaluating the necessary inspiratory flow using different DPIs in patients admitted to hospital during an AECOPD demonstrated the ability of patients to use these inhalers [ 42 ]. At admission, the median (interquartile range) of inspiratory flow (L/minutes) using the appropriate simulators of the resistance and the percentage of patients (%) achieving the minimum necessary inspiratory flow of 30 L/min required for each DPI device were 40 L/m (30–50) (91%), 50 L/m (40–60) (95%), 60 L/m (50–87.5) (100%), and 30 L/m (20–40) (82%) for Turbuhaler®, Diskus®, Aerolizer®, and Handihaler®, respectively [ 42 ]. This might open up the possibility of using long-acting β 2 agonists (LABA) for the treatment of AECOPD [ 43 ].…”

Section: Bronchodilatorsmentioning

confidence: 99%

Management of severe acute exacerbations of COPD: an updated narrative review

Crisafulli

Barbeta

Ielpo

et al. 2018

Multidiscip Respir Med

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BackgroundPatients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital.Main bodyIn this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD.ConclusionSeveral treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.

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Section: Bronchodilatorsmentioning

confidence: 99%

Management of severe acute exacerbations of COPD: an updated narrative review

Crisafulli

Barbeta

Ielpo

et al. 2018

Multidiscip Respir Med

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“…More details on data charting for all of the papers included in the systematic scoping review can be found in Supplementary Table S4. [11,17,21,22,25,28,30,32,34,3 5,44,47] Age ↑; PIF ↓ 1 (r ranging from −0.19 to −0.84; odds ratio ranging from 1.05 to 1.07) 5/17 (29%) [18,19,29,36,46] Gender 14/35 10/14 (71%) [16][17][18][19]22,26,32,35,36,47] Female gender; PIF ↓ 2 (odds ratio ranging from 0.28 to 2.41)…”

Section: Association Of Pif With Patient or Disease Characteristicsmentioning

confidence: 99%

“…4/14 (29%) [11,21,29,34] Height 11/35 8/11 (73%) [16][17][18][19]22,28,32,44] Height ↓; PIF ↓ 3 (r ranging from 0.26 to 0.44) 3/11 (27%) [11,25,35] Age ↑; PIF ↓ 1 (r ranging from −0.19 to −0.84; odds ratio ranging from 1.05 to 1.07) 5/17 (29%) [18,19,29,36,46] discussed or controlled for, thus scoring negatively.…”

Section: Association Of Pif With Patient or Disease Characteristicsmentioning

confidence: 99%

“…4/14 (29%) [11,21,29,34] In the studies included in this analysis, PIF refers to maximal inspiratory flow generated during a real or simulated inhaler maneuver. The cut-off for suboptimal/low and optimal PIF varied between studies (if reported).…”

Section: Association Of Pif With Patient or Disease Characteristicsmentioning

confidence: 99%

“…9 Nsour et al [51] noted a correlation between counseling and increased PIF but no statistical analysis was reported. 10 Represas-Represas et al [34] Pursed lip breathing 1/35 0/1 (0%) N/A 1/1 (100%) [38] LVEF 1/35 0/1 (0%) N/A 1/1 (100%) [11] Airway conductance 1/35 0/1 (0%) N/A 1/1 (100%) [42] Arterial pH, PO2/FiO2 1/35 0/1 (0%) N/A 1/1 (100%) [29] gender was no longer significant, suggesting that the impact of gender may be mediated by short stature [16]. For height, eight of the 11 papers (73%) evaluating an association with PIF found a positive correlation between shorter height and low PIF [16][17][18][19]22,28,32,44]; for the remaining three (27%), an association was not found [11,25,35].…”

Section: Association Of Pif With Patient or Disease Characteristicsmentioning

confidence: 99%

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Relationship between Peak Inspiratory Flow and Patient and Disease Characteristics in Individuals with COPD—A Systematic Scoping Review

et al. 2022

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Optimal delivery of medication via dry powder inhalers, the most commonly prescribed inhaler type, is dependent on a patient achieving a minimum level of inspiratory flow during inhalation. However, measurement of peak inspiratory flow (PIF) against the simulated resistance of a dry powder inhaler is not frequently performed in clinical practice due to time or equipment limitations. Therefore, defining which patient characteristics are associated with lower PIF is critically important to help clinicians optimize their inhaler choice through a more personalized approach to prescribing. The objective of this scoping review was to systematically evaluate patient and disease characteristics determining PIF in patients with chronic obstructive pulmonary disease (COPD). Medline, Cochrane and Embase databases were systematically searched for relevant studies on PIF in patients with COPD published in English between January 2000 and May 2021. The quality of evidence was assessed using a modified Grading of Recommendations Assessment, Development and Evaluation checklist. Of 3382 citations retrieved, 35 publications were included in the review (nine scored as high quality, 13 as moderate, nine as low, and four as very low). Factors correlating with PIF in >70% of papers included both patient characteristics (lower PIF correlated with increased age, female gender, shorter height, decreased handgrip and inspiratory muscle strength, and certain comorbidities) and disease characteristics (lower PIF correlated with markers of lung hyperinflation, lower peak expiratory flow [PEF] and increased disease severity). Other factors correlating with adequate/optimal or improved PIF included education/counseling and exercise/inspiratory muscle training; impaired physical function and errors in inhalation technique/non-adherence were associated with low/suboptimal PIF. In conclusion, clinicians should measure PIF against the simulated resistance of a particular device wherever possible. However, as this often cannot be done due to lack of resources or time, the patient and disease characteristics that influence PIF, as identified in this review, can help clinicians to choose the most appropriate inhaler type for their patients.

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