Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD

Abstract

Objective: Although the importance of assessing inspiratory flow in the selection of treatments for chronic obstructive pulmonary disease (COPD) is understood, evaluation of this factor is not yet widespread or standardized. The objective of the present work was to evaluate the peak inspiratory flow (PIF) of patients with COPD and to explore the variables associated with a suboptimal PIF. Methods: An observational, cross-sectional study was carried out at specialized nursing consultations over a period of 6 months. We collected clinical data as well as data on symptoms, treatment adherence, and patient satisfaction with their inhalers via questionnaires. PIF was determined using the In-Check Dial G16® device (Clement Clarke International, Ltd., Harlow, UK). In each case, the PIF was considered suboptimal when it was off-target for any of the prescribed inhalers. The association with suboptimal PIF was evaluated using multivariate logistic regression and the results were expressed as the odds ratio (OR) with 95% confidence interval (CI). Results: A total of 122 COPD patients were included in this study, of whom 34 (27.9%) had suboptimal PIF. A total of 229 inhalers were tested, of which 186 (81.2%) were dry powder devices. The multivariate analysis found an association between suboptimal PIF and age (OR = 1.072; 95% CI (1.019, 1.128); p = 0.007) and forced vital capacity (OR = 0.961; 95% CI (0.933, 0.989); p = 0.006). Conclusions: About a third of patients in complex specialized COPD care have suboptimal PIFs, which is related to age and forced vital capacity.

TRONARTO: A Randomized, Placebo-Controlled Study of Tiotropium/Olodaterol Delivered via Soft Mist Inhaler in COPD Patients Stratified by Peak Inspiratory Flow

“…This supports previous studies which have shown that female patients and older patients tend to have lower PIF. [7][8][9] Additionally, we noted a higher proportion of tall participants (>180 cm) in the PIF ≥60 L/min cohort than the PIF <60 L/min cohort, in line with previous studies that suggest an association between height and PIF. 8,34 Of note, there were more patients with severe COPD, according to GOLD classification, or a lower percent predicted FEV 1 in the PIF <60 L/min cohort.…”

“…5,6 The delivery and deposition of medication in the lungs by these devices is affected by both inhaler characteristics and patient-related factors, such as peak inspiratory flow (PIF). 6,7 DPIs, for example, require a PIF of >60 L/minute (low to medium-high resistance devices) 6,[8][9][10] to overcome the inhaler's internal resistance and separate the medicine from its carrier particles. [11][12][13][14] Duarte et al reported that as many as one in five ambulatory patients with COPD have suboptimal PIF.…”

Measuring Peak Inspiratory Flow in Patients with Chronic Obstructive Pulmonary Disease

“…7,8,12,[20][21][22][23][24]26,32,34,35, Reports of asthma studies (n = 30); review articles (n = 10); and non-English language articles, editorials, and articles involving healthy subjects or patients with other respiratory diseases; or reports from modeling/simulations (n = 48) were excluded. An additional seven articles were included from the authors' personal libraries; 33,[76][77][78][79][80][81] therefore, a total of 47 reports were included in the analysis.…”

Respimat as the new standard for inhalation therapy devices

“…Целый ряд исследований показал снижение эффективности порошковых ингаляторов у лиц с субоптимальным потоком на вдохе. В частности, у больных, не способных выполнить вдох с должным усилием, чаще отмечались обострения ХОБЛ [6,30,31].…”

“…Проблема усугубляется тем, что врач, наблюдая за выполнением вдоха, не может распознать больных с субоптимальным потоком на вдохе, а приборы, позволяющие измерить объемную скорость при вдохе через ингалятор, пока недоступны в нашей стране [5]. Больные ХОБЛ с субоптималым потоком на вдохе достоверно чаще совершают технические ошибки во время ингаляции, обострения у этих больных отмечаются почти в два раза чаще по сравнению с больными с оптимальным потоком [6]. Обучение не способно обеспечить увеличение потока на вдохе [7], так как причинами сниженного потока являются высокая гиперинфляция и снижение усилия дыхательной мускулатуры [5].…”