Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs

Leving, Marika T.; Boven, Job F M van; Bosnic‐Anticevich, Sinthia; Cooten, Joyce van; Sousa, Jaime Correia de; Cvetkovski, Biljana; Dekhuijzen, Richard; Dijk, Lars; Pardo, Marina García; Gardev, Asparuh; Gawlik, Radosław; Ham, Iris van der; Hartgers-Gubbels, Elisabeth Sophia; Janse, Ymke; Lavorini, Federico; Maricoto, Tiago; Meijer, Jiska; Metz, Boyd; Price, David; Román-Rodríguez, Miguel; Schuttel, Kirsten; Stoker, Nilouq; Tsiligianni, Ioanna; Usmani, Omar; Kocks, Janwillem

doi:10.2147/copd.s380736

Cited by 9 publications

(15 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1091 abstracts were eliminated, leaving 55 full-text articles for review in detail. Among these articles, 36 did not contain information about associations between errors and outcomes or were review articles, resulting in a total of 19 publications that were included in this review5 11–28 (table 1).…”

Section: Resultsmentioning

confidence: 99%

“…10 retrospective case–controlled studies, reported in 12 publications, compared the characteristics of patients who made and who did not make errors using their inhalers (table 1). 5 12 14 15 17 18 20 22 23 25 27 28 These included larger numbers of patients than the prospective studies. Three publications23 27 28 reported different outcomes from the same study (The PIFotal COPD study).…”

Section: Resultsmentioning

confidence: 99%

“…5 12 14 15 17 18 20 22 23 25 27 28 These included larger numbers of patients than the prospective studies. Three publications23 27 28 reported different outcomes from the same study (The PIFotal COPD study). In all of these studies it is impossible to determine cause and effect, and only the PIFotal COPD study accounted for the effect of adherence.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Halpin,

Mahler

2024

BMJ Open Resp Res

View full text Add to dashboard Cite

BackgroundErrors using inhaled delivery systems for COPD are common and it is assumed that these lead to worse clinical outcomes. Previous systematic reviews have included patients with both asthma and COPD and much of the evidence related to asthma. More studies in COPD have now been published. Through systematic review, the relationship between errors using inhalers and clinical outcomes in COPD, including the importance of specific errors, was assessed.MethodsElectronic databases were searched on 27 October 2023 to identify cohort, case–control or randomised controlled studies, which included patients with COPD, an objective assessment of inhaler errors and data on at least one outcome of interest (forced expiratory volume in 1 s, (FEV1), dyspnoea, health status and exacerbations). Study quality was assessed using the Newcastle and Ottawa scales. A narrative synthesis of the results was performed as there was insufficient detail in the publications to allow quantitative synthesis. There was no funding for the review.Results19 publications were included (7 cohort and 12 case–control) reporting outcomes on 6487 patients. 15 were considered low quality, and most were confounded by the absence of adherence data. There was weak evidence that lower error rates are associated with better FEV1, symptoms and health status and fewer exacerbations. Only one considered the effects of individual errors and found that only some were related to worse outcomes.ConclusionEvidence about the importance of specific errors using inhalers and outcomes would optimise the education and training of patients with COPD. Prospective studies, including objective monitoring of inhalation technique and adherence, are needed.PROSPERO registration numberCRD42023393120.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Halpin,

Mahler

2024

BMJ Open Resp Res

View full text Add to dashboard Cite

show abstract

“…A cross-sectional, multicountry study by Leving et al [8 ▪ ] including COPD patients using a DPI for maintenance therapy found that sPIF and inhalation technique errors were associated with higher COPD-related healthcare utilization and costs. PIF was measured with the In-Check DIAL G16, and sPIF was defined as a typical PIF lower than required for the device, which ranged from 15 to 60 l/min according to the DPI.…”

Section: Why Is Peak Inspiratory Flow Important?mentioning

confidence: 99%

Utility of peak inspiratory flow measurement for dry powder inhaler use in chronic obstructive pulmonary disease

Loh,

Ohar

2023

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

Purpose of review Every type of dry powder inhaler (DPI) device has its own intrinsic resistance. A patient's inspiratory effort produces a pressure drop that determines the inspiratory flow, depending on the inhaler's specific internal resistance. Optimal peak inspiratory flow (PIF) is needed for effective release of dry powder, disaggregation of drug-carrier agglomerates, and optimal deposition of respirable drug particles, particularly generation of a high fine-particle fraction to reach the small airways of the lungs. However, standardized recommendations for PIF measurements are lacking and instructions appeared vague in many instances. Recent findings Suboptimal PIFs are common in outpatient chronic obstructive pulmonary disease (COPD) patients and during acute exacerbations of COPD, and are associated with increased healthcare resource utilization. There is significant variation in the results of studies which is in part related to different definitions of optimal flow rates, and considerable variation in how PIF is measured in clinical and real-life studies. Summary Standardization of technique will facilitate comparisons among studies. Specific recommendations for PIF measurement have been proposed to standardize the process and better ensure accurate and reliable PIF values in clinical trials and clinical practice. Clinicians can then select and personalize the most appropriate inhaler for their patients and help them achieve the optimal PIF needed for effective drug dispersion.

show abstract

“…The PIFotal study revealed that inhalation technique errors were common and associated with worse health status 2 . In addition, a higher cumulative number of inhalation technique errors was associated with higher COPD-related healthcare costs 9 . These findings highlight the importance of correct DPI handling in managing COPD.…”

Section: Introductionmentioning

confidence: 99%

Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Leving

Bosnic‐Anticevich

Cooten

et al. 2022

npj Prim. Care Respir. Med.

Self Cite

View full text Add to dashboard Cite

Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health status, and thereby identifying critical errors, key clinical recommendations for primary care clinicians were determined, namely – measure PIF before prescribing a DPI to ensure inhalation manoeuvre ability is well-matched with the device. Some patients could benefit from inhalation training whereas others should have their DPI changed for one better suited to their inspiratory ability or alternatively be prescribed an active device (such as a soft mist inhaler or pressurized metered dose inhaler). Observing the inhalation technique was valuable however this misses suboptimal PIF (approaching one fourth of patients with a satisfactory observed manoeuvre had a suboptimal PIF for their DPI). Assess adherence as deliberate non-adherence can point to a mismatch between a patient and their inhaler (deliberate non-adherence was significantly associated with PIFs below the minimum for the DPI). In-person observation of inhalation technique was found to be inferior to video rating based on device-specific checklists. Where video assessments are not possible, observation training for healthcare professionals would therefore be valuable particularly to improve the ability to identify the critical errors associated with health status namely ‘teeth and lips sealed around mouthpiece’, ‘breathe in’ and ‘breathing out calmly after inhalation’. However, it is recommended that observation alone should not replace PIF measurement in the DPI selection process.Trial registration:https://clinicaltrials.gov/ct2/show/NCT04532853.

show abstract

Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs

Cited by 9 publications

References 43 publications

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Utility of peak inspiratory flow measurement for dry powder inhaler use in chronic obstructive pulmonary disease

Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Contact Info

Product

Resources

About