Correlation between Hand Grip Strength and Peak Inspiratory Flow Rate in Patients with Stable Chronic Obstructive Pulmonary Disease.

Abstract

Optimal peak inspiratory flow rate (PIFR) is required for effective drug delivery to distal airways when using dry powder inhalers (DPIs). This study aimed to examine the association between PIFR and hand grip strength (HGS) in stable COPD patients. A cross-sectional study was conducted. PIFR was measured using the In-check DIAL to assess for Accuhaler and Turbuhaler DPIs. HGS was measured using a handheld dynamometer. A PIFR of <60 L/min was considered suboptimal PIFR. Demographics, clinical data, and spirometric data were collected and compared. Eighty-one patients (86% men) were included. Mean age was 73.3 ± 8.9 years. FEV1 was 65.3 ± 23.7%. The prevalence of suboptimal PIFR was 38% and 59% for Accuhaler and Turbuhaler, respectively. HGS in the suboptimal PIFR group was lower than in the optimal PIFR group for Accuhaler (22.8 ± 4.7 vs. 33.2 ± 6.9 kg, p < 0.001) and for Turbuhaler (25.3 ± 6.4 vs. 35.1 ± 6.3 kg, p < 0.001). The equation for predicted Accuhaler PIFR (L/min) was -30.340 + (0.274 × hand grip strength) - (0.206 × age) + (0.219 × height) + (1.019 × FVC). The equation for predicted Turbuhaler PIFR (L/min) was 56.196 + (0.321 × hand grip strength) - (0.196 × female) - (0.224 × age) + (0.304 × FVC). The best cutoff values of HGS for predicting optimal PIFR in Accuhaler and Turbuhaler were 26.8 kg (with 82% sensitivity and 84% specificity) and 31.9 kg (with 79% sensitivity and 90% specificity), respectively. In conclusion, HGS correlated with PIFR in patients with clinically stable COPD, especially in the group with pronounced symptoms without frequent exacerbations. HGS threshold values associated with suboptimal PIFR were identified. HGS may be used as an alternative tool to assess an optimal inspiratory force for DPIs.