Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD.

Cristina Represas-Represas,Maribel Botana-Rial,Luz Aballe-Santos,Alberto Fernández-García,Almudena González-Montaos,Ana Priegue-Carrera,Alberto Fernández-Villar,José-Luis López-Campos

doi:10.3390/jcm9123949

Cristina Represas-Represas, Maribel Botana-Rial + Show 6 more

Open Access

https://doi.org/10.3390/jcm9123949

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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.

Highlights

Inhaled therapy currently constitutes one of the cornerstones in the treatment of patients with airway diseases
Performing a good inhalation technique with a dry powder devices involves correctly performing all the steps, and requires the patient to generate a sufficient inspiratory flow to guarantee the release of the medication from the device into their airways and for the drug to be released from the excipient [4]
This questionnaire included epidemiological data, the patient’s smoking status and cumulative consumption, and clinical data, including the degree of dyspnea according to the modified scale from the Medical Research Council, the number of exacerbations in the last year, and the number of inhalation devices (IDs) prescribed as maintenance treatment for chronic obstructive pulmonary disease (COPD)

Summary

Introduction

Inhaled therapy currently constitutes one of the cornerstones in the treatment of patients with airway diseases. To achieve an optimal therapeutic effect, patients must perform a correct inhalation technique. Carrying out inhalation correctly mainly depends on the patient completing all the steps described for performing this inhalation for each ID as well as avoiding critical errors [3]. Performing a good inhalation technique with a dry powder devices involves correctly performing all the steps, and requires the patient to generate a sufficient inspiratory flow to guarantee the release of the medication from the device into their airways and for the drug to be released from the excipient [4]

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Results

Conclusion