Late Breaking Abstract - Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy

Abstract

<b>Background:</b> Critical factors determining the effectiveness of COPD maintenance therapy with DPIs are poorly known. <b>Aim:</b> To determine associations of COPD health status &amp; exacerbations with peak inspiratory flow (PIF), inhalation technique and medication adherence. <b>Methods:</b> Cross-sectional observational study in the Netherlands, Spain, Portugal, Greece, Poland &amp; Australia in COPD patients (≥40yrs) on maintenance DPI therapy for ≥3 months. Typical PIF at resistance of patient’s DPI, health status (Clinical COPD Questionnaire), adherence (Test of Adherence to Inhalers) &amp; inhalation technique (video recording rated for errors) were assessed. Exacerbation frequency for previous 12 months was collected. Multilevel regression outcomes with 95% CI and p value are reported. <b>Results:</b> 1434 patients were included (69 ± 9yrs, 50% male). 29% of patients exhibited suboptimal PIF. Compared with optimal PIF, suboptimal PIF was associated with worse CCQ score (0.21 [CI-0.10, 0.33], p&lt;0.001) and increased exacerbation rates (0.75 [0.60, 0.94], p=0.01). 51% of patients exhibited at least one critical inhalation error. Based on association with CCQ, 3 critical errors were identified: Not sealing teeth &amp; lips around mouthpiece (0.21 [0.05, 0.36], p=0.01); Not inhaling strongly/calmly and deeply (0.234 [0.126, 0.343]; p&lt;0.001); Not breathing out calmly after inhaling (0.30 [0.04, 0.56], p=0.03). CCQ score did not differ between adherent (56%) and non-adherent patients (-0.001 [-0.11, 0.11], p=0.98). <b>Conclusion:</b> Suboptimal PIF is associated with poorer health status and more exacerbations. PIF could be important for inhaler selection. Inhalation technique should be assessed at every opportunity to optimize therapy.