Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers

Abstract

The study aimed to determine the associations of Peak Inspiratory Flow (PIF), inhalation technique and adherence with health status and exacerbations in participants with COPD using DPI maintenance therapy. This cross-sectional multi-country observational real-world study included COPD participants aged ≥40 years using a DPI for maintenance therapy. PIF was measured three times with the In-Check DIAL G16: (1) typical PIF at resistance of participant’s inhaler, (2) maximal PIF at resistance of participant’s inhaler, (3) maximal PIF at low resistance. Suboptimal PIF (sPIF) was defined as PIF lower than required for the device. Participants completed questionnaires on health status (Clinical COPD Questionnaire (CCQ)), adherence (Test of Adherence to Inhalers (TAI)) and exacerbations. Inhalation technique was assessed by standardised evaluation of video recordings. Complete data were available from 1434 participants (50.1% female, mean age 69.2 years). GOLD stage was available for 801 participants: GOLD stage I (23.6%), II (54.9%), III (17.4%) and IV (4.1%)). Of all participants, 29% had a sPIF, and 16% were shown able to generate an optimal PIF but failed to do so. sPIF was significantly associated with worse health status (0.226 (95% CI 0.107–0.346), worse units on CCQ; p = 0.001). The errors ‘teeth and lips sealed around mouthpiece’, ‘breathe in’, and ‘breathe out calmly after inhalation’ were related to health status. Adherence was not associated with health status. After correcting for multiple testing, no significant association was found with moderate or severe exacerbations in the last 12 months. To conclude, sPIF is associated with poorer health status. This study demonstrates the importance of PIF assessment in DPI inhalation therapy. Healthcare professionals should consider selecting appropriate inhalers in cases of sPIF.

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

“…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).…”

“…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).…”

“…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.…”

“…In many studies, the exacerbation rates were based on patient recall rather than being derived from medical records, and it was not clear how patients were selected for inclusion. Only the PIFotal COPD study23 27 28 was considered of good quality (table 2).…”

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

“…In a cross-sectional multicountry observational real-world study by Kocks et al [6 ▪ ], participants aged ≥40 years with COPD using a DPI for maintenance therapy were included. PIF was measured three times with the In-Check DIAL G16: typical PIF at resistance of participant's inhaler, maximal PIF at resistance of participant's inhaler, maximal PIF at low resistance.…”