Peak Inspiratory Flow Rate: An Emerging Biomarker in Chronic Obstructive Pulmonary Disease

Mahler, Donald A.

doi:10.1164/rccm.201901-0005le

Cited by 17 publications

(24 citation statements)

References 8 publications

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“…75 A suboptimal PIFR (<60 L/min) can identify patients who are more likely to have a less than favorable response to a DPI versus those with an optimal PIFR (≥60 L/min). 76 Suboptimal PIFR has been demonstrated in 19-78% of outpatients and 32-52% of inpatients before discharge from the hospital after treatment. 23,[77][78][79] Two randomized controlled trials showed that patients with severe to very severe COPD and a suboptimal PIFR had greater improvements in lung function with a nebulized bronchodilator versus a DPI.…”

Section: Discussionmentioning

confidence: 98%

<p>Nebulized Therapies in COPD: Past, Present, and the Future</p>

Barjaktarevic,

Milstone

2020

COPD

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Current guidelines recommend inhalation therapy as the preferred route of drug administration for treating patients with chronic obstructive pulmonary disease (COPD). Inhalation devices consist of nebulizers and handheld inhalers, such as dry-powder inhalers (DPIs), pressurized metered-dose inhalers (pMDIs), and soft mist inhalers (SMIs). Although pMDIs, DPIs and SMIs may be appropriate for most patients with COPD, certain patient populations may have challenges with these devices. Patients who have cognitive, neuromuscular, or ventilatory impairments (and receive limited assistance from caregivers), as well as those with suboptimal peak inspiratory flow may not derive the full benefit from handheld inhalers. A considerable number of patients are not capable of producing a peak inspiratory flow rate to overcome the internal resistance of DPIs. Furthermore, patients may have difficulty coordinating inhalation with device actuation, which is required for pMDIs and SMIs. However, inhalation devices such as spacers and valved holding chambers can be used with pMDIs to increase the efficiency of aerosol delivery. Nebulized treatment provides patients with COPD an alternative administration route that avoids the need for inspiratory flow, manual dexterity, or complex hand-breath coordination. The recent approval of two nebulized long-acting muscarinic antagonists has added to the extensive range of nebulized therapies in COPD. Furthermore, with the availability of quieter and more portable nebulizer devices, nebulization may be a useful treatment option in the management of certain patient populations with COPD. The aim of this narrative review was to highlight recent updates and the treatment landscape in nebulized therapy and COPD. We first discuss the pathophysiology of patients with COPD and inhalation device considerations. Second, we review the updates on recently approved and newly marketed nebulized treatments, nebulized treatments currently in development, and technological advances in nebulizer devices. Finally, we discuss the current applications of nebulized therapy in patients with COPD.

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Section: Discussionmentioning

confidence: 98%

<p>Nebulized Therapies in COPD: Past, Present, and the Future</p>

Barjaktarevic,

Milstone

2020

COPD

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“…Previously, concerns have been raised regarding the efficacy of treatments delivered through DPIs in patients with COPD who achieve a PIF <60 L/min, with or without device-specific resistance based on trials and retrospective analyses with small sample sizes. 6 , 8 , 9 , 15 , 32 For example, in one study of 123 patients hospitalized and in an acute exacerbation of COPD care plan, 52% had PIF of <60 L/min in the absence of resistance and these patients had high rates of 90-day readmission for COPD, days to all-cause mortality, and days to COPD readmissions 32 However, a recent study comparing the PIF generated from patients with moderate-to-very-severe COPD through three types of DPI, found that patients produced mean PIF values ≥60 L/min for two of the three DPIs tested, with values of 108±23 and 78±15 L/min recorded for the Breezhaler and the ELLIPTA, respectively. This provides further support that patients using ELLIPTA are able to achieve a PIF that should not negatively impact the effectiveness of inhalation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Although threshold spirometry and inhaler-specific PIF values are yet to be fully determined, a PIF value of ≥60 L/min is often described as “optimal” for most DPIs to ensure medication de-aggregation and lower respiratory tract disposition. 6 , 8 , 9 , 15 However, based on the findings of in vitro and small-scale observational studies, minimum and optimal inhaler-specific PIF values ranging from 20 to 50 L/min and from 30 to 65 L/min, respectively, have also been reported for different DPIs. 9 , 16 , 17 The majority (87–100%) of patients with stable COPD or who have experienced an acute COPD exacerbation can achieve an inhaler-specific PIF ≥30 L/min.…”

Section: Introductionmentioning

confidence: 99%

Peak Inspiratory Flow Rate in COPD: An Analysis of Clinical Trial and Real-World Data

Anderson¹,

Collison²,

Drummond³

et al. 2021

COPD

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Background The influence of peak inspiratory flow (PIF) on dose delivery from dry powder inhalers (DPIs) and association with treatment efficacy in patients with chronic obstructive pulmonary disease (COPD) has not been fully determined. In vitro studies have demonstrated adequate dose delivery through ELLIPTA DPI at PIF ≥30 L/min. This analysis of two clinical trials and a real-world population of COPD patients determined spirometric PIF distribution, and explored the relationship between PIF and outcomes in the trials. Methods The replicate Phase IV, 12-week, randomized, double-blind 207608/207609 (NCT03478683/NCT03478696) trials evaluated fluticasone furoate/umeclidinium/vilanterol via ELLIPTA DPI versus budesonide/formoterol+tiotropium in COPD patients. This post hoc analysis assessed spirometric PIF distribution at screening and relationship between PIF and lung function outcomes in the pooled 207608/207609 population. Spirometric PIF distributions in a real-world population of COPD patients were evaluated by retrospective analysis of the Kaiser Permanente Northwest (KPNW) database to assess similarities between clinical trial and real-world populations. Results A total of 1460 (207608/207609) and 3282 (KPNW) patients were included. There was considerable overlap between spirometric PIF distributions for both populations. Overall, 99.7% and 99.8% of the 207608/207609 and KPNW populations, respectively, reported spirometric PIF ≥50 L/min, estimated as equivalent to ELLIPTA PIFR ≥30 L/min. In the 207608/207609 combined analysis, there was no significant interaction between spirometric PIF and treatment for lung function endpoints, indicating treatment effect is independent of PIF. Conclusion Nearly all COPD patients in the 207608/207609 and KPNW populations achieved spirometric PIF values estimated as equivalent to PIFR of ≥30 L/min through the ELLIPTA DPI. Lack of correlation between spirometric PIF at screening and treatment efficacy aligns with consistent dose performance from the ELLIPTA DPI across a wide range of PIFs, achieved by patients with COPD of all severities.

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“…The routine spirometry test assesses the inspiratory as well expiratory efforts of the patient and gives parameters, graphs for both these efforts. 1 The Peak inspiratory flow rate (PIFR) measured from forced inspiratory maneuver is used for various purposes in clinical practice. PIFR is a good index of a patient's inspiratory effort as it measures the patient's capacity to generate adequate flow during inspiration.…”

Section: Introductionmentioning

confidence: 99%

Study of inspiratory lung function parameters in Indian children

Kale

Deshpande

Thatkar³

et al. 2021

Int J Res Med Sci

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Background: The inspiratory parameters of pulmonary function test commonly used for various purposes in clinical practice including diagnosing airway obstruction. Expiratory portion of the flow volume loop of the pulmonary function test is studied in detail. The prediction equations for expiratory parameters are available for different population. However, the reference equation for inspiratory parameters is not available in Indian context. The current study derived the prediction equation for inspiratory parameters of pulmonary function test.Methods: The current study was carried out in school going 732 healthy girls and 1377 boys aged 6-15 years in India. The children who meet the inclusion criteria were recruited in the study after detailed medical examination by registered medical practitioner. The lung function parameters were recorded by spirometry. The multivariate regression analysis was done to develop the prediction model.Results: The prediction equation for predicting inspiratory parameter were developed. This study revealed gender-wise and geographical variation in the inspiratory parameters. Hence this study recommends to derive gender wise prediction equations. The reference equations derived in this study can be used in population with similar background.Conclusions: Use of these equations for population having similar backgrounds will help for early and accurate diagnosis of the airway abnormalities in children. The inspiratory parameter assessment shall be included in the routine assessment of respiratory patient.

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Peak Inspiratory Flow Rate: An Emerging Biomarker in Chronic Obstructive Pulmonary Disease

Cited by 17 publications

References 8 publications

<p>Nebulized Therapies in COPD: Past, Present, and the Future</p>

<p>Nebulized Therapies in COPD: Past, Present, and the Future</p>

Peak Inspiratory Flow Rate in COPD: An Analysis of Clinical Trial and Real-World Data

Study of inspiratory lung function parameters in Indian children

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