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Observational Study
. 2019 Mar 1:14:585-595.
doi: 10.2147/COPD.S195438. eCollection 2019.

Prevalence and factors associated with suboptimal peak inspiratory flow rates in COPD

Sohini Ghosh  1 , Roy A Pleasants  2 , Jill A Ohar  3 , James F Donohue  1 , M Bradley Drummond  1
Affiliations
Observational Study

Prevalence and factors associated with suboptimal peak inspiratory flow rates in COPD

Sohini Ghosh et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Adequate peak inspiratory flow rate (PIFR) is required for drug dispersion with dry powder inhalers (DPIs). Prevalence of PIFR discordance (suboptimal PIFR with prescribed inhalers) and factors influencing device-specific PIFR are unclear in COPD. The objective of this study was to determine the prevalence of PIFR discordance and associated clinical factors in a stable COPD population.

Patients and methods: An observational, single-center, cohort study was conducted including 66 outpatients with COPD. PIFR was measured using the In-Check™ Dial with applied resistance of prescribed inhalers. Participants were defined as discordant if measured PIFR was <30 L/min and <60 L/min for high and low-medium resistance devices, respectively, using an inspiratory effort the participant normally used with their prescribed DPI.

Results: The median age of the COPD participants was 69.4 years, 92% were white and 47% were female. A total of 48% were using low-medium resistance DPIs (Diskus®/Ellipta®) and 76% used high-resistance DPI (Handihaler®). A total of 40% of COPD participants were discordant to prescribed inhalers. Female gender was the only factor consistently associated with lower PIFR. Shorter height was associated with reduced PIFR for low-medium resistance (r=0.44; P=0.01), but not high resistance (r=0.20; P=0.16). There was no correlation between PIFR by In-Check™ dial and PIFR measured by standard spirometer.

Conclusion: PIFR is reduced in stable COPD patients, with female gender being the only factor consistently associated with reduced PIFR. Discordance with prescribed inhalers was seen in 40% of COPD patients, suggesting that many COPD patients do not generate adequate inspiratory force to overcome prescribed DPIs resistance in the course of normal use.

Keywords: chronic obstructive; drug delivery systems; dry powder inhaler; peak inspiratory flow rate; pulmonary disease.

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Conflict of interest statement

Disclosure RAP has research support from Boehringer-Ingelheim and GlaxoSmithKline, served on Advisory Board for GlaxoSmithKline and Teva, has served as speaker for AstraZeneca and Sunovion, and served on Data Safety Monitoring Board for Grifols. JAO has performed advisory consulting for Boehringer-Ingelheim, GlaxoSmithKline, Theravance, Novartis, and AstraZeneca. She also has an investigator-initiated research grant from Sunovion. JFD has served as advisor to AZ, GSK, Novartis, Mylan, Sunovion, and Theravance. MBD has performed advisory consulting for Boehringer-Ingelheim, GlaxoSmithKline, and AstraZeneca. There were no funders, thus no funders had a role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; and in the decision to publish the results. SG reports no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Percentage of patients within bins of peak inspiratory flow (PIFR), measured against R2 low–medium resistance inhaler (eg, Diskus® and Ellipta®; blue) and R5 high resistance inhaler (Handihaler®; orange).
Figure 2
Figure 2
Distribution of patients with suboptimal peak inspiratory flow (PIFR) stratified by Global Initiative for Obstructive Lung Disease (GOLD) FEV1 severity stage, measured against R2 low–medium resistance inhaler (eg, Diskus® and Ellipta®; blue; suboptimal PIFR <60 L/min) and R5 high resistance inhaler (Handihaler®; orange; suboptimal PIFR <30 L/min).
Figure 3
Figure 3
Repeatability of peak inspiratory flow rate (PIFR) from baseline to 2–4 weeks, measured against R2 low–medium resistance inhaler (eg, Diskus® and Ellipta®; blue dashed line) and R5 high resistance inhaler (Handihaler®; orange solid line).
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