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Observational Study
. 2025 Sep 25;12(1):e002408.
doi: 10.1136/bmjresp-2024-002408.

Assessment of peak inspiratory flow in patients with chronic obstructive pulmonary disease: a multicentre, observational, prospective, real-life study

Valeria Perugini  1 , Chin Kook Rhee  2 , Ji-Yong Moon  3 , Tiew Pei Yee  4 , Seung Won Ra  5 , Pietro Pirina  6 , Kwang Ha Yoo  7 , Bernardino Alcázar Navarrete  8 , Caroline Gouder  9 , Almadana Pacheco  10 , Annie Navarro-Rolon  11 , Matevz Harlander  12 , Therese Lapperre  13 , Sean Chee Hong Loh  14 , David Fole  15 , Elsa Naval  16 , Pedro Jose Romero Palacios  17 , Marc Miravitlles  18 , Omar Usmani  19
Affiliations
Observational Study

Assessment of peak inspiratory flow in patients with chronic obstructive pulmonary disease: a multicentre, observational, prospective, real-life study

Valeria Perugini et al. BMJ Open Respir Res. .

Abstract

Introduction: Patients with chronic obstructive pulmonary disease (COPD) use dry powder inhalers (DPIs) for disease management. DPI effectiveness relies on the patient's peak inspiratory flow (PIF), which may not always be optimal. We conducted an observational multicentre, prospective, real-life cohort study to determine the prevalence of suboptimal PIF in patients with COPD.

Methods: 415 participants (11%, n=47 women, mean age=70±8.7 years, mean forced expiratory volume in 1 s (predicted %)=48.1%) recruited from 17 international centres had baseline PIF recorded with an In-Check Dial device at three resistance levels: (1) low, (2) high and (3) the participant's maintenance device. We also recorded PIF from participants as they would do at home to verify their proper inhalation technique. Participants underwent spirometry and completed questionnaires (COPD Assessment Test (CAT), Test of Adherence to Inhalers (TAI)-12).

Results: Of the 415 participants, 18% of DPI users (n=75) exhibited suboptimal values of PIF (as typical PIF <than what was required for tested inhalers in the study) when evaluated across DPI resistance groups ranging from low (R1) to high (R5) resistance, compared with 14% of participants (n=60) using devices without resistance (R0). Additionally, 14% of study participants were incapable of producing an optimal PIF or unwilling to do so (27%), impacting medication effectiveness. Participants with suboptimal PIF values had higher mean total CAT score (17.7±7) compared with those with optimal PIF values (12.1±7.6). When assessed globally, 37% (n=56) of participants with suboptimal PIF values did not adhere to treatment, highlighting the need for improved patient education and support.

Conclusion: Suboptimal PIF is common in COPD, requiring regular assessment and tailored inhalers.

Trial registration number: NCT04606394. Encepp EUPAS34689.

Keywords: COPD epidemiology; Inhaler devices.

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Conflict of interest statement

Competing interests: VP, TPY, SWR, PP, CG, AP, AN-R, TL, CHL, DF, EN, PRP: Declarations of interest: none. CKR: reports consulting/lecture fees from AstraZeneca, GSK, Novartis, Takeda, Mundipharma, Boehringer Ingelheim, Teva, Sanofi and Bayer, outside the submitted work. J-YM: reports consulting/lecture fees from AstraZeneca, GSK, Novartis, Boehringer Ingelheim, Sanofi, Organon, Daewon, Hanmi and Kolon, outside the submitted work. BAN: reports grants and personal fees from GSK, personal fees and/or non-financial support from Boehringer Ingelheim, Chiesi, Laboratorios Menarini, AstraZeneca, Gilead, MSD, Laboratorios BIAL, Sanofi, Zambon, outside the submitted work. KHY: received grant from pharmaceutical companies about the conduct of clinical trials in Asthma, COPD, Pneumonia including Amgen, Areteia Therapeutics, AZ, Bayer, Belluth Health, Boehringer Ingelheim, Chiesi, Genetech, GSK, MSD, Mundipharma, Novartis, Organon, Pfizar, Roche, Sanofi, TEVA, Ankook, Hanmi, Hyundai, Kolon. MH: received speaker or consulting fees from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, Chiesi, Novartis, Takeda and Teva, unrelated to the submitted manuscript. MM: has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Menarini, Kamada, Takeda, Zambon, CSL Behring, Specialty Therapeutics, Janssen, Grifols and Novartis, consulting fees from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim, BEAM Therapeutics, Chiesi, GlaxoSmithKline, CSL Behring, Ferrer, Inhibrx, Menarini, Mereo Biopharma, Spin Therapeutics, Specialty Therapeutics, ONO Pharma, Palobiofarma SL, Takeda, Novartis, Novo Nordisk, Sanofi, Zambon, Zentiva and Grifols and research grants from Grifols. OU: received research grants from AstraZeneca, Boehringer Ingelheim, Chiesi, GlazoSmithKline, consulting fees from AstraZeneca, Cipla, Mereo Biopharma and speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GalxoSmithKline, Mundipharma, Sandoz, Takeda, Cipla, Covis, Novartis, Orion, Menarini, UCB, Trudell Medical, Deva, Kamada.

Figures

Figure 1
Figure 1. Percentage of pMDIs, SMIs and DPIs used by the 415 participants enrolled in the study and percentage of those on DPIs based on the internal resistance of their inhaler device. DPI, dry powder inhaler; pMDI, pressurised metered-dose inhaler; SMI, soft mist inhaler.
Figure 2
Figure 2. Percentage of participants (N=267) (a) who ‘can and will do’, ‘can, but won’t do’ and ‘cannot do’ an optimal PIF. (b) Analysis of the three categories based on in-Check DIAL G16 device by the five internal resistance groups. PIF, peak inspiratory flow.
See this image and copyright information in PMC

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