Suboptimal Peak Inspiratory Flow, COPD Exacerbations, Hospitalisations, and Disease Burden: A Longitudinal Follow-Up in a Multicentre Real-World Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Peak Inspiratory Flow (PIF) is a critical determinant of dry powder inhaler (DPI) effectiveness in managing patients with Chronic Obstructive Pulmonary Disease (COPD). Suboptimal PIF may compromise drug delivery and clinical outcomes. Objective To evaluate the association between repeated PIF measures and disease exacerbations, hospitalisations, and symptom burden in patients with stable COPD. Methods In this multi-country, observational cohort, 415 participants aged ≥40 years with confirmed COPD and a smoking history underwent PIF measurements at their prescribed inhaler's resistance, and low-, and high-resistance levels using the In-Check DIAL G16. Clinical assessments occurred at 3 months (Follow-Up 1, FU1) and 6 months (Follow-Up 2, FU2) including spirometry, COPD Assessment Test (CAT) scores, medication use, and exacerbation/hospitalisation rates. Results At FU1, 29.4% (n=113/384) had typical suboptimal PIF and 28.6% (n=108/377) remained suboptimal at FU2. Participants with suboptimal PIF were more often female and current smokers, with consistently poorer lung function across both visits: lower FEV1 (% predicted: 33.7±9.1% versus 45.7±9.2%, p=0.01), actual FVC and inspiratory capacity were observed. Suboptimal PIF significantly predicted moderate (p=0.03) and severe (p=0.01) exacerbations, was associated with higher hospitalisation risks (p=0.05), and with greater use of short-acting beta agonist, oral corticosteroid, and triple therapy. Conclusions Suboptimal PIF is a stable, clinically meaningful marker of worse COPD outcomes and may guide more personalised inhaler selection.
Source: ERJ Open Research
Authors: Valeria Perugini, Chin Kook Rhee, Ji-Yong Moon, Tiew Pei Yee, Seung Won Ra, Pietro Pirina, Kwang Ha Yoo, Bernardino Alcázar Navarrete, Caroline Gouder, Virginia Almadana Pacheco, Annie Navarro-Rolon, Matevž Harlander, Thérèse S. Lapperre, Chee Hong Loh, Naval Elsa, Marc Miravitlles, Omar Usmani
Institutions: Respiratory Effectiveness Group, Konkuk University, Konkuk University Medical Center, Singapore General Hospital, University of Ulsan, Ulsan University Hospital, University of Sassari, Universidad de Granada, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario Virgen de las Nieves, Mater Dei Hospital, Hospital Universitario Virgen Macarena, Fundació Hospital Sant Joan de Déu de Martorell, Ljubljana University Medical Centre, University of Antwerp, Antwerp University Hospital, Changi General Hospital, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Royal Brompton Hospital, St Mary's Hospital, Imperial College London
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $808
Funder: Boehringer Ingelheim
Award: G2205560907
OpenAlex ID: W7165951234
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