Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers
Year: 2022
Type: article
Study design: Observational Study
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.
Authors: Janwillem W. H. Kocks, Hans Wouters, Sinthia Bosnic-Anticevich, Joyce van Cooten, Jaime Correia de Sousa, Biljana Cvetkovski, Richard Dekhuijzen, Lars Dijk, Evgeni Dvortsin, Marina Garcia Pardo, Asparuh Gardev, Radosław Gawlik, Iris van Geer - Postmus, Iris van der Ham, Marten Harbers, Alberto de la Hoz, Ymke Janse, Marjan Kerkhof, Federico Lavorini, Tiago Maricoto, Jiska Meijer, Boyd Metz, David Price, Miguel Roman-Rodriguez, Kirsten Schuttel, Nilouq Stoker, Ioanna Tsiligianni, Omar Usmani, Marika T. Leving
Institutions: University Medical Center Groningen, University of Groningen, General Practitioners Research Institute, Observational & Pragmatic Research Institute, The University of Sydney, Woolcock Institute of Medical Research, Sydney Local Health District, University of Minho, Radboud University Medical Center, Health Research Institute of the Balearic Islands, Boehringer Ingelheim (Germany), Medical University of Silesia, Azienda Ospedaliero-Universitaria Careggi, University of Beira Interior, University of Aberdeen, University of Crete, Royal Brompton Hospital, Imperial College London
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
Funders: Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi, Teva Pharmaceutical Industries, Chiesi Farmaceutici, Boehringer Ingelheim, Regeneron Pharmaceuticals, Covis Pharma, Respiratory Effectiveness Group, Mylan, Glenmark Pharmaceuticals, British Lung Foundation, AKL Research and Development, Sanofi Genzyme, Efficacy and Mechanism Evaluation Programme
OpenAlex ID: W4281565639