Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Marika Leving, Sinthia Bosnic-Anticevich, Joyce van Cooten, Jaime Correia de Sousa, Biljana Cvetkovski, Richard Dekhuijzen, Lars Dijk, Marina Garcia Pardo, Asparuh Gardev, Radosław Gawlik, Iris van der Ham, Ymke Janse, Federico Lavorini, Tiago Maricoto, Jiska Meijer, Boyd Metz, David Price, Miguel Román-Rodríguez, Kirsten Schuttel, Nilouq StokerIoanna Tsiligianni, Omar Usmani, Omar Usmani, Janwillem Kocks* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health status, and thereby identifying critical errors, key clinical recommendations for primary care clinicians were determined, namely – measure PIF before prescribing a DPI to ensure inhalation manoeuvre ability is well-matched with the device.
Some patients could benefit from inhalation training whereas others should have their DPI changed for one better suited to their inspiratory ability or alternatively be prescribed an active device (such as a soft mist inhaler or pressurized metered dose inhaler). Observing the inhalation technique was valuable however this misses sub-optimal PIF (approaching one fourth of patients with a satisfactory observed manoeuvre had a suboptimal PIF for their DPI). Assess adherence as deliberate non-adherence can point to a mismatch between a
patient and their inhaler (deliberate non-adherence was significantly associated with PIFs below the minimum for the DPI). In-person observation of inhalation technique was found to be inferior to video rating based on device-specific checklists. Where video assessments are not possible, observation training for healthcare professionals would therefore be valuable particularly to improve the ability to identify the critical errors associated with health status namely ‘teeth and lips sealed around mouthpiece’, ‘breathe in’ and ‘breathing out calmly
after inhalation’. However, it is recommended that observation alone should not replace PIF measurement in the DPI selection process.
Original languageEnglish
Article number59
Number of pages8
Journalnpj Primary Care Respiratory Medicine
Publication statusPublished - 27 Dec 2022


  • Chronic airways disease
  • primary care
  • respiratory medicine
  • dry power inhalers


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