Physiological predictors of peak inspiRatory flow using Observed lung function results (POROS)

evaluation at discharge among patients hospitalized for a COPD exacerbation

David B. Price (Corresponding Author), Sen Yang, Simon Wan Yau Ming, Antony Hardjojo, Claudia Cabrera, Andriana I. Papaioannou, Stelios Loukides, Vicky Kritikos, Sinthia Z. Bosnic-Anticevich, Victoria Carter, Paul M. Dorinsky

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Abstract

Background: Peak inspiratory flow (PIF) as generated through the resistance of a dry powder inhaler (DPI) device is a critical patient-dependent maneuver impacting the success of DPI medication delivery. Despite its importance, it is not routinely measured in clinical practice. Little is currently known about the relationship, if any, between PIF through DPI devices, routine spirometry and disease outcomes. Aim: The aim of this study was to identify potential predictors of PIF for different DPIs from spirometric parameters and patient characteristics and explore the association between PIF and follow-up events. Patients and methods: A retrospective observational study at discharge among patients hospitalized for a COPD exacerbation at Attikon hospital, Athens, Greece. Spirometry was performed using an Easy on-PC™ spirometer. PIF was measured through four DPI resistances using the In-Check™ DIAL. Regression analyses were used to investigate the association between PIF through resistances and spirometric parameters obtained at discharge, comorbidities and demographic parameters. Results: Forty-seven COPD patients (mean [±SD], age 71 [±9] years, 72% males, 51% current smokers) were included in this study. Overall, 85% and 15% were classified as GOLD (2017) groups D and C, respectively. Most prevalent comorbidities were hypertension (70%) and cardiovascular disease (53%). In the final regression model, higher PIF was significantly associated with the following: higher FEV1 and % predicted peak expiratory flow (PEF) for Turbohaler® (R-squared value 0.374); higher FEV1 and diagnosis of gastroesophageal reflux disease (GERD) for Aerolizer® (R-squared value 0.209) and higher FEV1, younger age and diagnosis of ischemic heart disease (IHD) for Diskus® (R-squared value 0.350). However, R-squared values for all three devices were weak (<0.4). Conclusion: The study did not provide evidence to support the use of surrogate measurements for PIF through device resistance, which could assist in determining the appropriateness of inhaler device type. Although PIF measurement is feasible in patients at discharge and could be a valuable addition to the standard of care in COPD management, it needs to be measured directly.
Original languageEnglish
Pages (from-to)3937—3946
Number of pages10
JournalInternational journal of chronic obstructive pulmonary disease
Volume13
DOIs
Publication statusPublished - 13 Dec 2018

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Patient Discharge
Dry Powder Inhalers
Chronic Obstructive Pulmonary Disease
Equipment and Supplies
Lung
Spirometry
Comorbidity
Dilatation and Curettage
Nebulizers and Vaporizers
Greece
Standard of Care
Gastroesophageal Reflux
Observational Studies
Myocardial Ischemia
Cardiovascular Diseases
Retrospective Studies
Regression Analysis
Demography
Hypertension

Keywords

  • hospital admission
  • COPD
  • dry powder inhaler devices
  • inhaler technique
  • resistance
  • spirometry

Cite this

Physiological predictors of peak inspiRatory flow using Observed lung function results (POROS) : evaluation at discharge among patients hospitalized for a COPD exacerbation. / Price, David B. (Corresponding Author); Yang, Sen; Ming, Simon Wan Yau ; Hardjojo, Antony; Cabrera, Claudia; Papaioannou, Andriana I.; Loukides, Stelios; Kritikos, Vicky; Bosnic-Anticevich, Sinthia Z.; Carter, Victoria; Dorinsky, Paul M.

In: International journal of chronic obstructive pulmonary disease , Vol. 13, 13.12.2018, p. 3937—3946.

Research output: Contribution to journalArticle

Price, David B. ; Yang, Sen ; Ming, Simon Wan Yau ; Hardjojo, Antony ; Cabrera, Claudia ; Papaioannou, Andriana I. ; Loukides, Stelios ; Kritikos, Vicky ; Bosnic-Anticevich, Sinthia Z. ; Carter, Victoria ; Dorinsky, Paul M. / Physiological predictors of peak inspiRatory flow using Observed lung function results (POROS) : evaluation at discharge among patients hospitalized for a COPD exacerbation. In: International journal of chronic obstructive pulmonary disease . 2018 ; Vol. 13. pp. 3937—3946.
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abstract = "Background: Peak inspiratory flow (PIF) as generated through the resistance of a dry powder inhaler (DPI) device is a critical patient-dependent maneuver impacting the success of DPI medication delivery. Despite its importance, it is not routinely measured in clinical practice. Little is currently known about the relationship, if any, between PIF through DPI devices, routine spirometry and disease outcomes. Aim: The aim of this study was to identify potential predictors of PIF for different DPIs from spirometric parameters and patient characteristics and explore the association between PIF and follow-up events. Patients and methods: A retrospective observational study at discharge among patients hospitalized for a COPD exacerbation at Attikon hospital, Athens, Greece. Spirometry was performed using an Easy on-PC™ spirometer. PIF was measured through four DPI resistances using the In-Check™ DIAL. Regression analyses were used to investigate the association between PIF through resistances and spirometric parameters obtained at discharge, comorbidities and demographic parameters. Results: Forty-seven COPD patients (mean [±SD], age 71 [±9] years, 72{\%} males, 51{\%} current smokers) were included in this study. Overall, 85{\%} and 15{\%} were classified as GOLD (2017) groups D and C, respectively. Most prevalent comorbidities were hypertension (70{\%}) and cardiovascular disease (53{\%}). In the final regression model, higher PIF was significantly associated with the following: higher FEV1 and {\%} predicted peak expiratory flow (PEF) for Turbohaler{\circledR} (R-squared value 0.374); higher FEV1 and diagnosis of gastroesophageal reflux disease (GERD) for Aerolizer{\circledR} (R-squared value 0.209) and higher FEV1, younger age and diagnosis of ischemic heart disease (IHD) for Diskus{\circledR} (R-squared value 0.350). However, R-squared values for all three devices were weak (<0.4). Conclusion: The study did not provide evidence to support the use of surrogate measurements for PIF through device resistance, which could assist in determining the appropriateness of inhaler device type. Although PIF measurement is feasible in patients at discharge and could be a valuable addition to the standard of care in COPD management, it needs to be measured directly.",
keywords = "hospital admission, COPD, dry powder inhaler devices, inhaler technique, resistance, spirometry",
author = "Price, {David B.} and Sen Yang and Ming, {Simon Wan Yau} and Antony Hardjojo and Claudia Cabrera and Papaioannou, {Andriana I.} and Stelios Loukides and Vicky Kritikos and Bosnic-Anticevich, {Sinthia Z.} and Victoria Carter and Dorinsky, {Paul M.}",
note = "This study was supported by AstraZeneca. The abstract of this paper was presented at the American Thoracic Society International Conference 2017 as a poster presentation with interim findings.",
year = "2018",
month = "12",
day = "13",
doi = "10.2147/COPD.S174371",
language = "English",
volume = "13",
pages = "3937—3946",
journal = "International journal of chronic obstructive pulmonary disease",
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TY - JOUR

T1 - Physiological predictors of peak inspiRatory flow using Observed lung function results (POROS)

T2 - evaluation at discharge among patients hospitalized for a COPD exacerbation

AU - Price, David B.

AU - Yang, Sen

AU - Ming, Simon Wan Yau

AU - Hardjojo, Antony

AU - Cabrera, Claudia

AU - Papaioannou, Andriana I.

AU - Loukides, Stelios

AU - Kritikos, Vicky

AU - Bosnic-Anticevich, Sinthia Z.

AU - Carter, Victoria

AU - Dorinsky, Paul M.

N1 - This study was supported by AstraZeneca. The abstract of this paper was presented at the American Thoracic Society International Conference 2017 as a poster presentation with interim findings.

PY - 2018/12/13

Y1 - 2018/12/13

N2 - Background: Peak inspiratory flow (PIF) as generated through the resistance of a dry powder inhaler (DPI) device is a critical patient-dependent maneuver impacting the success of DPI medication delivery. Despite its importance, it is not routinely measured in clinical practice. Little is currently known about the relationship, if any, between PIF through DPI devices, routine spirometry and disease outcomes. Aim: The aim of this study was to identify potential predictors of PIF for different DPIs from spirometric parameters and patient characteristics and explore the association between PIF and follow-up events. Patients and methods: A retrospective observational study at discharge among patients hospitalized for a COPD exacerbation at Attikon hospital, Athens, Greece. Spirometry was performed using an Easy on-PC™ spirometer. PIF was measured through four DPI resistances using the In-Check™ DIAL. Regression analyses were used to investigate the association between PIF through resistances and spirometric parameters obtained at discharge, comorbidities and demographic parameters. Results: Forty-seven COPD patients (mean [±SD], age 71 [±9] years, 72% males, 51% current smokers) were included in this study. Overall, 85% and 15% were classified as GOLD (2017) groups D and C, respectively. Most prevalent comorbidities were hypertension (70%) and cardiovascular disease (53%). In the final regression model, higher PIF was significantly associated with the following: higher FEV1 and % predicted peak expiratory flow (PEF) for Turbohaler® (R-squared value 0.374); higher FEV1 and diagnosis of gastroesophageal reflux disease (GERD) for Aerolizer® (R-squared value 0.209) and higher FEV1, younger age and diagnosis of ischemic heart disease (IHD) for Diskus® (R-squared value 0.350). However, R-squared values for all three devices were weak (<0.4). Conclusion: The study did not provide evidence to support the use of surrogate measurements for PIF through device resistance, which could assist in determining the appropriateness of inhaler device type. Although PIF measurement is feasible in patients at discharge and could be a valuable addition to the standard of care in COPD management, it needs to be measured directly.

AB - Background: Peak inspiratory flow (PIF) as generated through the resistance of a dry powder inhaler (DPI) device is a critical patient-dependent maneuver impacting the success of DPI medication delivery. Despite its importance, it is not routinely measured in clinical practice. Little is currently known about the relationship, if any, between PIF through DPI devices, routine spirometry and disease outcomes. Aim: The aim of this study was to identify potential predictors of PIF for different DPIs from spirometric parameters and patient characteristics and explore the association between PIF and follow-up events. Patients and methods: A retrospective observational study at discharge among patients hospitalized for a COPD exacerbation at Attikon hospital, Athens, Greece. Spirometry was performed using an Easy on-PC™ spirometer. PIF was measured through four DPI resistances using the In-Check™ DIAL. Regression analyses were used to investigate the association between PIF through resistances and spirometric parameters obtained at discharge, comorbidities and demographic parameters. Results: Forty-seven COPD patients (mean [±SD], age 71 [±9] years, 72% males, 51% current smokers) were included in this study. Overall, 85% and 15% were classified as GOLD (2017) groups D and C, respectively. Most prevalent comorbidities were hypertension (70%) and cardiovascular disease (53%). In the final regression model, higher PIF was significantly associated with the following: higher FEV1 and % predicted peak expiratory flow (PEF) for Turbohaler® (R-squared value 0.374); higher FEV1 and diagnosis of gastroesophageal reflux disease (GERD) for Aerolizer® (R-squared value 0.209) and higher FEV1, younger age and diagnosis of ischemic heart disease (IHD) for Diskus® (R-squared value 0.350). However, R-squared values for all three devices were weak (<0.4). Conclusion: The study did not provide evidence to support the use of surrogate measurements for PIF through device resistance, which could assist in determining the appropriateness of inhaler device type. Although PIF measurement is feasible in patients at discharge and could be a valuable addition to the standard of care in COPD management, it needs to be measured directly.

KW - hospital admission

KW - COPD

KW - dry powder inhaler devices

KW - inhaler technique

KW - resistance

KW - spirometry

U2 - 10.2147/COPD.S174371

DO - 10.2147/COPD.S174371

M3 - Article

VL - 13

SP - 3937—3946

JO - International journal of chronic obstructive pulmonary disease

JF - International journal of chronic obstructive pulmonary disease

SN - 1176-9106

ER -