Tuberculosis and Respiratory Diseases

  • 제87권4호
  • /
  • Pages.458-464
  • /
  • 2024
  • /
  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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Inappropriate Peak Inspiratory Flow Rate in the Patients with Stable Chronic Obstructive Pulmonary Disease in Korea

  • Seong Hwan Youn (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Hyun Jung Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Jae Seok Park (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Sun Hyo Park (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Yong Shik Kwon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Mi-Ae Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine)
  • 투고 : 2023.12.20
  • 심사 : 2024.04.23
  • 발행 : 2024.10.31
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초록

Background: While inhalation therapy efficacy hinges on attaining proper peak inspiratory flow rate (PIFR), the prevalence of inappropriate PIFR among patients with chronic obstructive pulmonary disease (COPD) remains unstudied in Korea. This study aimed to assess the prevalence of inappropriate PIFR, its correlation with COPD assessment test (CAT) scores, and factors associated with suboptimal PIFR. Methods: We enrolled 108 patients with COPD who had been using the same inhaler for at least 1 year without exacerbations. PIFR was measured using an inspiratory flow meter (In-Check DIAL G16). Demographic, clinical, pulmonary function, and CAT score data were collected. Inappropriate was defined as PIFR <60 L/min for dry power inhaler (DPI) users, and >90 L/min for aerosol device users. Results: The cohort comprised 87 (80.6%) men, mean age 71.0±8.5 years, with mean post-bronchodilator forced expiratory volume in 1 second of 69.1%±1.8% predicted. Twenty-nine (26.9%) used aerosol devices only, 76 (70.4%) used DPIs only, and three (2.8%) used both. Inappropriate PIFRs were found in 17.2% of aerosol device users, and 42.1% of DPI users. CAT scores were significantly higher in the inappropriate PIFR group than in the appropriate PIFR group (11.2±7.7 vs. 7.5±4.9, p=0.003). In DPI users, female, shorter height, lower body weight and maximal voluntary ventilation (MVV) were associated with inappropriate PIFR. Conclusion: The prevalence of inappropriate PIFR among patients with COPD is 17.2% for aerosol device users, and 42.1% for DPI users. Suboptimal PIFR correlates with female gender, shorter stature, lower weight and MVV in DPI users.

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참고문헌

  1. Ibrahim M, Verma R, Garcia-Contreras L. Inhalation drug delivery devices: technology update. Med Devices (Auckl) 2015;8:131-9.
  2. Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest 2016;150:394-406.
  3. Price DB, Roman-Rodriguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract 2017;5:1071-81.
  4. Pauwels R, Newman S, Borgstrom L. Airway deposition and airway effects of antiasthma drugs delivered from metered-dose inhalers. Eur Respir J 1997;10:2127-38.
  5. Newman S, Steed K, Hooper G, Kallen A, Borgstrom L. Comparison of gamma scintigraphy and a pharmacokinetic technique for assessing pulmonary deposition of terbutaline sulphate delivered by pressurized metered dose inhaler. Pharm Res 1995;12:231-6.
  6. Chrystyn H. Is inhalation rate important for a dry powder inhaler?: using the In-Check Dial to identify these rates. Respir Med 2003;97:181-7.
  7. Ghosh S, Ohar JA, Drummond MB. Peak inspiratory flow rate in chronic obstructive pulmonary disease: implications for dry powder inhalers. J Aerosol Med Pulm Drug Deliv 2017;30:381-7.
  8. Sanders MJ. Guiding inspiratory flow: development of the In-Check DIAL G16, a tool for improving inhaler technique. Pulm Med 2017;2017:1495867.
  9. Hwang YI, Jung KS, Lim SY, Lee YS, Kwon NH. A validation study for the Korean version of Chronic Obstructive Pulmonary Disease Assessment Test (CAT). Tuberc Respir Dis (Seoul) 2013;74:256-63.
  10. Janssens W, VandenBrande P, Hardeman E, De Langhe E, Philps T, Troosters T, et al. Inspiratory flow rates at different levels of resistance in elderly COPD patients. Eur Respir J 2008;31:78-83.
  11. Laube BL, Janssens HM, de Jongh FH, Devadason SG, Dhand R, Diot P, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J 2011;37:1308-31.
  12. Mahler DA. Peak inspiratory flow rate: an emerging biomarker in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2019;199:1577-9.
  13. Leving M, Wouters H, de la Hoz A, Bosnic-Anticevich S, Dekhuijzen R, Gardev A, et al. Impact of PIF, inhalation technique and medication adherence on health status and exacerbations in COPD: protocol of a real-world observational study (PIFotal COPD Study). Pulm Ther 2021;7:591-606.
  14. Broeders ME, Molema J, Vermue NA, Folgering HT. Peak inspiratory flow rate and slope of the inhalation profiles in dry powder inhalers. Eur Respir J 2001;18:780-3.
  15. Mahler DA, Niu X, Deering KL, Dembek C. Prospective evaluation of exacerbations associated with suboptimal peak inspiratory flow among stable outpatients with COPD. Int J Chron Obstruct Pulmon Dis 2022;17:559-68.
  16. Clark B, Wells BJ, Saha AK, Franchino-Elder J, Shaikh A, Donato BM, et al. Low peak inspiratory flow rates are common among COPD inpatients and are associated with increased healthcare resource utilization: a retrospective cohort study. Int J Chron Obstruct Pulmon Dis 2022;17:1483-94.
  17. Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 2003;124:459-67.
  18. Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996;154(4 Pt 1):959-67.
  19. Mahler DA. The role of inspiratory flow in selection and use of inhaled therapy for patients with chronic obstructive pulmonary disease. Respir Med 2020;161:105857.
  20. Harb HS, Laz NI, Rabea H, Abdelrahim ME. Prevalence and predictors of suboptimal peak inspiratory flow rate in COPD patients. Eur J Pharm Sci 2020;147:105298.
  21. Ding N, Zhang W, Wang Z, Bai C, He Q, Dong Y, et al. Prevalence and associated factors of suboptimal daily peak inspiratory flow and technique misuse of dry powder inhalers in outpatients with stable chronic airway diseases. Int J Chron Obstruct Pulmon Dis 2021;16:1913-24.
  22. Loh CH, Peters SP, Lovings TM, Ohar JA. Suboptimal inspiratory flow rates are associated with chronic obstructive pulmonary disease and all-cause readmissions. Ann Am Thorac Soc 2017;14:1305-11.
  23. Ghosh S, Pleasants RA, Ohar JA, Donohue JF, Drummond MB. Prevalence and factors associated with suboptimal peak inspiratory flow rates in COPD. Int J Chron Obstruct Pulmon Dis 2019;14:585-95.
  24. Duarte AG, Tung L, Zhang W, Hsu ES, Kuo YF, Sharma G. Spirometry measurement of peak inspiratory flow identifies suboptimal use of dry powder inhalers in ambulatory patients with COPD. Chronic Obstr Pulm Dis 2019;6:246-55.
  25. Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus® dry powder inhaler. J Aerosol Med Pulm Drug Deliv 2013;26:174-9.
  26. Ohar JA, Ferguson GT, Mahler DA, Drummond MB, Dhand R, Pleasants RA, et al. Measuring peak inspiratory flow in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2022;17:79-92.