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

Marika T. Leving, Sinthia Bosnic-Anticevich, Joyce van Cooten, Jamie Correia de Sousa, Biljana Cvetkovski, Richard Dekhuijzen, Lars Dijk, Marina Garcia Pardo, Asparuh Gardev, Radoslaw Gawlik, Iris van der Ham, Ymke Janse, Federico Lavorini, Tiago Maricoto, Jiska Meijer, Boyd Metz, David Price, Miguel Roman-Rodriguez, Kirsten Schuttel, Nilouq StokerIoanna Tsiligianni, Omar Usmani, Rachel Emerson-Stadler, Janwillem W. H. Kocks

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
23 Downloads (Pure)


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 suboptimal 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.

Trial registration:
Original languageEnglish
Article number59
Pages (from-to)1-8
Number of pages8
Journalnpj Primary Care Respiratory Medicine
Issue number1
Publication statusPublished - 27 Dec 2022
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


Dive into the research topics of 'Clinical recommendations for dry powder inhaler use in the management of COPD in primary care'. Together they form a unique fingerprint.

Cite this