Late Breaking Abstract: Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy

Janwillem Kocks, Hans Wouters, Sinthia Bosnic-Anticevich, Joyce van Cooten, Jamie Correia de Sousa, Biljana Cvetkovski, Richard Dekhuijzen, Lars Dijk, Evgeni Dvortsin, Marina Garcia Pardo, Asparuh Gardev, Radosław Gawlik, Iris van Geer, Iris van der Ham, Marten Harbers, Alberto de la Hoz, Ymke Janse, Federico Lavorini, Tiago Maricoto, Jiska MeijerBoyd Metz, David Price, Miguel Roman Rodriguez, Kirsten Schuttel, Nilouq Stoker, Ioanna Tsiligianni, Omar Usmani, Marika Leving

Research output: Contribution to journalMeeting abstractpeer-review


Background: Critical factors determining the effectiveness of COPD maintenance therapy with DPIs are poorly known.

Aim: To determine associations of COPD health status & exacerbations with peak inspiratory flow (PIF), inhalation technique and medication adherence.

Methods: Cross-sectional observational study in the Netherlands, Spain, Portugal, Greece, Poland & Australia in COPD patients (≥40yrs) on maintenance DPI therapy for ≥3 months. Typical PIF at resistance of patient’s DPI, health status (Clinical COPD Questionnaire), adherence (Test of Adherence to Inhalers) & inhalation technique (video recording rated for errors) were assessed. Exacerbation frequency for previous 12 months was collected. Multilevel regression outcomes with 95% CI and p value are reported.

Results: 1434 patients were included (69 ± 9yrs, 50% male). 29% of patients exhibited suboptimal PIF. Compared with optimal PIF, suboptimal PIF was associated with worse CCQ score (0.21 [CI-0.10, 0.33], p< 0.001) and increased exacerbation rates (0.75 [0.60, 0.94], p=0.01). 51% of patients exhibited at least one critical inhalation error. Based on association with CCQ, 3 critical errors were identified: Not sealing teeth & lips around mouthpiece (0.21 [0.05, 0.36], p=0.01); Not inhaling strongly/calmly and deeply (0.234 [0.126, 0.343]; p<0.001); Not breathing out calmly after inhaling (0.30 [0.04, 0.56], p=0.03). CCQ score did not differ between adherent (56%) and non-adherent patients (-0.001 [-0.11, 0.11], p=0.98).

Conclusion: Suboptimal PIF is associated with poorer health status and more exacerbations. PIF could be important for inhaler selection. Inhalation technique should be assessed at every opportunity to optimize therapy.
Original languageEnglish
Article numberOA81
Number of pages3
JournalEuropean Respiratory Journal
Issue numberSupplement 65
Publication statusPublished - 25 Nov 2021
Externally publishedYes
EventEuropean Respiratory Society (ERS) International Congress 2021 - Virtual
Duration: 7 Sept 20209 Sept 2020


  • Primary care
  • COPD
  • Exacerbation


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