Abstract
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.
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 language | English |
|---|---|
| Article number | OA81 |
| Number of pages | 3 |
| Journal | European Respiratory Journal |
| Volume | 58 |
| Issue number | Supplement 65 |
| DOIs | |
| Publication status | Published - 25 Nov 2021 |
| Externally published | Yes |
| Event | European Respiratory Society (ERS) International Congress 2021 - Virtual Duration: 7 Sept 2020 → 9 Sept 2020 |
Keywords
- Primary care
- COPD
- Exacerbation