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 Meijer; Boyd Metz; David Price; Miguel Roman Rodriguez; Kirsten Schuttel; Nilouq Stoker; Ioanna Tsiligianni; Omar Usmani; Marika Leving

doi:10.1183/13993003.congress-2021.OA81

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 journal › Meeting abstract › peer-review

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.

Original language	English
Article number	OA81
Number of pages	3
Journal	European Respiratory Journal
Volume	58
Issue number	Supplement 65
DOIs	https://doi.org/10.1183/13993003.congress-2021.OA81
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

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10.1183/13993003.congress-2021.OA81

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Kocks, J., Wouters, H., Bosnic-Anticevich, S., van Cooten, J., de Sousa, J. C., Cvetkovski, B., Dekhuijzen, R., Dijk, L., Dvortsin, E., Garcia Pardo, M., Gardev, A., Gawlik, R., van Geer, I., van der Ham, I., Harbers, M., de la Hoz, A., Janse, Y., Lavorini, F., Maricoto, T., ... Leving, M. (2021). Late Breaking Abstract: Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy. European Respiratory Journal, 58(Supplement 65), Article OA81. https://doi.org/10.1183/13993003.congress-2021.OA81

@article{267ddfacee49435185e1a2ff59508059,

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

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{\textquoteright}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.",

keywords = "Primary care, COPD, Exacerbation",

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

year = "2021",

month = nov,

day = "25",

doi = "10.1183/13993003.congress-2021.OA81",

language = "English",

volume = "58",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

number = "Supplement 65",

note = "European Respiratory Society (ERS) International Congress 2021 ; Conference date: 07-09-2020 Through 09-09-2020",

}

Kocks, J, Wouters, H, Bosnic-Anticevich, S, van Cooten, J, de Sousa, JC, Cvetkovski, B, Dekhuijzen, R, Dijk, L, Dvortsin, E, Garcia Pardo, M, Gardev, A, Gawlik, R, van Geer, I, van der Ham, I, Harbers, M, de la Hoz, A, Janse, Y, Lavorini, F, Maricoto, T, Meijer, J, Metz, B, Price, D, Roman Rodriguez, M, Schuttel, K, Stoker, N, Tsiligianni, I, Usmani, O & Leving, M 2021, 'Late Breaking Abstract: Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy', European Respiratory Journal, vol. 58, no. Supplement 65, OA81. https://doi.org/10.1183/13993003.congress-2021.OA81

TY - JOUR

T1 - Late Breaking Abstract

T2 - European Respiratory Society (ERS) International Congress 2021

AU - Kocks, Janwillem

AU - Wouters, Hans

AU - Bosnic-Anticevich, Sinthia

AU - van Cooten, Joyce

AU - de Sousa, Jamie Correia

AU - Cvetkovski, Biljana

AU - Dekhuijzen, Richard

AU - Dijk, Lars

AU - Dvortsin, Evgeni

AU - Garcia Pardo, Marina

AU - Gardev, Asparuh

AU - Gawlik, Radosław

AU - van Geer, Iris

AU - van der Ham, Iris

AU - Harbers, Marten

AU - de la Hoz, Alberto

AU - Janse, Ymke

AU - Lavorini, Federico

AU - Maricoto, Tiago

AU - Meijer, Jiska

AU - Metz, Boyd

AU - Price, David

AU - Roman Rodriguez, Miguel

AU - Schuttel, Kirsten

AU - Stoker, Nilouq

AU - Tsiligianni, Ioanna

AU - Usmani, Omar

AU - Leving, Marika

PY - 2021/11/25

Y1 - 2021/11/25

N2 - 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.

AB - 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.

KW - Primary care

KW - COPD

KW - Exacerbation

U2 - 10.1183/13993003.congress-2021.OA81

DO - 10.1183/13993003.congress-2021.OA81

M3 - Meeting abstract

SN - 0903-1936

VL - 58

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - Supplement 65

M1 - OA81

Y2 - 7 September 2020 through 9 September 2020

ER -

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

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Keywords

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