Suboptimal peak inspiratory flow and inhalation technique errors are associated with higher COPD-related healthcare costs: results from the PIFotal COPD study

Introduction: Suboptimal Peak Inspiratory Flow (sPIF), non-adherence and inhalation technique errors are prevalent among COPD patients on Dry Powder Inhaler (DPI) maintenance therapy. We aimed to investigate the association of sPIF, non-adherence, and inhalation technique errors with Health Care Resource Utilization (HCRU) and related costs in COPD patients using a DPI. Methods: The PIFotal COPD study is a cross-sectional multi-country observational real-world study including COPD patients that used a DPI for maintenance therapy (n=1,434, 50.1% female, mean (SD) age 69.2 (9.3) years). PIF was measured with the In-Check DIAL G16. sPIF was defined as the day-to-day typical PIF lower than required for the patient’s device to guarantee optimal lung deposition of the medication. HCRU in the past year was computed as COPD-related primary healthcare costs, secondary healthcare costs, medication costs, and the total COPD-related HCRU costs (Table 1). Results: sPIF was associated with higher medication costs (cost ratio [CR] 1.07, 95% confidence interval [CI] 1.01-1.14; Figure 1). Non-adherence was not associated with HCRU. The error ‘breathe in’ was associated with higher secondary healthcare costs (CR 2.20, 95% CI 1.37-3.54) and total COPD-related costs (CR 1.16 95% CI 1.03-1.31); ‘hold breath’ was associated with higher medication costs (CR 1.08, 95% CI 1.02-1.15) and total COPD-related costs (CR 1.17, 95% CI 1.07-1.28); error ‘breathe out calmly after inhalation’ was associated with higher medication costs (CR 1.19, 95% CI 1.04-1.37). Discussion: This study highlights the complex relationship between the patient’s ability to correctly use their inhaler and HCRU. Suboptimal breathing manoeuvres were associated with increased medication, secondary- and total COPD-related healthcare costs. Interventions focussing on PIF assessment and inhalation technique training may aid in reducing HCRU and costs in COPD.