Ghosh Sohini, Pleasants Roy A, Ohar Jill A, Donohue James F, Drummond M Bradley
Division of Pulmonary Diseases and Critical Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
Durham VA Medical Center, Durham, NC, USA.
Int J Chron Obstruct Pulmon Dis. 2019 Mar 1;14:585-595. doi: 10.2147/COPD.S195438. eCollection 2019.
Adequate peak inspiratory flow rate (PIFR) is required for drug dispersion with dry powder inhalers (DPIs). Prevalence of PIFR discordance (suboptimal PIFR with prescribed inhalers) and factors influencing device-specific PIFR are unclear in COPD. The objective of this study was to determine the prevalence of PIFR discordance and associated clinical factors in a stable COPD population.
An observational, single-center, cohort study was conducted including 66 outpatients with COPD. PIFR was measured using the In-Check™ Dial with applied resistance of prescribed inhalers. Participants were defined as discordant if measured PIFR was <30 L/min and <60 L/min for high and low-medium resistance devices, respectively, using an inspiratory effort the participant normally used with their prescribed DPI.
The median age of the COPD participants was 69.4 years, 92% were white and 47% were female. A total of 48% were using low-medium resistance DPIs (Diskus/Ellipta) and 76% used high-resistance DPI (Handihaler). A total of 40% of COPD participants were discordant to prescribed inhalers. Female gender was the only factor consistently associated with lower PIFR. Shorter height was associated with reduced PIFR for low-medium resistance (=0.44; =0.01), but not high resistance (=0.20; =0.16). There was no correlation between PIFR by In-Check™ dial and PIFR measured by standard spirometer.
PIFR is reduced in stable COPD patients, with female gender being the only factor consistently associated with reduced PIFR. Discordance with prescribed inhalers was seen in 40% of COPD patients, suggesting that many COPD patients do not generate adequate inspiratory force to overcome prescribed DPIs resistance in the course of normal use.
使用干粉吸入器（DPI）进行药物分散需要足够的吸气峰流速（PIFR）。慢性阻塞性肺疾病（COPD）患者中PIFR不一致（使用规定吸入器时PIFR未达最佳）的发生率以及影响特定装置PIFR的因素尚不清楚。本研究的目的是确定稳定期COPD患者中PIFR不一致的发生率及相关临床因素。
开展了一项观察性、单中心队列研究，纳入66例COPD门诊患者。使用In-Check™ Dial测量PIFR，并应用规定吸入器的阻力。如果参与者使用其规定DPI时正常吸气努力下，对于高阻力和低-中阻力装置，测量的PIFR分别<30 L/分钟和<60 L/分钟，则定义为不一致。
COPD参与者的中位年龄为69.4岁，92%为白人，47%为女性。共有48%的患者使用低-中阻力DPI（Diskus/Ellipta），76%的患者使用高阻力DPI（Handihaler）。共有40%的COPD参与者与规定吸入器不一致。女性是唯一始终与较低PIFR相关的因素。身高较矮与低-中阻力装置的PIFR降低相关（=0.44；=0.01），但与高阻力装置无关（=0.20；=0.16）。In-Check™ Dial测量的PIFR与标准肺量计测量的PIFR之间无相关性。
稳定期COPD患者的PIFR降低，女性是唯一始终与PIFR降低相关的因素。40%的COPD患者存在与规定吸入器不一致的情况，这表明许多COPD患者在正常使用过程中无法产生足够的吸气力来克服规定DPI的阻力。
