Division of Pulmonary, Allergy, Emory University School of Medicine, Critical Care and Sleep Medicine, Atlanta, Georgia.
Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
PLoS One. 2020 Jan 31;15(1):e0227737. doi: 10.1371/journal.pone.0227737. eCollection 2020.
Ineffective peak inspiratory flow rate (PIFR) generation in patients using inhalers results in insufficient drug delivery to the lungs and poor clinical outcomes. Low inspiratory muscle strength is associated with suboptimal PIFR.
To examine in a prospective study the relationship between PIFR and skeletal muscle strength using hand grip strength (HGS) as a surrogate.
Adult patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled. PIFR was measured within 48 hours before discharge. PIFR below 60L/min was considered suboptimal. HGS was measured using a handheld dynamometer. Any readmissions and emergency department visit data were collected. The associations between PIFR, HGS, 30 and 90-day COPD and all-cause readmissions were examined, without and with adjustment for age, race and gender.
Of the 75 enrolled patients, 56% had suboptimal PIFR; they were older (63.9±9.7 vs. 58.2±7.7 years) and had significantly lower HGS (24.2±11.1 vs. 30.9±10.9 Kg) compared to those with optimal PIFR. There were no significant differences between the two PIFR groups by gender, race, history of coronary artery disease, congestive heart failure, hypertension or functional scores. Each kilogram increase in HGS was associated with 0.50 (95%CI 0.18-0.89, p = 0.003) L/min increase in PIFR. We did not observe an association between PIFR and 30 or 90-day readmission rates.
We found a significant association between HGS and PIFR in hospitalized patients with acute exacerbations of COPD. Whether interventions aimed at increasing skeletal muscle strength also result in improvement in PIFR remains unclear and need further study.
使用吸入器的患者吸气峰流速（PIFR）生成无效会导致肺部药物输送不足和临床效果不佳。吸气肌力量不足与 PIFR 不理想有关。
前瞻性研究中，使用手握力（HGS）作为替代指标，检查 PIFR 与骨骼肌力量之间的关系。
纳入因慢性阻塞性肺疾病（COPD）急性加重而入院的成年患者。在出院前 48 小时内测量 PIFR。PIFR 低于 60L/min 被认为是不理想的。使用手持测力计测量 HGS。收集任何再入院和急诊就诊的数据。在不调整年龄、种族和性别以及调整年龄、种族和性别后，检查 PIFR、HGS、30 天和 90 天 COPD 和所有原因再入院之间的关系。
在纳入的 75 名患者中，56%的患者 PIFR 不理想；与 PIFR 理想的患者相比，他们年龄更大（63.9±9.7 岁比 58.2±7.7 岁），HGS 明显更低（24.2±11.1 千克比 30.9±10.9 千克）。两组患者在性别、种族、冠心病、充血性心力衰竭、高血压或功能评分方面无显著差异。HGS 每增加 1 千克，PIFR 增加 0.50（95%CI 0.18-0.89，p = 0.003）L/min。我们没有观察到 PIFR 与 30 天或 90 天再入院率之间存在关联。
我们发现 COPD 急性加重住院患者的 HGS 与 PIFR 之间存在显著关联。旨在增强骨骼肌力量的干预措施是否也能改善 PIFR 尚不清楚，需要进一步研究。
