稳定期慢性阻塞性肺疾病中吸气峰流速对身体姿势的影响：一项观察性研究。
Effect on Physical Position of Peak Inspiratory Flow in Stable COPD: An Observational Study.
作者信息
Pleasants Roy A, Henderson Ashley G, Bayer Valentina, Shaikh Asif, Drummond M Bradley
机构信息
Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States.
出版信息
Chronic Obstr Pulm Dis. 2024 Mar 26;11(2):174-186. doi: 10.15326/jcopdf.2023.0460.
BACKGROUND
We examined the effect of physical position on peak inspiratory flow (PIF) in patients with chronic obstructive pulmonary disease (COPD) using dry-powder inhalers (DPIs) with low‑medium internal resistance (R2) and/or high internal resistance (R5).
METHODS
This prospective study in stable, ambulatory patients with spirometry-confirmed COPD evaluated the effect of 3 physical positions on maximal PIF achieved. Participants had PIFs of 30-90L/min (R5) or 60-90L/min (R2 DPIs) using the In-Check™ DIAL. PIF was measured in triplicate randomly in 3 positions that patients might be in while using their inhaler (standing, sitting, and semi-upright [supine position with the head of the bed at 45°, neck flexed forward]) against prescribed DPI resistance (R2/R5/both). Correlations between PIF and percentage decline in PIF between positions and differences in participant characteristics with >10% versus ≤10% PIF decline standing to semi-upright were calculated.
RESULTS
A total of 76 participants (mean age, 65.2 years) had positional measurements; 59% reported seated DPI use at home. The mean (standard deviation) PIF standing, sitting, and semi-upright was 80.7 (13.4), 77.8 (14.3), and 74.0 (14.5) L/min, respectively, for R2 and 51.1 (9.52), 48.6 (9.84), and 45.8 (7.69) L/min, respectively, for R5 DPIs. PIF semi-upright was significantly lower than sitting and standing (R2; < 0.0001) and standing (R5; = 0.002). Approximately half of the participants had >10% decline in PIF from standing to semi-upright. Patient characteristics exceeding the 0.10 absolute standardized difference threshold with the decline in PIF for both the R2 and R5 DPIs were waist-to-hip ratio, modified Medical Research Council dyspnea score, and postbronchodilator percentage predicted forced vital capacity and PIF by spirometry.
CONCLUSIONS
PIF was significantly affected by physical position regardless of DPI resistance. PIF was highest when standing and lowest when semi-upright. We recommend that patients with COPD stand while using an R2 or R5 DPI. Where unfeasible, the position should be sitting rather than semi-upright. ClinicalTrials.gov identifier NCT04168775.
背景
我们使用中低内部阻力（R2）和/或高内部阻力（R5）的干粉吸入器（DPI），研究了体位对慢性阻塞性肺疾病（COPD）患者吸气峰流速（PIF）的影响。
方法
这项前瞻性研究纳入了稳定的、可走动的、经肺功能测定确诊为COPD的患者，评估了3种体位对达到的最大PIF的影响。参与者使用In-Check™ DIAL测定的PIF为30 - 90L/分钟（R5）或60 - 90L/分钟（R2 DPI）。在患者使用吸入器时可能处于的3种体位（站立、坐立和半直立[床头抬高45°、颈部前屈的仰卧位]）下，按照规定的DPI阻力（R2/R5/两者），对PIF进行3次重复测量。计算了PIF与体位间PIF下降百分比之间的相关性，以及站立至半直立时PIF下降>10%与≤10%的参与者特征差异。
结果
共有76名参与者（平均年龄65.2岁）进行了体位测量；59%的参与者报告在家中使用坐立位DPI。对于R2 DPI，站立、坐立和半直立时的平均（标准差）PIF分别为80.7（13.4）、77.8（14.3）和74.0（14.5）L/分钟，对于R5 DPI，分别为51.1（9.52）、48.6（9.84）和45.8（7.69）L/分钟。半直立位时的PIF显著低于坐立位和站立位（R2；<0.0001）以及站立位（R5；=0.002）。大约一半的参与者从站立位到半直立位时PIF下降>10%。对于R2和R5 DPI，PIF下降时超过0.10绝对标准化差异阈值的患者特征为腰臀比、改良的医学研究委员会呼吸困难评分以及支气管扩张剂使用后通过肺功能测定预测的用力肺活量和PIF百分比。
结论
无论DPI阻力如何，体位对PIF均有显著影响。站立时PIF最高，半直立时最低。我们建议COPD患者使用R2或R5 DPI时采用站立位。若不可行，应采用坐立位而非半直立位。ClinicalTrials.gov标识符：NCT04168775。
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