{
  "abstract": "Introduction Patients with chronic obstructive pulmonary disease (COPD) use dry powder inhalers (DPIs) for disease management. DPI effectiveness relies on the patient’s peak inspiratory flow (PIF), which may not always be optimal. We conducted an observational multicentre, prospective, real-life cohort study to determine the prevalence of suboptimal PIF in patients with COPD.Methods 415 participants (11%, n=47 women, mean age=70±8.7 years, mean forced expiratory volume in 1 s (predicted %)=48.1%) recruited from 17 international centres had baseline PIF recorded with an In-Check Dial device at three resistance levels: (1) low, (2) high and (3) the participant’s maintenance device. We also recorded PIF from participants as they would do at home to verify their proper inhalation technique. Participants underwent spirometry and completed questionnaires (COPD Assessment Test (CAT), Test of Adherence to Inhalers (TAI)-12).Results Of the 415 participants, 18% of DPI users (n=75) exhibited suboptimal values of PIF (as typical PIF <than what was required for tested inhalers in the study) when evaluated across DPI resistance groups ranging from low (R1) to high (R5) resistance, compared with 14% of participants (n=60) using devices without resistance (R0). Additionally, 14% of study participants were incapable of producing an optimal PIF or unwilling to do so (27%), impacting medication effectiveness. Participants with suboptimal PIF values had higher mean total CAT score (17.7±7) compared with those with optimal PIF values (12.1±7.6). When assessed globally, 37% (n=56) of participants with suboptimal PIF values did not adhere to treatment, highlighting the need for improved patient education and support.Conclusion Suboptimal PIF is common in COPD, requiring regular assessment and tailored inhalers.Trial registration number NCT04606394. Encepp EUPAS34689.",
  "authors": [
    {
      "affiliations": [
        "Respiratory Effectiveness Group, Ely, Cambridgeshire, UK"
      ],
      "name": "Valeria Perugini"
    },
    {
      "affiliations": [
        "College of Medicine, Seoul St Mary’s Hospital, Catholic University of Korea, Seoul, Korea (the Republic of)"
      ],
      "name": "Chin Kook Rhee"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Ji-Yong Moon"
    },
    {
      "affiliations": [
        "Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"
      ],
      "name": "Tiew Pei Yee"
    },
    {
      "affiliations": [
        "Department of Internal Medicine,Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (the Republic of)"
      ],
      "name": "Seung Won Ra"
    },
    {
      "affiliations": [
        "Department of Medicine, Surgery and Pharmacy, Università degli Studi di Sassari, Sassari, Italy"
      ],
      "name": "Pietro Pirina"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Kwang Ha Yoo"
    },
    {
      "affiliations": [
        "Department of Respiratory, IBS-Granada, CIBER de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen de las Nieves, Granada, Spain"
      ],
      "name": "Bernardino Alcázar Navarrete"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta"
      ],
      "name": "Caroline Gouder"
    },
    {
      "affiliations": [
        "Physical Medicine and Rehabilitation, Virgen Macarena University Hospital, Sevilla, Spain"
      ],
      "name": "Almadana Pacheco"
    },
    {
      "affiliations": [
        "Department of Pneumology, Fundació Hospital Sant Joan de Déu de Martorell, Barcelona, Spain"
      ],
      "name": "Annie Navarro-Rolon"
    },
    {
      "affiliations": [
        "Department of Pulmonary Diseases, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"
      ],
      "name": "Matevz Harlander"
    },
    {
      "affiliations": [
        "Department of Pulmonary Medicine, University Hospital Antwerp, Edegem. Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerpen, Belgium"
      ],
      "name": "Therese Lapperre"
    },
    {
      "affiliations": [
        "Respiratory and Critical Care Medicine, Changi General Hospital, Singapore"
      ],
      "name": "Sean Chee Hong Loh"
    },
    {
      "affiliations": [
        "Department of Neumologia, Torrecardenas University Hospital, Almeria, Spain"
      ],
      "name": "David Fole"
    },
    {
      "affiliations": [
        "Pneumology Service, Hospital Universitario de La Ribera, Alzira, Spain"
      ],
      "name": "Elsa Naval"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Granada, Granada, Spain"
      ],
      "name": "Pedro Jose Romero Palacios"
    },
    {
      "affiliations": [
        "Pneumology Department,Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus. CIBER de Enfermedades Respiratorias (CIBERES), Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Marc Miravitlles"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute (NHLI), Royal Brompton Hospital (RBH) and St Mary’s Hospital London, Imperial College London, London, UK"
      ],
      "name": "Omar Usmani"
    }
  ],
  "title": "Assessment of peak inspiratory flow in patients with chronic obstructive pulmonary disease: a multicentre, observational, prospective, real-life study",
  "uid": "e2ddb231-06a5-5a15-a896-da8b02d60acb"
}