Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World...

Area of Science:

• Respiratory Medicine
• Pulmonology
• Pharmacology

Background:

• Optimal inhaler selection for COPD patients is crucial, aligning with their peak inspiratory flow (PIF) and device type.
• Current regimens may not always consider individual patient PIF capabilities or device consistency.

Purpose of the Study:

• To determine the prevalence of suboptimal PIF and inappropriate inhaler devices in a specialized COPD clinic.
• To identify patient-related risk factors for suboptimal PIF.
• To assess the impact of point-of-care PIF measurement on clinical decisions.

Main Methods:

• A single-center, real-world observational study involving systematic PIF measurement at outpatient visits.
• Coprimary outcomes focused on the prevalence of suboptimal PIF and inappropriate devices.
• Secondary outcomes included risk factor analysis and the effect of PIF results on prescribing.

Main Results:

• 28% of patients exhibited suboptimal PIF, and 11.2% used inappropriate devices.
• Risk factors for suboptimal PIF included female sex, older age, lower BMI, and reduced FEV1.
• 36.6% of patients had inhaler regimens with inappropriate devices or non-single inhaler therapy (SIT)/nonsimilar devices, prompting prescription changes.

Conclusions:

• Suboptimal PIF and inappropriate inhaler devices are common in specialized COPD clinics.
• Female sex, reduced FEV1, and low BMI are key, identifiable risk factors for suboptimal PIF.
• Point-of-care PIF measurement effectively informs clinical decision-making for inhaler therapy.