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

Sarah Pankovitch; Michael Frohlich; Bader AlOthman; Jeffrey Marciniuk; Joanie Bernier; Dorcas Paul-Emile; Jean Bourbeau; Bryan A Ross

doi:10.1016/j.chest.2024.09.031

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

Chest. 2024 Oct 9:S0012-3692(24)05290-5. doi: 10.1016/j.chest.2024.09.031. Online ahead of print.

Authors

Sarah Pankovitch¹, Michael Frohlich², Bader AlOthman¹, Jeffrey Marciniuk³, Joanie Bernier¹, Dorcas Paul-Emile¹, Jean Bourbeau⁴, Bryan A Ross⁵

Affiliations

¹ Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
² Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Specialist Medicine, Hull Hospital, Gatineau, QC, Canada.
³ Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
⁴ Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
⁵ Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada. Electronic address: bryan.ross@mcgill.ca.

PMID: 39384100
DOI: 10.1016/j.chest.2024.09.031

Abstract

Background: COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s).

Research questions: In a subspecialized COPD clinic: (1) What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? (2) Are there patient-related risk factors associated with suboptimal PIF? (3) What is the prevalence of patients with non-single inhaler therapy (SIT)/nonsimilar devices? (4) Does point-of-care PIF affect clinical decision-making?

Study design and methods: In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic, and point-of-care results were provided to the clinician. Coprimary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF. Secondary outcomes were patient-related risk factors associated with suboptimal PIF, the prevalence of non-SIT/nonsimilar devices, the prevalence of regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices, and the effect of point-of-care PIF on clinical decision-making.

Results: Suboptimal PIF was identified in 45 of 161 participants (28%), and inappropriate device(s) for measured PIF were identified in 18 participants (11.2%). Significant associations were observed between suboptimal PIF and age (1.09; 95% CI, 1.04-1.15), female sex (10.30; 95% CI, 4.45-27.10), height (0.92; 95% CI, 0.88-0.96), BMI (0.90; 95% CI, 0.84-0.96), and FEV₁ (0.09; 95% CI, 0.03-0.26). After adjustment for age and sex, the association between suboptimal PIF and BMI, but not height, remained significant. Non-SIT and/or nonsimilar devices were identified in 50 participants (31.1%). Regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices were observed in 59 participants (36.6%). Inhaler prescription changes were observed in this latter group (3.39; 95% CI, 1.76-6.64), as well as in patients with suboptimal PIF who already had SIT/similar regimens (2.93; 95% CI, 1.07-7.92).

Interpretation: Suboptimal PIF and inappropriate devices for measured PIF are highly prevalent among outpatients from a subspecialized COPD clinic. Female sex, reduced FEV₁, and low BMI are important, readily identifiable risk factors for suboptimal PIF, and point-of-care PIF can inform clinical decision-making.

Keywords: copd; dry powder inhaler; long-acting bronchodilator; peak inspiratory flow; single inhaler therapy.