CHEST Guidelines-Peak-Inspiratory-Flow-and-Inhaler-Prescription-Str

Peak-Inspiratory-Flow-and-Inhaler-Prescription-Str

Pdf Summary

The study investigates the prevalence of suboptimal peak inspiratory flow (PIF) and the inappropriate use of inhaler devices among COPD patients. It also identifies risk factors for suboptimal PIF, evaluates the use of non-single inhaler therapy (non-SIT), and examines if point-of-care PIF measurements influence clinical decisions. Conducted at the Montreal Chest Institute, 161 COPD patients' PIF was measured during their clinic visits from September 2022 to May 2023. Findings reveal 28% had suboptimal PIF and 11.2% used inappropriate devices for their PIF. Risk factors for suboptimal PIF include female sex, more severe airflow obstruction, and low BMI. However, height was not consistently associated with PIF outcomes.<br /><br />Non-SIT or nonsimilar devices were identified in 31.1% of participants, highlighting a prevalent mismatch in inhaler prescription. The study indicates that point-of-care PIF results influence clinical decision-making, leading to prescription changes, especially when inappropriate devices are identified. The study also finds that PIF is relatively stable over time, suggesting that prescriptions adjusted based on a single PIF measurement remain appropriate.<br /><br />The study underscores the importance of personalized inhaler regimens aligning with the patient's inspiratory capacity, possibly preventing exacerbations linked to inappropriate inhaler use. The high prevalence of inappropriate inhaler regimens even in specialized clinics calls for targeted screening, especially for females, underweight individuals, and those with severe obstruction.<br /><br />While innovative, the study is limited by its single-center design, potential selection bias, and lack of coverage of milder COPD cases, affecting generalizability. It calls for further investigation into the impact of suboptimal PIF on clinical outcomes and the stability of PIF during exacerbations. The findings support adopting precision medicine approaches in COPD management by utilizing PIF measurements for tailored inhaler therapy.

Keywords

COPD

suboptimal PIF

inhaler devices

risk factors

non-SIT

point-of-care

personalized regimens

precision medicine

Montreal Chest Institute

clinical decision-making