Suboptimal peak inspiratory flow rate in dry-powder inhaler users for chronic obstructive pulmonary disease in Korea

Ji-Yong Moon; Sang Hyuk Kim; Youlim Kim; Hyun Lee; Chin Kook Rhee; Seung Won Ra; Chang Youl Lee; Joo Hun Park; Yong Bum Park; Kwang Ha Yoo

doi:10.1016/j.pupt.2024.102298

Suboptimal peak inspiratory flow rate in dry-powder inhaler users for chronic obstructive pulmonary disease in Korea

Pulm Pharmacol Ther. 2024 Apr 10:85:102298. doi: 10.1016/j.pupt.2024.102298. Online ahead of print.

Authors

Ji-Yong Moon¹, Sang Hyuk Kim², Youlim Kim³, Hyun Lee¹, Chin Kook Rhee⁴, Seung Won Ra⁵, Chang Youl Lee⁶, Joo Hun Park⁷, Yong Bum Park⁸, Kwang Ha Yoo⁹

Affiliations

¹ Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
² Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea.
³ Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁵ Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
⁶ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, South Korea.
⁷ Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea.
⁸ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea. Electronic address: bfspark2@gmail.com.
⁹ Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea. Electronic address: 20010025@kuh.ac.kr.

PMID: 38604404
DOI: 10.1016/j.pupt.2024.102298

Abstract

Background: A suboptimal peak inspiratory flow rate (PIFR) in dry-powder inhaler (DPI) users can lead to insufficient therapeutic effects in the treatment of chronic obstructive pulmonary disease (COPD). However, few data on the prevalence of and factors associated with suboptimal PIFR in Korean patients with COPD are available.

Methods: We conducted a cross-sectional study of patients with COPD who had been using DPIs for more than three months. PIFR was measured using an In-Check DIAL G16 device. Suboptimal PIFR was defined as below the resistance-matched threshold. Multivariable logistic regression analysis was used to determine factors associated with suboptimal PIFR.

Results: Of 444 DPI users with COPD, the rate of suboptimal PIFR was 22.0 % (98/444). In a multivariable analysis, significant factors associated with suboptimal PIFR were age (adjusted odds ratio [aOR] = 1.06 by 1-year increase; 95 % confidence interval [CI] = 1.02-1.09), male sex (aOR = 0.28; 95 % CI = 0.11-0.73), body mass index (BMI) (aOR = 0.91 by 1 kg/m² increase; 95 % CI = 0.85-0.99), post-bronchodilator forced vital capacity (FVC) %pred (aOR = 0.97 by 1%pred increase; 95 % CI = 0.95-0.99), and In-Check DIAL R2-type inhaler [medium-low resistance] use (aOR = 3.70 compared with R1-type inhalers [low resistance]; 95 % CI = 2.03-7.03).

Conclusions: In Korea, more than one-fifth of DPI users with COPD had a suboptimal PIFR. The factors associated with suboptimal PIFR were age, female gender, low BMI, low FVC, and R2-type inhaler use. Therefore, clinicians should carefully evaluate the possibility of suboptimal PIFR when prescribing DPIs.

Keywords: Administration; Chronic pulmonary; Inhalation; Inhalation devices; Inspiratory capacity; Obstructive disease; Respiratory function tests.