Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice

Trushenko, Natalia V.; Lavginova, Baina B.; Chikina, Svetlana Yu.; Obukhova, Natalia E.; Levina, Iuliia A.; Tkachenko, Fedor D.; Nekludova, Galina V.; Merzhoeva, Zamira M.; Avdeev, Sergey N.

doi:.0..

Original Article

DOI: https://doi.org/10.4046/trd.2024.0154 [Accepted]
Published online March 6, 2025.

Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice

Natalia V. Trushenko^1,2

, Baina B. Lavginova¹

, Svetlana Yu. Chikina¹

, Natalia E. Obukhova³

, Iuliia A. Levina¹

, Fedor D. Tkachenko¹

, Galina V. Nekludova^1,2

, Zamira M. Merzhoeva¹

, Sergey N. Avdeev^1,2

¹Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, 5, Dovator St.15, Bldg. 2, 119048, Moscow, Russia
²Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
³Department of Otorhinolaryngology, Central State Medical Academy, Moscow, Russia

Correspondence: Natalia V. Trushenko,
Email: trushenko.natalia@yandex.ru

Received: 1 November 2024 • Revised: 17 February 2025 • Accepted: 4 March 2025

Abstract

Background
Incorrect inhalation technique is one of the most common reasons for the ineffectiveness of Chronic Obstructive Pulmonary Disease (COPD) therapy, increasing the frequency of exacerbations. Selection of treatment based on Peak Inspiratory Flow (PIF) measurements or predictors of suboptimal PIF (sPIF) could optimize therapy in patients with COPD. The goal of this study was to investigate a prevalence and predictors of sPIF in hospitalized patients with acute exacerbation of COPD in clinical practice.
Methods
The study involved 72 patients hospitalized with acute COPD exacerbation. The analysis included demographic, clinical and lung function parameters. PIF was measured at the resistance level of patients’ inhalation device using In-Check DIAL G16 before and after explaining the inhalation technique, as well as at medium-low resistance (R2) and high resistance (R5) at admission and on discharge.
Results
Upon admission and before explaining the inhalation technique, sPIF was observed in 52.7% of patients, while after the explanation, the proportion of patients with sPIF decreased to 19.4% (p < 0.0001). ROC analysis revealed that independent predictors of suboptimal PIF were age >70 years; FVC <73% pred.; FEV1< 35% pred.; RV > 194% pred.; RV/TLC > 70%; DLco < 36% pred. The most significant predictors of sPIF were age (OR 0.89) and FEV1 (OR 0.59).
Conclusion
When choosing dry powder inhaler for the maintenance therapy in patients with acute exacerbation of COPD, it is important to consider the patient's ability to generate the optimal PIF taking into account the patient's age and the severity of functional impairments.

Key Words: COPD, exacerbation, peak inspiratory flow, dry powder inhaler, inhalation technique

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ORCID iDs

Natalia V. Trushenko
https://orcid.org/0000-0002-0685-4133

Baina B. Lavginova
https://orcid.org/0000-0003-1254-6863

Svetlana Yu. Chikina
https://orcid.org/0000-0002-5536-9388

Natalia E. Obukhova
https://orcid.org/0009-0001-6012-4107

Iuliia A. Levina
https://orcid.org/0000-0002-0928-2900

Fedor D. Tkachenko
https://orcid.org/0009-0009-6219-844X

Galina V. Nekludova
https://orcid.org/0000-0002-9509-0867

Zamira M. Merzhoeva
https://orcid.org/0000-0002-3174-5000

Sergey N. Avdeev
https://orcid.org/0000-0002-5999-2150

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