Suboptimal peak inspiratory flow rate: a noticeable risk factor for inhaler concordance in patients with chronic airway diseases

IF 3.6 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2024-04-01 DOI:10.1136/bmjresp-2023-001981

Weiwei Meng, Ruoyan Xiong, Zhiqi Zhao, Huihui Zeng, Yan Chen

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引用次数: 0

Abstract

Background Inhaler concordance and the peak inspiratory flow rate (PIFR) are important determinants of treatment effects in patients with chronic airway diseases. Adequate PIFR is required for driving aerosol medication into the lower respiratory tract. However, the relationship between them has not been discussed previously. This study aimed to describe the characteristics of inhaler concordance and PIFR in Chinese patients with chronic airway diseases and discuss the associated variables and the relationship between them. Methods In this single-centre, observational study, a total of 680 patients with chronic airway diseases were enrolled from July 2021 to April 2023. We collected data on the socio-demographic and clinical variables of inhaler concordance using the test of adherence to inhalers (TAI) and PIFR. Multivariate logistic regression was conducted to examine variables related to inhaler concordance and PIFR. Results A total of 49.4% of patients had low concordance. Patients with chronic obstructive pulmonary disease (COPD) were more concordant than patients with asthma (mean TAI score: 43.60 vs 41.20; p<0.01), while there was no difference in concordance between the asthma-COPD overlap group and the asthma or COPD group. Suboptimal PIFR (adjusted OR, 1.61; 95% CI 1.04 to 2.51) increased the risk of poor concordance among all patients, while triple therapy (adjusted OR, 0.60; 95% CI 0.35 to 0.86) reduced the risk. A total of 54.9% of patients had suboptimal PIFR. Older age, lower educational level, use of dry powder inhalers and lower forced expiratory volume in 1 s % predicted were significantly correlated with insufficient PIFR. Subgroup analysis revealed a greater proportion of patients with insufficient PIFR during exacerbation than during the stable phase (61.7% vs 43.5%, p<0.001). Conclusion Inhaler concordance was low, and suboptimal PIFR was a risk factor for poor concordance among Chinese patients with chronic airway diseases. In addition, current inhalation devices may not be suitable, and PIFR reassessment should be considered for patients with COPD during exacerbation. Trial registration number The study was registered in chictr.org.cn (ChiCTR2100052527) on 31 October 2021. Data are available upon reasonable request.

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吸气峰流速不达标：慢性气道疾病患者吸入器一致性的一个明显风险因素

背景吸入器一致性和吸气峰流速（PIFR）是决定慢性气道疾病患者治疗效果的重要因素。将气溶胶药物送入下呼吸道需要足够的 PIFR。然而，这两者之间的关系以前还没有讨论过。本研究旨在描述中国慢性气道疾病患者吸入器一致性和 PIFR 的特征，并讨论相关变量及其之间的关系。方法在这项单中心观察性研究中，我们在 2021 年 7 月至 2023 年 4 月期间共招募了 680 名慢性气道疾病患者。我们使用吸入器依从性测试（TAI）和 PIFR 收集了吸入器依从性的社会人口学和临床变量数据。我们采用多变量逻辑回归法研究了与吸入器依从性和 PIFR 相关的变量。结果 49.4%的患者吸入器一致性较低。慢性阻塞性肺病（COPD）患者的一致性高于哮喘患者（平均 TAI 评分：43.60 vs 41.20；P<0.01），而哮喘-COPD 重叠组与哮喘或 COPD 组之间的一致性没有差异。次优 PIFR（调整 OR，1.61；95% CI 1.04 至 2.51）增加了所有患者一致性差的风险，而三联疗法（调整 OR，0.60；95% CI 0.35 至 0.86）降低了风险。共有54.9%的患者PIFR不达标。年龄较大、受教育程度较低、使用干粉吸入器和 1 秒内用力呼气量预测值较低与 PIFR 不足显著相关。亚组分析显示，病情加重期 PIFR 不足的患者比例高于病情稳定期（61.7% 对 43.5%，P<0.001）。结论中国慢性气道疾病患者的吸入器一致性较低，而 PIFR 不达标是导致吸入器一致性差的一个风险因素。此外，目前的吸入装置可能并不适用，慢性阻塞性肺病患者在病情加重时应考虑重新评估 PIFR。试验注册号该研究于 2021 年 10 月 31 日在 chictr.org.cn 注册（ChiCTR2100052527）。如有合理要求，可提供相关数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.