Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors.

IF 2 4区 医学 Q3 RESPIRATORY SYSTEM
Almudena González-Montaos, Luis Pazos-Area, Cristina Represas-Represas, Cristina Ramos-Hernández, Irene Lojo-Rodríguez, Ana Priegue-Carrera, Luz Aballe-Santos, Alberto Fernández-Villar
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Abstract

Introduction: Despite the importance of an adequate peak inspiratory flow (PIF) during inhaled therapy in patients with COPD, the available evidence in patients with severe exacerbations and their evolution after admission is limited. We conducted this study to evaluate the PIF during an exacerbation, its variability, and predictors of suboptimal PIF. Material and Methods: A prospective study that included patients admitted for COPD exacerbation. Clinical, demographic, and functional variables were recorded. Using the In-Check DIAL G16®, PIF without resistance (PIF-nr) and that obtained by simulating the resistance of the patients' usual inhalers (PIF) were determined within the first 48 hours of admission and prior to discharge; also assessed during a stable phase in a subgroup of patients. The results were compared and, through a multivariate study, the factors related to a suboptimal PIF were analyzed. Results: A total of 137 patients were included; 27% were women and the mean age was 69.4 ± 9.8 years. Moreover, 30.8% of the participants with dry powder inhalers had a suboptimal PIF at admission and it was independently associated with female sex (odds ratio [OR] = 8.635; 95% confidence interval [CI] [2.007, 37.152]; p < 0.01) and forced expiratory volume in the 1st second (FEV1) (OR = 0.997; 95% CI: [0.995, 0.999]; p = 0.04). At discharge, suboptimal PIF reduced to 17% (p < 0.01). PIF-nr increased from the time of admission to the stable phase. Conclusion: One third of COPD patients admitted with a severe exacerbation had a suboptimal PIF, being female sex and lower FEV1 independent predictors. PIF-nr improved progressively after the exacerbation.

慢性阻塞性肺疾病恶化住院患者的峰值吸气流量不达标:患病率和预测因素
简介:尽管慢性阻塞性肺病患者在吸入治疗过程中保持足够的吸气峰值流速(PIF)非常重要,但针对严重病情恶化患者及其入院后病情发展的现有证据却很有限。我们开展了这项研究,以评估病情加重期间的吸气峰值流速、其可变性以及吸气峰值流速不达标的预测因素。材料和方法:这是一项前瞻性研究,纳入了因慢性阻塞性肺疾病加重而入院的患者。记录了临床、人口统计学和功能变量。使用 In-Check DIAL G16®,测定了入院后 48 小时内和出院前的无阻力 PIF(PIF-nr)和通过模拟患者常用吸入器阻力获得的 PIF(PIF);还评估了稳定期亚组患者的 PIF。对结果进行了比较,并通过多变量研究分析了与 PIF 不达标有关的因素。研究结果共纳入 137 名患者,其中 27% 为女性,平均年龄为 69.4 ± 9.8 岁。此外,30.8%使用干粉吸入器的患者在入院时PIF不达标,这与女性性别(比值比[OR]=8.635;95%置信区间[CI][2.007, 37.152];P < 0.01)和第一秒用力呼气容积(FEV1)(比值比[OR]=0.997;95%置信区间[CI][0.995, 0.999];P = 0.04)独立相关。出院时,次优 PIF 降至 17%(p < 0.01)。从入院到稳定期,PIF-nr 一直在增加。结论三分之一因严重恶化而入院的慢性阻塞性肺病患者的 PIF 值不达标,女性和较低的 FEV1 是独立的预测因素。病情恶化后,PIF-nr 逐步改善。
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来源期刊
CiteScore
6.70
自引率
2.90%
发文量
34
审稿时长
>12 weeks
期刊介绍: Journal of Aerosol Medicine and Pulmonary Drug Delivery is the only peer-reviewed journal delivering innovative, authoritative coverage of the health effects of inhaled aerosols and delivery of drugs through the pulmonary system. The Journal is a forum for leading experts, addressing novel topics such as aerosolized chemotherapy, aerosolized vaccines, methods to determine toxicities, and delivery of aerosolized drugs in the intubated patient. Journal of Aerosol Medicine and Pulmonary Drug Delivery coverage includes: Pulmonary drug delivery Airway reactivity and asthma treatment Inhalation of particles and gases in the respiratory tract Toxic effects of inhaled agents Aerosols as tools for studying basic physiologic phenomena.
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