Better breathing, better treatment for COPD
New research from researchers at The Institute finds that nearly a third of patients with COPD are at risk of using inhalers ill-suited to their breathing strength—highlighting a simple test that could improve care
SOURCE: Research Institute of the McGill University Health Centre (The Institute)
A recent study led by researchers at the Research Institute of the McGill University Health Centre (The Institute) underscores the critical role of assessing patients' peak inspiratory flow (PIF) when prescribing inhalers for chronic obstructive pulmonary disease (COPD). Published in the journal CHEST, the study was led by Bryan A. Ross, MD, M.Sc., a researcher in the Translational Research in Respiratory Diseases Program at The Institute. The work reveals that nearly one-third of COPD patients may be using inhalers that are not optimally suited to their breathing capabilities, potentially compromising treatment effectiveness.
COPD is a progressive lung disease characterized by airflow limitation, leading to symptoms such as shortness of breath, chronic cough, and frequent respiratory infections. Inhaled medications are central to COPD management, but their efficacy depends on the patient's ability to generate sufficient inspiratory flow to properly inhale the medication.
In this real-world observational study, the research team systematically measured PIF in 161 outpatients at a specialized COPD clinic. They found that 28% of patients had a suboptimal PIF, and 11.2% were using inhaler devices inappropriate for their measured PIF. Beyond factors such as older age, and reduced lung function, a low body mass index (BMI) and most notably, female sex, were associated with suboptimal PIF. Additionally, 31.1% of patients were prescribed multiple inhalers or devices with differing operational techniques, which can lead to confusion and improper use.
"Our findings highlight the importance of assessing PIF to ensure that patients are prescribed inhalers that they can use effectively," said Dr. Ross, senior author of the study and a respirologist at the Montreal Chest Institute, part of the McGill University Health Centre. "A major study finding was that, while only 8.4% of men in the study had a suboptimal PIF, 48.7% (nearly one in two) women did. By tailoring inhaler prescriptions to individual patient profiles, we can enhance treatment outcomes and reduce the risk of exacerbations."
The study suggests that incorporating routine PIF assessment into clinical practice can inform more personalized inhaler prescribing strategies. This approach may be particularly beneficial for patients at higher risk of suboptimal PIF, such as older adults, reduced lung function, lower BMI, and importantly, women living with COPD.
The next phase of Dr. Ross's research involves a prospective longitudinal study called the Canadian Exacerbations of COPD Trial (CAN-EXACT). This study will follow patients with COPD who are at high risk of acute lung attacks, or exacerbations, and will track changes in their peak inspiratory flow (PIF) over time—both during hospital stays and at home. The goal is to better understand how PIF fluctuations relate to clinical outcomes, including the frequency and severity of exacerbations.
About the study
Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program - A Real-World Observational Study was published by Sarah Pankovitch, Michael Frohlich, Bader AlOthman, Jeffrey Marciniuk, Joanie Bernier, Dorcas Paul-Emile, Jean Bourbeau, and Bryan A. Ross. It was published in the journal CHEST, Volume 167, Issue 3, 736 – 745.