Measuring peak inspiratory flow in patients with chronic obstructive pulmonary disease

Jill A. Ohar* (Corresponding Author), Gary T. Ferguson, Donald A. Mahler, M. Bradley Drummond, Rajiv Dhand, Roy A. Pleasants, Antonio Anzueto, David M.G. Halpin, David B. Price, Gail S. Drescher, Haley M. Hoy, John Haughney, Michael W. Hess, Omar S Usmani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)
11 Downloads (Pure)


Dry powder inhalers (DPIs) are breath actuated, and patients using DPIs need to generate an optimal inspiratory flow during the inhalation maneuver for effective drug delivery to the lungs. However, practical and standardized recommendations for measuring peak inspiratory flow (PIF)—a potential indicator for effective DPI use in chronic obstructive pulmonary disease (COPD)—are lacking. To evaluate recommended PIF assessment approaches, we reviewed
the Instructions for Use of the In-Check™ DIAL and the prescribing information for eight DPIs approved for use in the treatment of COPD in the United States. To evaluate applied PIF assessment approaches, we conducted a PubMed search from inception to August 31, 2021, for reports of clinical and real-life studies where PIF was measured using the In-Check™ DIAL or through a DPI in patients with COPD. Evaluation of collective sources including 47 applicable studies showed that instructions related to the positioning of the patient with their DPI, instructions for exhalation before the inhalation maneuver, the inhalation maneuver itself, and post-inhalation breath-hold times varied, and in many instances, appeared vague and/or incomplete. We observed considerable variation in how PIF was measured in clinical and real life studies, underscoring the need for a standardized method of PIF measurement.

Standardization of technique will facilitate comparisons among studies. Based on these findings and our clinical and research experience, we propose specific recommendations for PIF measurement to standardize the process and better ensure accurate and reliable PIF values in clinical trials and in daily clinical practice.
Original languageEnglish
Pages (from-to)79-92
Number of pages14
JournalInternational journal of chronic obstructive pulmonary disease
Early online date6 Jan 2022
Publication statusPublished - 6 Jan 2022

Bibliographical note

The authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors. The authors received no direct compensation related to the development of the manuscript. Writing, editorial support, and formatting assistance was provided by Suchita Nath-Sain, PhD, and Maribeth Bogush, PhD, of Cactus Life Sciences (part of Cactus Communications), which was contracted and compensated by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) for these services. BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.
Writing, editorial support, and formatting assistance was contracted and compensated by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI).


  • chronic obstructive pulmonary disease
  • dry powder inhalers
  • peak inspiratory flow


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