Sufficient inspiratory effort for a dry powder inhaler - do we have to measure it, or can we observe it? Post hoc analysis of the PIFotal study.

Marika Leving, Sinthia Z Bosnic-Anticevich, Joyce van Cooten, Jaime Correia de Sousa, Biljana Cvetkovski, P N Richard Dekhuijzen, Lars Dijk, Marina Garcia Pardo, Asparuh Gardev, Radosław Gawlik, Iris van der Ham, Ymke Janse, Federico Lavorini, Tiago Maricoto, Jiska Meijer, Boyd Metz, David Price, Miguel Roman-Rodriguez, Kirsten Schuttel, Nilouq StokerIoanna Tsiligianni, Omar Usmani, Wilma Zijlema, Janwillem W H Kocks

Research output: Contribution to journalArticlepeer-review


Background: The PIFotal study found that nearly a third of COPD patients on dry powder inhaler (DPI) maintenance therapy did not generate an optimal peak inspiratory flow (PIF) for their device during a typical inhalation manoeuvre. PIF can be assessed by either observing inhalation technique or by measuring it objectively. However, it is unclear whether these methods differ in their accuracy to guide optimal DPI use.Method: Cross-sectional observational multinational study in 1,389 COPD patients (mean±SD: 69±9yrs) on DPI maintenance therapy. PIF was assessed by 1) videorecording and rated with checklists (i.e. ‘inspiratory effort’) and 2) measurement at the resistance of patient’s DPI with In-Check Dial G16. Health status was assessed with Clinical COPD Questionnaire.Results: Patients with sufficient inspiratory effort, as assessed with video (n = 987), but with suboptimal PIF (sPIF n = 365), as measured with In-Check Dial G16, had significantly worse health status compared to patients with optimal PIF and sufficient inspiratory effort (Fig. 1, β* 0.19; 95%CI [0.03, 0.35]; p = 0.02).Conclusion: Even when PIF was observed to be sufficient, 37% of patients had sPIF when measured. Thus, observations were inadequate to identify sPIF, a factor associated with poorer health status. Objective measurements of PIF should guide the DPI selection process.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 2052.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at (ERS member access only).
Original languageEnglish
Article number2052
JournalEuropean Respiratory Journal
Issue numbersuppl 66
Early online date1 Dec 2022
Publication statusPublished - 2022
EventEuropean Respiratory Society (ERS) International Congress. - FIRA Barcelona Gran Via Congress Centre, Barcelona, Spain
Duration: 4 Sept 20226 Sept 2022


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