Observational studyNPJ primary care respiratory medicine2022
Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers.
Observational study in NPJ primary care respiratory medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD.BMJ open respiratory research · 2024Pooled it
- Advantages and challenges of training of inhalation technique with the Vitalograph AIM device.Scientific reports · 2026Trial
- Inhaler mastery and retention after stepwise training in cognitively impaired older COPD.ERJ open research · 2026Article
- Beyond the Lungs: A Narrative Review of Cardiopulmonary Risk Reduction and Management Perspectives in Thai COPD Patients.International journal of chronic obstructive pulmonary disease · 2026Review
- Predictors of Suboptimal Peak Inspiratory Flow in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Clinical Practice.Tuberculosis and respiratory diseases · 2025Article
- Effectiveness of an educational intervention on different types of errors -occurring during inhaler therapy use in COPD patients during a -Pulmonary Rehabilitation Program.Multidisciplinary respiratory medicine · 2024Article
- Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized with COPD in a Department of General Internal Medicine: A Cross-Sectional Study.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2024Article
- Aerosol Plumes of Inhalers Used in COPD.Pulmonary therapy · 2024Article
- Demystifying Dry Powder Inhaler Resistance with Relevance to Optimal Patient Care.Clinical drug investigation · 2024Review
- Inhaler personalisation based on peak inspiratory flow (PIF) among dry powder inhaler users: a pilot randomised control trial (RCT) in COPD.Journal of pharmaceutical policy and practice · 2024Article
- Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study.BMJ open respiratory research · 2023Article
- Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease.Annals of the American Thoracic Society · 2023Review
- Identifying critical inhalation technique errors in Dry Powder Inhaler use in patients with COPD based on the association with health status and exacerbations: findings from the multi-country cross-sectional observational PIFotal study.BMC pulmonary medicine · 2023Observational
- Clinical Implications of Peak Inspiratory Flow in COPD: Post Hoc Analyses of the TRONARTO Study.International journal of chronic obstructive pulmonary disease · 2023Article
- Clinical Management of COPD in the Real World: Can Studies Reveal Errors in Management and Pathways to Improve Patient Care?Pragmatic and observational research · 2023Review
- Clinical recommendations for dry powder inhaler use in the management of COPD in primary care.NPJ primary care respiratory medicine · 2022Article
- Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs.International journal of chronic obstructive pulmonary disease · 2022Article
Corrections and comments
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Authors and funding
29 authors at 13 institutions in 10 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The study aimed to determine the associations of Peak Inspiratory Flow (PIF), inhalation technique and adherence with health status and exacerbations in participants with COPD using DPI maintenance therapy. This cross-sectional multi-country observational real-world study included COPD participants aged ≥40 years using a DPI for maintenance therapy. PIF was measured three times with the In-Check DIAL G16: (1) typical PIF at resistance of participant's inhaler, (2) maximal PIF at resistance of participant's inhaler, (3) maximal PIF at low resistance. Suboptimal PIF (sPIF) was defined as PIF lower than required for the device. Participants completed questionnaires on health status (Clinical COPD Questionnaire (CCQ)), adherence (Test of Adherence to Inhalers (TAI)) and exacerbations. Inhalation technique was assessed by standardised evaluation of video recordings. Complete data were available from 1434 participants (50.1% female, mean age 69.2 years). GOLD stage was available for 801 participants: GOLD stage I (23.6%), II (54.9%), III (17.4%) and IV (4.1%)). Of all participants, 29% had a sPIF, and 16% were shown able to generate an optimal PIF but failed to do so. sPIF was significantly associated with worse health status (0.226 (95% CI 0.107-0.346), worse units on CCQ; p = 0.001). The errors 'teeth and lips sealed around mouthpiece', 'breathe in', and 'breathe out calmly after inhalation' were related to health status. Adherence was not associated with health status. After correcting for multiple testing, no significant association was found with moderate or severe exacerbations in the last 12 months. To conclude, sPIF is associated with poorer health status. This study demonstrates the importance of PIF assessment in DPI inhalation therapy. Healthcare professionals should consider selecting appropriate inhalers in cases of sPIF.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.