ArticleFrontiers in pharmacology2026
Changes in device-matched peak inspiratory flow after bedside inhaler coaching and factors associated with residual suboptimal flow: a retrospective observational study.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Peak inspiratory flow rate (PIFR) is a critical determinant of inhaler-device compatibility, particularly when assessed under resistance conditions matching the prescribed inhaler. However, changes in device-matched PIFR patterns after inhaler coaching and factors associated with persistent abnormalities remain insufficiently characterized among hospitalized patients with chronic airway diseases. Methods: We conducted a retrospective single-center observational study of hospitalized adults with chronic obstructive pulmonary disease, asthma, or asthma-COPD overlap who underwent routine device-matched PIFR assessment between July 2024 and December 2025. PIFR was measured using the In-Check DIAL G16 before and after standardized bedside coaching under resistance settings matched to the prescribed inhaler. Logistic regression analyses were performed to identify factors associated with persistent post-coaching PIFR abnormalities. Results: Among 286 patients, the distribution of device-matched PIFR shifted substantially toward the device-specific optimal PIFR range after bedside assessment and coaching. The proportion of patients within the optimal PIFR range increased from 42.3% to 89.2%, whereas insufficient and excessive PIFR decreased from 25.2% to 6.9% and from 32.5% to 3.9%, respectively (all P < 0.001). Lower body mass index was independently associated with persistent insufficient PIFR, whereas ICS-containing therapy was also associated with this residual abnormality. Persistent excessive PIFR was uncommon and primarily observed among patients using pMDI/SMI devices. Conclusion: Device-matched PIFR assessment combined with individualized coaching was associated with a substantial shift toward the device-specific optimal PIFR range among hospitalized patients with chronic airway diseases. However, persistent insufficient PIFR remained in a subset of patients and was associated with lower BMI and ICS-containing therapy, suggesting that these factors may help identify patients who warrant closer reassessment of inhaler-device compatibility.
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