ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Peak Inspiratory Flow Measured Against the Resistance of Two Common Dry Powder Inhalers in Chronic Obstructive Pulmonary Disease (COPD) Inpatients
Session Title
TP37 - TP037 PHYSIOLOGIC ASSESSMENT IN CHRONIC LUNG DISEASE
Abstract
A2165 - Peak Inspiratory Flow Measured Against the Resistance of Two Common Dry Powder Inhalers in Chronic Obstructive Pulmonary Disease (COPD) Inpatients
Author Block: J. A. Ohar1, B. Clark2, B. J. Wells3, A. Shaikh4, J. F. Elder2, A. K. Saha1, B. M. K. Donato2; 1Wake Forest Univ Sch of Medicine, Winston-Salem, NC, United States, 2Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, United States, 3CTSI, Wake Forest Univ Sch of Medicine, Winston-Salem, NC, United States, 4Medical Affairs, Boehringer-Ingelheim, Ridgefield, CT, United States.
Rationale: Peak inspiratory flow (PIF), the maximal airflow generated during the inspiratory cycle, has been proposed as an “emerging biomarker” in COPD. Dry powder inhalers (DPIs) are breath-actuated devices that require user-generated inspiratory forces. Our objective was to assess the prevalence of suboptimal PIF (sPIF) and determine associations between sPIF and baseline demographic, clinical, and treatment characteristics of a COPD population hospitalized for acute exacerbation.
Methods: We conducted a retrospective cohort study using electronic health record data of patients hospitalized and treated according to an acute exacerbation of COPD (AECOPD) care plan between January 1, 2018 and May 31, 2020, at Wake Forest Baptist Health System. Individuals with diagnosis of cystic fibrosis or alpha-1 antitrypsin deficiency, and those aged <40 years were excluded. PIF was measured using the In-Check™ DIAL at two settings to simulate the resistance of medium-low (R-2) and high resistance (R-5) DPIs, and was deemed optimal or suboptimal based on published criteria (<60 L/min against medium-low or <30 L/min against high resistance DPIs). The first hospitalization in which PIF was measured against both resistances was defined as the index admission. Patient demographic and clinical characteristics were captured during the index admission. Baseline healthcare resource utilization (HRU) was captured for one year prior to the index admission’s discharge date.
Results: A total of 743 patients were included in the study cohort; 423 (56.9%) had sPIF to R-2 and 109 (14.7%) were suboptimal to R-5 during index hospitalization. Overall, 104 (95.4%) patients with sPIF to R-5 were also suboptimal to R-2. Conversely, only 24.6% of patients with sPIF to R-2 were also suboptimal to R-5. Consistent with published data, individuals with sPIF were older, had lower body mass index, and were more likely to be female. Subjects with sPIF tended to be more symptomatic, as evidenced by their baseline COPD assessment test (CAT) scores. They also were more likely to need the intensive care unit (ICU) and had greater hospital and ICU length of stays. More than half of subjects discharged on at least one R-2 DPI were suboptimal to that resistance, whereby only 11% of subjects discharged on an R-5 DPI had sPIF to R-5 during hospitalization.
Conclusion: sPIF is common in a large population of patients hospitalized for AECOPD and is associated with markers of frailty and increased HRU. Despite increasing evidence of these associations, a significant proportion of sPIF patients were prescribed DPIs at discharge.
Author Block: J. A. Ohar1, B. Clark2, B. J. Wells3, A. Shaikh4, J. F. Elder2, A. K. Saha1, B. M. K. Donato2; 1Wake Forest Univ Sch of Medicine, Winston-Salem, NC, United States, 2Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, United States, 3CTSI, Wake Forest Univ Sch of Medicine, Winston-Salem, NC, United States, 4Medical Affairs, Boehringer-Ingelheim, Ridgefield, CT, United States.
Rationale: Peak inspiratory flow (PIF), the maximal airflow generated during the inspiratory cycle, has been proposed as an “emerging biomarker” in COPD. Dry powder inhalers (DPIs) are breath-actuated devices that require user-generated inspiratory forces. Our objective was to assess the prevalence of suboptimal PIF (sPIF) and determine associations between sPIF and baseline demographic, clinical, and treatment characteristics of a COPD population hospitalized for acute exacerbation.
Methods: We conducted a retrospective cohort study using electronic health record data of patients hospitalized and treated according to an acute exacerbation of COPD (AECOPD) care plan between January 1, 2018 and May 31, 2020, at Wake Forest Baptist Health System. Individuals with diagnosis of cystic fibrosis or alpha-1 antitrypsin deficiency, and those aged <40 years were excluded. PIF was measured using the In-Check™ DIAL at two settings to simulate the resistance of medium-low (R-2) and high resistance (R-5) DPIs, and was deemed optimal or suboptimal based on published criteria (<60 L/min against medium-low or <30 L/min against high resistance DPIs). The first hospitalization in which PIF was measured against both resistances was defined as the index admission. Patient demographic and clinical characteristics were captured during the index admission. Baseline healthcare resource utilization (HRU) was captured for one year prior to the index admission’s discharge date.
Results: A total of 743 patients were included in the study cohort; 423 (56.9%) had sPIF to R-2 and 109 (14.7%) were suboptimal to R-5 during index hospitalization. Overall, 104 (95.4%) patients with sPIF to R-5 were also suboptimal to R-2. Conversely, only 24.6% of patients with sPIF to R-2 were also suboptimal to R-5. Consistent with published data, individuals with sPIF were older, had lower body mass index, and were more likely to be female. Subjects with sPIF tended to be more symptomatic, as evidenced by their baseline COPD assessment test (CAT) scores. They also were more likely to need the intensive care unit (ICU) and had greater hospital and ICU length of stays. More than half of subjects discharged on at least one R-2 DPI were suboptimal to that resistance, whereby only 11% of subjects discharged on an R-5 DPI had sPIF to R-5 during hospitalization.
Conclusion: sPIF is common in a large population of patients hospitalized for AECOPD and is associated with markers of frailty and increased HRU. Despite increasing evidence of these associations, a significant proportion of sPIF patients were prescribed DPIs at discharge.
