Academic Journal
Peak Inspiratory Flow in COPD Patients Treated with Pressurized Metered-Dose Inhalers and Spacers: Implications for Inhaler Selection. A Multicenter Cross-Sectional Study.
| Τίτλος: | Peak Inspiratory Flow in COPD Patients Treated with Pressurized Metered-Dose Inhalers and Spacers: Implications for Inhaler Selection. A Multicenter Cross-Sectional Study. |
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| Συγγραφείς: | Bravo Quiroga L; Department of Pneumology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.; Doctoral School, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain., González-Moro Rodríguez JM; Department of Pneumology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.; Department of Medicine and Medical Specialties, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain., Álvarez-Gutiérrez FJ; Department of Pneumology, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Baynova K; Department of Pneumology, Hospital Universitario Virgen del Rocío, Sevilla, Spain., de la Poza Abad M; Centro de Salud Doctor Carles Ribas, Barcelona, Spain., Izquierdo-Alonso JL; Department of Medicine and Medical Specialties, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.; Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain. |
| Πηγή: | International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2026 Aug 25; Vol. 21, pp. 621909. Date of Electronic Publication: 2026 Aug 25 (Print Publication: 2026). |
| Τύπος έκδοσης: | Journal Article; Multicenter Study; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: DOVE Medical Press Country of Publication: New Zealand NLM ID: 101273481 Publication Model: eCollection Cited Medium: Internet ISSN: 1178-2005 (Electronic) Linking ISSN: 11769106 NLM ISO Abbreviation: Int J Chron Obstruct Pulmon Dis Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Auckland, N.Z. : DOVE Medical Press |
| Ιατρικοί όροι (MeSH): | Bronchodilator Agents*/administration & dosage , Lung*/physiopathology , Lung*/drug effects , Pulmonary Disease, Chronic Obstructive*/physiopathology , Pulmonary Disease, Chronic Obstructive*/drug therapy , Pulmonary Disease, Chronic Obstructive*/diagnosis , Dry Powder Inhalers* , Inhalation Spacers* , Inspiratory Capacity* , Metered Dose Inhalers*, Aged ; Female ; Humans ; Male ; Middle Aged ; Administration, Inhalation ; Cross-Sectional Studies ; Equipment Design ; Health Knowledge, Attitudes, Practice ; Patient Satisfaction ; Spain ; Surveys and Questionnaires ; Treatment Outcome |
| Περίληψη: | Background: Spacer devices are frequently prescribed with pressurized metered-dose inhalers (pMDIs) in patients with COPD for a variety of clinical and practical reasons, including concerns about inspiratory capacity, inhaler technique, and hand-breath coordination. However, inspiratory flow is rarely measured objectively. Purpose: To determine whether COPD patients treated with pMDIs and spacers can generate adequate peak inspiratory flow (PIF) for dry powder inhaler (DPI) use, to evaluate the impact of incomplete exhalation, and to examine patient perceptions of spacer use. Patients and Methods: This multicenter, cross-sectional study included 273 clinically stable COPD patients treated with pMDIs and spacers across 70 Spanish centers. PIF was measured with the In-Check Dial at medium-low (R2) and medium-high (R4) resistance under both standard and suboptimal conditions. Patient knowledge, satisfaction, and perceived barriers were evaluated using structured study questionnaires. Results: Overall, 96.0% of patients achieved a PIF ≥30 L/min at R4, whereas 61.9% reached ≥60 L/min. Incomplete exhalation had only a limited effect on inspiratory performance, with 94.1% of patients maintaining a PIF ≥30 L/min at R4. Lower PIF was associated with greater dyspnea and more severe airflow limitation in bivariate analyses. Spacer prescription was seldom based on objective PIF assessment. Most patients reported practical limitations associated with spacer use and expressed a preference for simpler inhaler devices. Conclusion: Most COPD patients treated with pMDIs and spacers appear to have sufficient inspiratory capacity to use medium- to high-resistance DPIs. Routine objective assessment of PIF may help optimize individualized inhaler selection and identify patients who could benefit from alternative inhaler devices. (© 2026 Bravo Quiroga et al.) |
| Competing Interests: | L Bravo Quiroga reports consulting fees and payment or honoraria for lectures and presentations from AstraZeneca, CSL Behring, Chiesi, GSK, and Zambon; support for the manuscript from Orion Company, during the conduct of the study; meeting/travel support from Meetings Separ, outside the submitted work. JM González-Moro has received honoraria for training and consultancy from AstraZeneca, GSK, MSD, Orion, and Sanofi-Regeneron, and support for professional activities from Vitalaire; meeting/travel support from GSK, AstraZeneca, Orion Pharma, Menarini, outside the submitted work. FJ Álvarez-Gutiérrez has received honoraria for training and consultancy from AstraZeneca, GSK, Orion, and Sanofi-Regeneron, and support for professional activities from AstraZeneca, Sanofi-Regeneron, Chiesi, Gebro, and Menarini. K Baynova reports data safety/advisory board participation from CSL, Otsuka, Biocryst, outside the submitted work. M de la Poza reports consulting fees and payment or honoraria for lectures and presentations from AstraZeneca, GSK, Boehringer Ingelheim, Orion, Pfizer, Teva, and Almirall; data safety/advisory board participation from Astra Zeneca; leadership or fiduciary roles from Sociedad Española de medicina general y de familia; equipment/materials/services from Astra Zeneca, Orion, Boehringer Ingelheim, Pfizer and other, outside the submitted work. JL Izquierdo reports grants or contracts from GSK and AstraZeneca; consulting fees and payment or honoraria for lectures and presentations from AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi, GSK, Grifols, Menarini, Novartis, Orion, Pfizer, Sandoz, Teva, and Zambon. The authors declare that the funding received did not influence the study design, results, or conclusions. |
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| Contributed Indexing: | Keywords: COPD; dry powder inhalers; pMDI+spacer; patient satisfaction; peak inspiratory flow |
| Substance Nomenclature: | 0 (Bronchodilator Agents) |
| Entry Date(s): | Date Created: 20260830 Date Completed: 20260830 Latest Revision: 20260910 |
| Update Code: | 20260910 |
| PubMed Central ID: | PMC13525770 |
| DOI: | 10.2147/COPD.S621909 |
| PMID: | 42668822 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1178-2005 |
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| DOI: | 10.2147/COPD.S621909 |