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oai:repisalud.isciii.es:20.500.12105/234022024-11-29T04:55:41Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Leving, Marika T author Bosnic-Anticevich, Sinthia author van Cooten, Joyce author Correia de Sousa, Jaime author Cvetkovski, Biljana author Dekhuijzen, Richard author Dijk, Lars author Garcia Pardo, Marina author Gardev, Asparuh author Gawlik, Radosław author van der Ham, Iris author Janse, Ymke author Lavorini, Federico author Maricoto, Tiago author Meijer, Jiska author Metz, Boyd author Price, David author Roman-Rodriguez, Miguel author Schuttel, Kirsten author Stoker, Nilouq author Tsiligianni, Ioanna author Usmani, Omar author Emerson-Stadler, Rachel author Kocks, Janwillem WH author 2022-12-27 Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health status, and thereby identifying critical errors, key clinical recommendations for primary care clinicians were determined, namely - measure PIF before prescribing a DPI to ensure inhalation manoeuvre ability is well-matched with the device. Some patients could benefit from inhalation training whereas others should have their DPI changed for one better suited to their inspiratory ability or alternatively be prescribed an active device (such as a soft mist inhaler or pressurized metered dose inhaler). Observing the inhalation technique was valuable however this misses suboptimal PIF (approaching one fourth of patients with a satisfactory observed manoeuvre had a suboptimal PIF for their DPI). Assess adherence as deliberate non-adherence can point to a mismatch between a patient and their inhaler (deliberate non-adherence was significantly associated with PIFs below the minimum for the DPI). In-person observation of inhalation technique was found to be inferior to video rating based on device-specific checklists. Where video assessments are not possible, observation training for healthcare professionals would therefore be valuable particularly to improve the ability to identify the critical errors associated with health status namely 'teeth and lips sealed around mouthpiece', 'breathe in' and 'breathing out calmly after inhalation'. However, it is recommended that observation alone should not replace PIF measurement in the DPI selection process.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04532853 . Leving MT, Bosnic-Anticevich S, van Cooten J, de Sousa JC, Cvetkovski B, Dekhuijzen R, et al. Clinical recommendations for dry powder inhaler use in the management of COPD in primary care. npj Prim Care Respir Med. 2022 Dec 27;32(1):59. 10.1038/s41533-022-00318-3 2055-1010 NPJ primary care respiratory medicine https://hdl.handle.net/20.500.13003/18773 36575175 L2020855204 2-s2.0-85144793230 https://hdl.handle.net/20.500.12105/23402 905054800001 Clinical recommendations for dry powder inhaler use in the management of COPD in primary care