<?xml version="1.0" encoding="UTF-8"?><?xml-stylesheet type="text/xsl" href="static/style.xsl"?><OAI-PMH xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/ http://www.openarchives.org/OAI/2.0/OAI-PMH.xsd"><responseDate>2026-06-14T02:08:02Z</responseDate><request verb="GetRecord" identifier="oai:repisalud.isciii.es:20.500.12105/23529" metadataPrefix="mets">https://repisalud.isciii.es/rest/oai/request</request><GetRecord><record><header><identifier>oai:repisalud.isciii.es:20.500.12105/23529</identifier><datestamp>2024-11-29T00:58:52Z</datestamp><setSpec>com_20.500.12105_15322</setSpec><setSpec>com_20.500.12105_2051</setSpec><setSpec>col_20.500.12105_16967</setSpec></header><metadata><mets xmlns="http://www.loc.gov/METS/" xmlns:doc="http://www.lyncode.com/xoai" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" ID="&#xa;&#x9;&#x9;&#x9;&#x9;DSpace_ITEM_20.500.12105-23529" TYPE="DSpace ITEM" PROFILE="DSpace METS SIP Profile 1.0" xsi:schemaLocation="http://www.loc.gov/METS/ http://www.loc.gov/standards/mets/mets.xsd" OBJID="&#xa;&#x9;&#x9;&#x9;&#x9;hdl:20.500.12105/23529">
   <metsHdr CREATEDATE="2026-06-14T04:08:02Z">
      <agent ROLE="CUSTODIAN" TYPE="ORGANIZATION">
         <name>Repisalud</name>
      </agent>
   </metsHdr>
   <dmdSec ID="DMD_20.500.12105_23529">
      <mdWrap MDTYPE="MODS">
         <xmlData xmlns:mods="http://www.loc.gov/mods/v3" xsi:schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-1.xsd">
            <mods:mods xsi:schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-1.xsd">
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Leving, Marika T</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>van Boven, Job FM</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Bosnic-Anticevich, Sinthia Z</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>van Cooten, Joyce</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Correia de Sousa, Jaime</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Cvetkovski, Biljana</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Dekhuijzen, Richard</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Dijk, Lars</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Garcia Pardo, Marina</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Gardev, Asparuh</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Gawlik, Radosław</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>van der Ham, Iris</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Hartgers-Gubbels, Elisabeth Sophia</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Janse, Ymke</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Lavorini, Federico</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Maricoto, Tiago</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Meijer, Jiska</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Metz, Boyd</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Price, David B</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Roman-Rodriguez, Miguel</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Schuttel, Kirsten</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Stoker, Nilouq</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Tsiligianni, Ioanna</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Usmani, Omar</mods:namePart>
               </mods:name>
               <mods:name>
                  <mods:role>
                     <mods:roleTerm type="text">author</mods:roleTerm>
                  </mods:role>
                  <mods:namePart>Kocks, Janwillem H</mods:namePart>
               </mods:name>
               <mods:extension>
                  <mods:dateAccessioned encoding="iso8601">2024-10-04T13:57:57Z</mods:dateAccessioned>
               </mods:extension>
               <mods:extension>
                  <mods:dateAvailable encoding="iso8601">2024-10-04T13:57:57Z</mods:dateAvailable>
               </mods:extension>
               <mods:originInfo>
                  <mods:dateIssued encoding="iso8601">2022</mods:dateIssued>
               </mods:originInfo>
               <mods:identifier type="citation">Leving MT, van Boven JF, Bosnic-Anticevich SZ, van Cooten J, Correia de Sousa J, Cvetkovski B, et al. Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs. Int J Chron Obstruct Pulmon Dis. 2022 Sep;Volume 17:2401-15.</mods:identifier>
               <mods:identifier type="doi">10.2147/COPD.S380736</mods:identifier>
               <mods:identifier type="e-issn">1178-2005</mods:identifier>
               <mods:identifier type="journal">International journal of chronic obstructive pulmonary disease</mods:identifier>
               <mods:identifier type="other">http://hdl.handle.net/20.500.13003/18231</mods:identifier>
               <mods:identifier type="pubmedID">36185173</mods:identifier>
               <mods:identifier type="pui">L2018087771</mods:identifier>
               <mods:identifier type="scopus">2-s2.0-85138903587</mods:identifier>
               <mods:identifier type="uri">https://hdl.handle.net/20.500.12105/23529</mods:identifier>
               <mods:identifier type="wos">864663600001</mods:identifier>
               <mods:abstract>Purpose: To assess the relationship between suboptimal Peak Inspiratory Flow (sPIF), inhalation technique errors, and non-adherence, with Healthcare Resource Utilisation (HCRU) in Chronic Obstructive Pulmonary Disease (COPD) patients receiving maintenance therapy via a Dry Powder Inhaler (DPI). Patients and methods: The cross-sectional, multi-country PIFotal study included 1434 COPD patients (≥40 years) using a DPI for maintenance therapy. PIF was measured with the In-Check DIAL G16, and sPIF was defined as a typical PIF lower than required for the device. Inhalation technique was assessed by standardised evaluation of video recordings and grouped into 10 steps. Patients completed the "Test of Adherence to Inhalers" questionnaire. HCRU was operationalised as COPD-related costs for primary healthcare, secondary healthcare, medication, and total COPD-related costs in a 1-year period. Results: Participants with sPIF had higher medication costs compared with those with optimal PIF (cost ratio [CR]: 1.07, 95% CI [1.01, 1.14]). Multiple inhalation technique errors were associated with increased HCRU. Specifically, "insufficient inspiratory effort" with higher secondary healthcare costs (CR: 2.20, 95% CI [1.37, 3.54]) and higher total COPD-related costs (CR: 1.16, 95% CI 1.03-1.31). "no breath-hold following the inhalation manoeuvre (&lt;6 s)" with higher medication costs (CR: 1.08, 95% CI [1.02, 1.15]) and total COPD-related costs (CR 1.17, 95% CI [1.07, 1.28]), and "not breathing out calmly after inhalation" with higher medication costs (CR: 1.19, 95% CI [1.04, 1.37]). Non-adherence was not significantly associated with HCRU. Conclusion: sPIF and inhalation technique errors were associated with higher COPD-related healthcare utilisation and costs in COPD patients on DPI maintenance therapy.</mods:abstract>
               <mods:language>
                  <mods:languageTerm authority="rfc3066">eng</mods:languageTerm>
               </mods:language>
               <mods:accessCondition type="useAndReproduction"/>
               <mods:titleInfo>
                  <mods:title>Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs</mods:title>
               </mods:titleInfo>
               <mods:genre>research article</mods:genre>
            </mods:mods>
         </xmlData>
      </mdWrap>
   </dmdSec>
   <structMap LABEL="DSpace Object" TYPE="LOGICAL">
      <div TYPE="DSpace Object Contents" ADMID="DMD_20.500.12105_23529"/>
   </structMap>
</mets></metadata></record></GetRecord></OAI-PMH>