Suboptimal Inspiratory Flow Rates Are Associated with Chronic Obstructive Pulmonary Disease and All-Cause Readmissions

Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery. To study the impact of PIF on readmission after hospitalization for AECOPD. A retrospective analysis of hospitalized patients, enrolled in an AEC...

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Published in:	Annals of the American Thoracic Society Vol. 14; no. 8; pp. 1305 - 1311
Main Authors:	Loh, Chee H., Peters, Stephen P., Lovings, Tina M., Ohar, Jill A.
Format:	Journal Article
Language:	English
Published:	United States American Thoracic Society 01.08.2017
Subjects:	Acute Disease Administration, Inhalation Age Aged Asthma Chronic obstructive pulmonary disease Comorbidity Disease Progression Drug dosages Female Forced Expiratory Volume Hospitalization Hospitals Humans Inspiratory Capacity Male Middle Aged Multivariate Analysis Nebulizers and Vaporizers North Carolina Patient Readmission - statistics & numerical data Patients Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - physiopathology Quality of life Regression Analysis Respiratory therapy Retrospective Studies Studies chronic obstructive pulmonary disease exacerbation peak inspiratory flow rate nebulizers readmission peak inspiratory flow
ISSN:	2329-6933, 2325-6621, 2325-6621
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Abstract	Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery. To study the impact of PIF on readmission after hospitalization for AECOPD. A retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, sex, length of stay, Charlson Comorbidity Index, COPD Assessment Test score, modified Medical Research Council score, percent predicted FEV , FVC, and inspiratory capacity. A PIF equal to and less than 60 L/min was defined as suboptimal (sPIF). Outcome measures included 30- and 90-day COPD and all-cause readmissions, and days to next COPD and all-cause readmissions. Of the 123 subjects, 52% (n = 64) had sPIF. They had greater COPD Assessment Test scores (29.1 ± 5.9 vs. 25.3 ± 8.7; P = 0.0073), rates of 90-day COPD readmissions (28.1 vs. 13.6%; P = 0.048), fewer median days to COPD (63.5 [interquartile range (IQR), 21-89.8] vs. 144 [IQR, 66-218]; P = 0.002) and all-cause readmissions (65.5 [IQR, 24.3-107.3] vs. 101 [IQR, 54.5-205.5]; P = 0.009). PIF was the only variable (P = 0.041) that predicted days to COPD readmission in a multivariate model incorporating age, sex, percent predicted FEV , Charlson Comorbidity Index, and inspiratory flow group. In a group of patients with sPIF (n = 22), all-cause and COPD 30- and 90-day readmission rates were significantly lower for those discharged with nebulizer compared with DPI therapy. sPIF is common during AECOPD and predicts all-cause and COPD readmissions. Patients with sPIF may benefit from nebulized therapies. We recommend checking PIF in patients hospitalized for AECOPD for selection of delivery devices.
AbstractList	Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery.RATIONALEDry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery.To study the impact of PIF on readmission after hospitalization for AECOPD.OBJECTIVESTo study the impact of PIF on readmission after hospitalization for AECOPD.A retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, sex, length of stay, Charlson Comorbidity Index, COPD Assessment Test score, modified Medical Research Council score, percent predicted FEV1, FVC, and inspiratory capacity. A PIF equal to and less than 60 L/min was defined as suboptimal (sPIF). Outcome measures included 30- and 90-day COPD and all-cause readmissions, and days to next COPD and all-cause readmissions.METHODSA retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, sex, length of stay, Charlson Comorbidity Index, COPD Assessment Test score, modified Medical Research Council score, percent predicted FEV1, FVC, and inspiratory capacity. A PIF equal to and less than 60 L/min was defined as suboptimal (sPIF). Outcome measures included 30- and 90-day COPD and all-cause readmissions, and days to next COPD and all-cause readmissions.Of the 123 subjects, 52% (n = 64) had sPIF. They had greater COPD Assessment Test scores (29.1 ± 5.9 vs. 25.3 ± 8.7; P = 0.0073), rates of 90-day COPD readmissions (28.1 vs. 13.6%; P = 0.048), fewer median days to COPD (63.5 [interquartile range (IQR), 21-89.8] vs. 144 [IQR, 66-218]; P = 0.002) and all-cause readmissions (65.5 [IQR, 24.3-107.3] vs. 101 [IQR, 54.5-205.5]; P = 0.009). PIF was the only variable (P = 0.041) that predicted days to COPD readmission in a multivariate model incorporating age, sex, percent predicted FEV1, Charlson Comorbidity Index, and inspiratory flow group. In a group of patients with sPIF (n = 22), all-cause and COPD 30- and 90-day readmission rates were significantly lower for those discharged with nebulizer compared with DPI therapy.RESULTSOf the 123 subjects, 52% (n = 64) had sPIF. They had greater COPD Assessment Test scores (29.1 ± 5.9 vs. 25.3 ± 8.7; P = 0.0073), rates of 90-day COPD readmissions (28.1 vs. 13.6%; P = 0.048), fewer median days to COPD (63.5 [interquartile range (IQR), 21-89.8] vs. 144 [IQR, 66-218]; P = 0.002) and all-cause readmissions (65.5 [IQR, 24.3-107.3] vs. 101 [IQR, 54.5-205.5]; P = 0.009). PIF was the only variable (P = 0.041) that predicted days to COPD readmission in a multivariate model incorporating age, sex, percent predicted FEV1, Charlson Comorbidity Index, and inspiratory flow group. In a group of patients with sPIF (n = 22), all-cause and COPD 30- and 90-day readmission rates were significantly lower for those discharged with nebulizer compared with DPI therapy.sPIF is common during AECOPD and predicts all-cause and COPD readmissions. Patients with sPIF may benefit from nebulized therapies. We recommend checking PIF in patients hospitalized for AECOPD for selection of delivery devices.CONCLUSIONSsPIF is common during AECOPD and predicts all-cause and COPD readmissions. Patients with sPIF may benefit from nebulized therapies. We recommend checking PIF in patients hospitalized for AECOPD for selection of delivery devices. Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery. To study the impact of PIF on readmission after hospitalization for AECOPD. A retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, sex, length of stay, Charlson Comorbidity Index, COPD Assessment Test score, modified Medical Research Council score, percent predicted FEV , FVC, and inspiratory capacity. A PIF equal to and less than 60 L/min was defined as suboptimal (sPIF). Outcome measures included 30- and 90-day COPD and all-cause readmissions, and days to next COPD and all-cause readmissions. Of the 123 subjects, 52% (n = 64) had sPIF. They had greater COPD Assessment Test scores (29.1 ± 5.9 vs. 25.3 ± 8.7; P = 0.0073), rates of 90-day COPD readmissions (28.1 vs. 13.6%; P = 0.048), fewer median days to COPD (63.5 [interquartile range (IQR), 21-89.8] vs. 144 [IQR, 66-218]; P = 0.002) and all-cause readmissions (65.5 [IQR, 24.3-107.3] vs. 101 [IQR, 54.5-205.5]; P = 0.009). PIF was the only variable (P = 0.041) that predicted days to COPD readmission in a multivariate model incorporating age, sex, percent predicted FEV , Charlson Comorbidity Index, and inspiratory flow group. In a group of patients with sPIF (n = 22), all-cause and COPD 30- and 90-day readmission rates were significantly lower for those discharged with nebulizer compared with DPI therapy. sPIF is common during AECOPD and predicts all-cause and COPD readmissions. Patients with sPIF may benefit from nebulized therapies. We recommend checking PIF in patients hospitalized for AECOPD for selection of delivery devices. DPIs generally require an initial fast inhalation to generate turbulent flow that breaks up weak bonds between drug particles and their inert carriers, thus generating fine particles (less than 5 mm in diameter) that are ideal for deposition in the lower respiratory tract (4). [...]DPI delivery is dependent on peak inspiratory flow (PIF). According to the care plan, patients were discharged with triple bronchodilator therapy that included an inhaled corticosteroid (ICS) and ß-adrenergic (long-acting ß-agonist [LABA]) and anticholinergic (long-acting muscarinic antagonist [LAMA]) drugs. [...]using a 30-day readmission end point may not demonstrate a difference if a patient with sPIF is readmitted outside this relatively short-term end point. [...]our methods preclude easy comparison with previously published studies.
Author	Peters, Stephen P. Loh, Chee H. Ohar, Jill A. Lovings, Tina M.
Author_xml	– sequence: 1 givenname: Chee H. orcidid: 0000-0002-2232-2057 surname: Loh fullname: Loh, Chee H. organization: Wake Forest School of Medicine Medical Center, Winston Salem, North Carolina – sequence: 2 givenname: Stephen P. surname: Peters fullname: Peters, Stephen P. organization: Wake Forest School of Medicine Medical Center, Winston Salem, North Carolina – sequence: 3 givenname: Tina M. surname: Lovings fullname: Lovings, Tina M. organization: Wake Forest School of Medicine Medical Center, Winston Salem, North Carolina – sequence: 4 givenname: Jill A. surname: Ohar fullname: Ohar, Jill A. organization: Wake Forest School of Medicine Medical Center, Winston Salem, North Carolina
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Snippet	Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery. To... DPIs generally require an initial fast inhalation to generate turbulent flow that breaks up weak bonds between drug particles and their inert carriers, thus... Dry powder inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI...
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SubjectTerms	Acute Disease Administration, Inhalation Age Aged Asthma Chronic obstructive pulmonary disease Comorbidity Disease Progression Drug dosages Female Forced Expiratory Volume Hospitalization Hospitals Humans Inspiratory Capacity Male Middle Aged Multivariate Analysis Nebulizers and Vaporizers North Carolina Patient Readmission - statistics & numerical data Patients Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - physiopathology Quality of life Regression Analysis Respiratory therapy Retrospective Studies Studies
Title	Suboptimal Inspiratory Flow Rates Are Associated with Chronic Obstructive Pulmonary Disease and All-Cause Readmissions
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