Impact of Preliminary Bronchodilator Dose in Chronic Obstructive Pulmonary Disease Patients With Suboptimal Peak Inspiratory Flow.

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY Clinical therapeutics Pub Date : 2024-09-30 DOI:10.1016/j.clinthera.2024.09.016

Mohamed Ismail Hassan, Nabila Ibrahim Laz, Yasmin M Madney, Mohamed E A Abdelrahim, Hadeer S Harb

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Abstract

Purpose: Suboptimal peak inspiratory flow rate (PIFR) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) owing to the mismatch of their PIFR with the corresponding inhaler-device resistance. This study aimed to investigate the impact of a preliminary dose of pressurized metered dose inhalers (pMDIs) on patients with COPD with suboptimal PIFR using Diskus dry powder inhalers (DPIs).

Methods: A prospective, randomized, case-control study included 24 patients with COPD. PIFR was measured using the In-Check Dial G16 with low-to-medium resistance. Spirodoc was used to measure baseline spirometric data and compare it before and 30 minutes after the administration of Diskus DPI. On a different day, the study dose was given to each suboptimal patient by the same aerosol generator with preceded 2 puffs of salbutamol pMDI and re-evaluated for spirometric parameters 30 minutes after the study dose.

Findings: There was a significant difference between the optimal and suboptimal groups in peak expiratory flow (2.38 ± 1.20 vs 1.49 ± 1.06 L/s, P = 0.050). PIFR showed a statistically significant difference between the optimal and suboptimal groups (71.66 ± 6.15 vs 41.25 ± 9.79 L/min, P < 0.0001). There was a significant difference in forced vital capacity (ΔFVC) between optimal and suboptimal groups without a preliminary dose (0.42 ± 0.21 vs 0.16 ± 0.11 L, P = 0.002), forced expiratory volume in 6 seconds (ΔFEV₆) (0.53 ± 0.49 vs 0.17 ± 0.11 L, P = 0.022), forced expiratory volume in 3 seconds (ΔFEV₃) (0.41 ± 0.38 vs 0.1 ± 0.16 L, P = 0.013), forced expiratory volume in 1 second (ΔFEV₁)/FVC (-2.38 ± 8.41 vs 2.96% ± 2.95%, P = 0.033), and ΔFEV₁/FEV₆ (-4.32 ± 11.23 vs 2.91% ± 4.35%, P = 0.015). There was a significant difference in ΔFVC between optimal and suboptimal groups with a preliminary dose (0.42 ± 0.21 vs 0.23 ± 0.18 L, P = 0.046), ΔFEV₁/FVC (-2.38 ± 8.41 vs 5.67% ± 6.53%, P = 0.009), ΔFEV₁/FEV₆ (-4.32 ± 11.23 vs 5.16% ± 4.99%, P = 0.008), and forced expiratory time (ΔFET) (0.28 ± 0.45 vs -0.31 ± 0.70 seconds, P = 0.022). The only parameter that showed a significant difference between suboptimal groups without and with a preliminary dose is Δ peak expiratory flow (0.24 ± 0.59 vs 0.65 ± 0.68 L/s, P = 0.004).

Implications: Administering a preliminary dose of pMDI can minimally enhance the effectiveness of DPIs in patients with COPD with suboptimal PIFR and health outcomes.

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支气管扩张剂初步剂量对峰值吸气流量不达标的慢性阻塞性肺病患者的影响

目的：由于慢性阻塞性肺病（COPD）患者的吸入峰流速（PIFR）与相应的吸入器-设备阻力不匹配，因此在慢性阻塞性肺病（COPD）患者中普遍存在吸入峰流速不达标的情况。本研究旨在探讨初步剂量的加压计量吸入器（pMDIs）对使用 Diskus 干粉吸入器（DPIs）且 PIFR 不达标的慢性阻塞性肺病患者的影响：一项前瞻性随机病例对照研究纳入了 24 名慢性阻塞性肺病患者。使用中低阻力的 In-Check Dial G16 测量 PIFR。Spirodoc 用于测量基线肺活量数据，并在服用 Diskus DPI 之前和之后 30 分钟进行比较。在不同的一天，用相同的气雾发生器给每个次优患者注射研究剂量，并在注射研究剂量后 30 分钟重新评估肺活量参数：最佳组和次优组的呼气流量峰值有明显差异（2.38 ± 1.20 vs 1.49 ± 1.06 L/s，P = 0.050）。最佳组和次优组的 PIFR 差异有统计学意义（71.66 ± 6.15 vs 41.25 ± 9.79 L/min，P < 0.0001）。最佳组和次优组的强迫生命容量（ΔFVC）在无初步剂量（0.42 ± 0.21 vs 0.16 ± 0.11 L，P = 0.002）、6 秒内强迫呼气量（ΔFEV6）（0.53 ± 0.49 vs 0.17 ± 0.11 L，P = 0.022）、3 秒内用力呼气容积（ΔFEV3）（0.41 ± 0.38 vs 0.1 ± 0.16 L，P = 0.013）、1 秒内用力呼气容积（ΔFEV1）/FVC（-2.38 ± 8.41 vs 2.96% ± 2.95%，P = 0.033）和 ΔFEV1/FEV6（-4.32 ± 11.23 vs 2.91% ± 4.35%，P = 0.015）。初步剂量的最佳组和次优组之间的ΔFVC（0.42 ± 0.21 vs 0.23 ± 0.18 L，P = 0.046）、ΔFEV1/FVC（-2.38 ± 8.41 vs 5.67% ± 6.53%，P = 0.009）、ΔFEV1/FEV6（-4.32 ± 11.23 vs 5.16% ± 4.99%，P = 0.008）和用力呼气时间（ΔFET）（0.28 ± 0.45 vs -0.31 ± 0.70 秒，P = 0.022）。在未使用和使用初步剂量的次优组之间，唯一显示出显著差异的参数是Δ呼气峰流速（0.24 ± 0.59 vs 0.65 ± 0.68 L/s，P = 0.004）：意义：给慢性阻塞性肺病患者施用初步剂量的 pMDI 可在最小程度上提高 DPIs 的疗效，从而改善患者的 PIFR 和健康状况。

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.