专业慢性阻塞性肺病临床项目中的峰值吸入流量和吸入器处方策略:真实世界观察研究

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2024-10-09 DOI:10.1016/j.chest.2024.09.031
Sarah Pankovitch, Michael Frohlich, Bader AlOthman, Jeffrey Marciniuk, Joanie Bernier, Dorcas Paul-Emile, Jean Bourbeau, Bryan A Ross
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引用次数: 0

摘要

背景:慢性阻塞性肺病吸入器治疗方案应与患者的吸气峰值流量(PIF)相适应,最好由单一或类似装置组成:研究问题:在慢性阻塞性肺疾病亚专科门诊中:研究问题:在慢性阻塞性肺疾病专科门诊中:1:PIF 不达标和使用不合适的设备测量 PIF 的患者比例是多少?2:是否存在与患者相关的风险因素导致 PIF 不达标?3: 使用非单一吸入器疗法(SIT)/非类似设备的患者比例是多少?4:护理点 PIF 是否会影响临床决策?在这项单中心真实世界观察性研究中,慢性阻塞性肺疾病亚专科门诊在每次门诊时都会对 PIF 进行系统测量,并向临床医生提供护理点结果。共同主要结果是门诊患者中 PIF 不达标和使用不适当设备测量 PIF 的比例。次要结果是与次优 PIF 相关的患者相关风险因素、非 SIT/非相似设备的患病率、由用于测量 PIF 的不适当设备和/或非 SIT/非相似设备组成的治疗方案的患病率,以及护理点 PIF 对临床决策的影响:结果:161 名参与者中有 45 人(28%)发现了 PIF 不达标,18 人(11.2%)发现了用于测量 PIF 的不适当设备。观察发现,PIF 不达标与年龄(1.09 [1.04,1.15])、女性性别(10.30 [4.45,27.10])、身高(0.92 [0.88,0.96])、体重指数(0.90 [0.84,0.96])和 FEV1(0.09 [0.03,0.26])之间存在显著关联。在对年龄和性别进行调整后,次优 PIF 与体重指数(BMI)(而非身高)之间的关系仍然显著。有 50 名参与者(31.1%)发现了非 SIT 和/或非类似装置。59名参与者(36.6%)的治疗方案中使用了不适合测量PIF的设备和/或非SIT/非类似设备。在后一组患者(3.39 [1.76,6.64])以及已使用 SIT/类似方案的 PIF 不达标的患者(2.93 [1.07,7.92])中观察到了吸入器处方的变化:在慢性阻塞性肺疾病专科门诊的门诊患者中,PIF不达标和测量PIF的设备不合适的情况非常普遍。女性性别、FEV1降低和低体重指数是导致PIF不达标的重要且易于识别的风险因素,而护理点PIF可为临床决策提供依据。
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Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study.

Background: COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s).

Research questions: In a subspecialized COPD clinic: (1) What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? (2) Are there patient-related risk factors associated with suboptimal PIF? (3) What is the prevalence of patients with non-single inhaler therapy (SIT)/nonsimilar devices? (4) Does point-of-care PIF affect clinical decision-making?

Study design and methods: In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic, and point-of-care results were provided to the clinician. Coprimary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF. Secondary outcomes were patient-related risk factors associated with suboptimal PIF, the prevalence of non-SIT/nonsimilar devices, the prevalence of regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices, and the effect of point-of-care PIF on clinical decision-making.

Results: Suboptimal PIF was identified in 45 of 161 participants (28%), and inappropriate device(s) for measured PIF were identified in 18 participants (11.2%). Significant associations were observed between suboptimal PIF and age (1.09; 95% CI, 1.04-1.15), female sex (10.30; 95% CI, 4.45-27.10), height (0.92; 95% CI, 0.88-0.96), BMI (0.90; 95% CI, 0.84-0.96), and FEV1 (0.09; 95% CI, 0.03-0.26). After adjustment for age and sex, the association between suboptimal PIF and BMI, but not height, remained significant. Non-SIT and/or nonsimilar devices were identified in 50 participants (31.1%). Regimens consisting of either inappropriate device(s) for measured PIF and/or non-SIT/nonsimilar devices were observed in 59 participants (36.6%). Inhaler prescription changes were observed in this latter group (3.39; 95% CI, 1.76-6.64), as well as in patients with suboptimal PIF who already had SIT/similar regimens (2.93; 95% CI, 1.07-7.92).

Interpretation: Suboptimal PIF and inappropriate devices for measured PIF are highly prevalent among outpatients from a subspecialized COPD clinic. Female sex, reduced FEV1, and low BMI are important, readily identifiable risk factors for suboptimal PIF, and point-of-care PIF can inform clinical decision-making.

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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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