title: Investigating the relationship between peak inspiratory flow rate and volume of inhalation from a Diskus™ Inhaler and baseline spirometric parameters: a cross-sectional study.
abstract: Drug delivery from a Dry Powder Inhaler (DPI) is dependent on the peak inspiratory flow rate (PIFR) generated. Currently available methods for estimating PIFR from most DPIs are limited and mainly rely on subjective assessment. We aim to show that spirometric and Diskus™ PIFR and Inspiratory Vital Capacity (IVC) are related to the underlying respiratory condition and that spirometric PIFR can be used to assess whether Diskus™ PIFR will be adequate when using this DPI. Healthy volunteers and patients with asthma, COPD, neuromuscular disease and non-respiratory disorders were recruited (n = 85). Demographics and baseline lung function by spirometry were recorded. Flow and volume readings were taken while patients used a Diskus™ DPI, housed in an airtight container connected to a spirometer. T-tests were performed to compare mean spirometric and Diskus™ PIFR/ IVC between groups. Stepwise regression analysis of Diskus™ PIFR versus spirometric PIFR, spirometric IVC, age, gender, condition, BMI, FEV1 and FVC was performed. The Diskus™ PIFR for the COPD and Neuromuscular Disease group was more than 10 L/min lower than the Healthy or Asthma groups (p < 0.05). The mean spirometric and Diskus™ IVC of the Healthy group was significantly (>0.75 L) higher than the mean for the other three groups (p < 0.05). Diskus™ PIFR was moderately correlated with spirometric PIFR and age (Adjusted R(2) = 0.58, p < 0.0001). PIFR generated using a Diskus™ DPI is dependent on the underlying disease and age. A spirometric PIFR of less than 196 L/min should prompt further investigation into the suitability of a patient for a Diskus™ DPI, with possible consideration of alternate devices.
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Jansen N
authors.initials: JN
authors.lastname: Seheult
authors.affiliation: School of Mathematics, Trinity College Dublin, Dublin, Ireland.
authors.forename: Simon
authors.initials: S
authors.lastname: Costello
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Kee Chun
authors.initials: KC
authors.lastname: Tee
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Tariq
authors.initials: T
authors.lastname: Bholah
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Hasan
authors.initials: H
authors.lastname: Al Bannai
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Imran
authors.initials: I
authors.lastname: Sulaiman
authors.affiliation: Department of Medicine Respiratory Research Division, RCSI-Beaumont Hospital, Beaumont Road, Dublin, Ireland.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Costello
keywords: Aerosol delivery; Dry powder inhaler; Inhaler technique; Peak inspiratory flow rate