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Распространенность и предикторы субоптимальных значений пикового инспираторного потока при использовании дозированных порошковых ингаляторов у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких
Распространенность и предикторы субоптимальных значений пикового инспираторного потока при использовании дозированных порошковых ингаляторов у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких
Лавгинова Б.Б., Трушенко Н.В., Неклюдова Г.В., Белкина О.С., Авдеев С.Н. Распространенность и предикторы субоптимальных значений пикового инспираторного потока при использовании дозированных порошковых ингаляторов у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких. Терапевтический архив. 2026;98(1):35–42. DOI: 10.26442/00403660.2026.01.203558
© ООО «КОНСИЛИУМ МЕДИКУМ», 2026 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2026 г.
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Аннотация
Обоснование. Одним из ключевых условий эффективного использования дозированных порошковых ингаляторов (ДПИ) является достаточное инспираторное усилие пациента, которое можно оценить по уровню пикового инспираторного потока (ПИП).
Цель. Изучить распространенность и предикторы развития субоптимальных для ДПИ значений ПИП у пациентов с хронической обструктивной болезнью легких (ХОБЛ) и бронхиальной астмой (БА) в амбулаторной практике.
Материалы и методы. В исследование включались больные БА и ХОБЛ, использующие в качестве базисной терапии ДПИ. Значение ПИП оценивалось с помощью портативного инспираторного флоуметра In-Check DIAL G16® на уровне сопротивления соответствующего ДПИ, используемого пациентом, исходно и после объяснения правильной техники ингаляций при БА и ХОБЛ. С целью определения предикторов субоптимального ПИП оценивали основные клинические показатели и параметры комплексного исследования функции дыхания.
Результаты. В исследование вошли 61 пациент с БА и 30 пациентов с ХОБЛ. Доля пациентов с субоптимальными показателями ПИП исходно составляла 34% в группе БА и 63% – в группе ХОБЛ. После обучения правильной технике ингаляции доля пациентов с субоптимальным ПИП значительно снизилась в обеих группах: до 10% в группе БА и до 23% – в группе ХОБЛ (p<0,0001). Наиболее значимыми факторами, существенно ограничивающими вероятность достижения у пациента оптимального ПИП, необходимого для эффективного использования ДПИ, стали возраст ≥60 лет, форсированная жизненная емкость легких ≤70%долж. и объем форсированного выдоха за 1-ю секунду ≤45%долж.
Заключение. Многие пациенты имели недостаточную силу вдоха для эффективного применения ДПИ из-за ошибок в технике ингаляций или возрастных/функциональных ограничений. Измерение ПИП перед назначением ДПИ позволяет объективно оценить возможность его использования и повысить эффективность терапии.
Ключевые слова: пиковый инспираторный поток, техника ингаляций, дозированные порошковые ингаляторы, бронхиальная астма, хроническая обструктивная болезнь легких
Aim. To assess the prevalence of suboptimal PIF values, and identify factors significantly affecting PIF in pulmonary disease (COPD) and asthma outpatients.
Materials and methods. The study enrolled asthma and COPD patients using DPIs for maintenance therapy. PIF was measured using In-Check DIAL G16® at resistance levels matching each patient's DPI, both before and after proper inhalation technique training. Clinical and functional parameters were evaluated to identify predictors of suboptimal PIF.
Results. The study included 61 asthma and 30 COPD patients. Baseline suboptimal PIF rates were 34% (asthma) and 63% (COPD). After training, these decreased significantly to 10% (asthma) and 23% (COPD); p<0.0001. Key limiting factors for achieving optimal PIF were age ≥60 years, FVC≤70% predicted, and FEV1≤45% predicted.
Conclusion. Many patients had insufficient inspiratory flow for effective DPI use due to technique errors or age/functional limitations. Pre-prescription PIF measurement objectively evaluates DPI suitability and enhances treatment efficacy.
Keywords: peak inspiratory flow, inhalation technique, dry powder inhalers, bronchial asthma, chronic obstructive pulmonary disease
Цель. Изучить распространенность и предикторы развития субоптимальных для ДПИ значений ПИП у пациентов с хронической обструктивной болезнью легких (ХОБЛ) и бронхиальной астмой (БА) в амбулаторной практике.
Материалы и методы. В исследование включались больные БА и ХОБЛ, использующие в качестве базисной терапии ДПИ. Значение ПИП оценивалось с помощью портативного инспираторного флоуметра In-Check DIAL G16® на уровне сопротивления соответствующего ДПИ, используемого пациентом, исходно и после объяснения правильной техники ингаляций при БА и ХОБЛ. С целью определения предикторов субоптимального ПИП оценивали основные клинические показатели и параметры комплексного исследования функции дыхания.
Результаты. В исследование вошли 61 пациент с БА и 30 пациентов с ХОБЛ. Доля пациентов с субоптимальными показателями ПИП исходно составляла 34% в группе БА и 63% – в группе ХОБЛ. После обучения правильной технике ингаляции доля пациентов с субоптимальным ПИП значительно снизилась в обеих группах: до 10% в группе БА и до 23% – в группе ХОБЛ (p<0,0001). Наиболее значимыми факторами, существенно ограничивающими вероятность достижения у пациента оптимального ПИП, необходимого для эффективного использования ДПИ, стали возраст ≥60 лет, форсированная жизненная емкость легких ≤70%долж. и объем форсированного выдоха за 1-ю секунду ≤45%долж.
Заключение. Многие пациенты имели недостаточную силу вдоха для эффективного применения ДПИ из-за ошибок в технике ингаляций или возрастных/функциональных ограничений. Измерение ПИП перед назначением ДПИ позволяет объективно оценить возможность его использования и повысить эффективность терапии.
Ключевые слова: пиковый инспираторный поток, техника ингаляций, дозированные порошковые ингаляторы, бронхиальная астма, хроническая обструктивная болезнь легких
________________________________________________
Aim. To assess the prevalence of suboptimal PIF values, and identify factors significantly affecting PIF in pulmonary disease (COPD) and asthma outpatients.
Materials and methods. The study enrolled asthma and COPD patients using DPIs for maintenance therapy. PIF was measured using In-Check DIAL G16® at resistance levels matching each patient's DPI, both before and after proper inhalation technique training. Clinical and functional parameters were evaluated to identify predictors of suboptimal PIF.
Results. The study included 61 asthma and 30 COPD patients. Baseline suboptimal PIF rates were 34% (asthma) and 63% (COPD). After training, these decreased significantly to 10% (asthma) and 23% (COPD); p<0.0001. Key limiting factors for achieving optimal PIF were age ≥60 years, FVC≤70% predicted, and FEV1≤45% predicted.
Conclusion. Many patients had insufficient inspiratory flow for effective DPI use due to technique errors or age/functional limitations. Pre-prescription PIF measurement objectively evaluates DPI suitability and enhances treatment efficacy.
Keywords: peak inspiratory flow, inhalation technique, dry powder inhalers, bronchial asthma, chronic obstructive pulmonary disease
Полный текст
Список литературы
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14. Silva CPD, Cordeiro JSA, Britto MCA, et al. Peak inspiratory flow in children and adolescents with asthma using dry powder inhalers: a cross-sectional study. J Bras Pneumol. 2021;47(3):e20200473. DOI:10.36416/1806-3756/e20200473
15. Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142-52. DOI:10.1089/jamp.2015.1212
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18. Pankovitch S, Frohlich M, AlOthman B, et al. Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study. Chest. 2024;167(3):736-45. DOI:10.1016/j.chest.2024.09.031
19. González-Montaos A, Pazos-Area L, Represas-Represas C, et al. Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors. J Aerosol Med Pulm Drug Deliv. 2024;37(5):225-31. DOI:10.1089/jamp.2024.0002
20. Trushenko NV, Lavginova BB, Chikina SY, et al. Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice. Tuberc Respir Dis (Seoul). 2025;88(3):516-25. DOI:10.4046/trd.2024.0154
21. Kuek SL, Wong NX, Dalziel S, et al. Dry-powder inhaler use in primary school-aged children with asthma: a systematic review. ERJ Open Res. 2024;10(6):455-2024. DOI:10.1183/23120541.00455-2024
22. Murugaiya S, Murugesan BSP. Prevalence and Factors Affecting the Optimal and Non-optimal Peak Inspiratory Flow Rate in Stable and Exacerbation Phases of Chronic Obstructive Pulmonary Disease and Bronchial Asthma in India. Cureus. 2024;16(4):e58670. DOI:10.7759/cureus.58670
23. Haughney J, Lee AJ, McKnight E, et al. Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma. J Allergy Clin Immunol Pract. 202;9(2):890-6. DOI:10.1016/j.jaip.2020.09.026
24. Mohd Rhazi NA, Muneswarao J, Abdul Aziz F, et al. Can patients achieve sufficient peak inspiratory flow rate (PIFR) with Turbuhaler® during acute exacerbation of asthma? J Asthma. 2023;60(8):1608-12. DOI:10.1080/02770903.2023.2169930
25. Kocks J, Wouters H, Bosnic-Anticevich S, et al. Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med. 2022;32(1):18. DOI:10.1038/s41533-022-00282-y
26. Azouz W, Chetcuti P, Hosker H, et al. Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study. BMC Pulm Med. 2015;15:47. DOI:10.1186/s12890-015-0043-x
27. Malmberg LP, Rytila P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257-62. DOI:10.2147/copd.s11474
28. Davidson HE, Radlowski P, Han L, et al. Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease. Sr Care Pharm. 2021;36:248-57. DOI:10.4140/TCP.n.2021.248
29. Sharma G, Mahler DA, Mayorga VM, et al. Prevalence of Low Peak Inspiratory Flow Rate at Discharge in Patients Hospitalized for COPD Exacerbation. Chronic Obstr Pulm Dis. 2017;4(3):217-24. DOI:10.15326/jcopdf.4.3.2017.0183
30. Ding N, Zhang W, Wang Z, et al. Prevalence and Associated Factors of Suboptimal Daily Peak Inspiratory Flow and Technique Misuse of Dry Powder Inhalers in Outpatients with Stable Chronic Airway Diseases. Int J Chron Obstruct Pulmon Dis. 2021;16:1913-24. DOI:10.2147/COPD.S311178
31. Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus® dry powder inhaler. J Aerosol Med Pulm Drug Deliv. 2013;26(3):174-9. DOI:10.1089/jamp.2012.0987
32. Harb HS, Laz NI, Rabea H, Abdelrahim MEA. Prevalence and predictors of suboptimal peak inspiratory flow rate in COPD patients. Eur J Pharm Sci. 2020;147:105298. DOI:10.1016/j.ejps.2020.105298
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34. Duarte AG, Tung L, Zhang W, et al. Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD. Chronic Obstr Pulm Dis. 2019;6(3):246-55. DOI:10.15326/jcopdf.6.3.2018.0163
35. Represas-Represas C, Aballe-Santos L, Fernández-García A, et al. Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD. J Clin Med. 2020;9(12):3949. DOI:10.3390/jcm9123949
2. Lannefors L. Inhalation therapy: practical considerations for nebulisation therapy. Physic TherRev. 2006;11:21-7. DOI:10.1179/108331906X98976
3. Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic Obstr Pulm Dis. 2019;6(3):267-80. DOI:10.15326/jcopdf.6.3.2018.0168.
4. Çakmaklı S, Özdemir A, Fırat H, Aypak C. An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease. J Taibah Univ Med Sci. 2023;18(4):860-7. DOI:10.1016/j.jtumed.2023.01.001
5. Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50(9):1209-27.
6. Mohan AR, Wang Q, Dhapare S, et al. Advancements in the Design and Development of Dry Powder Inhalers and Potential Implications for Generic Development. Pharmaceutics. 2022;14(11):2495. DOI:10.3390/pharmaceutics14112495
7. Mahler DA, Demirel S, Hollander R, et al. High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study. Chronic Obstr Pulm Dis. 2022;9(3):427-38. DOI:10.15326/jcopdf.2022.0291
8. Laube BL, Janssens HM, de Jongh FH, et al.; European Respiratory Society; International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308-31. DOI:10.1183/09031936.00166410
9. Clark AR, Hollingworth AM. The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers – implications for in vitro testing. J Aerosol Med. 1993;6(2):99-110. DOI:10.1089/jam.1993.6.99
10. Ganderton D. General factors influencing drug delivery to the lung. Respir Med. 1997;91(Suppl. A):13-6. DOI:10.1016/s0954-6111(97)90099-8
11. Sanders MJ. Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique. Pulm Med. 2017;1495867. DOI:10.1155/2017/1495867
12. Trushenko NV, Lavginova BB, Obukhova NE, et al. The role of peak inspiratory flow in the selection of inhalation therapy in patients with chronic obstructive pulmonary disease. Meditsinskiy Sovet. 2023;17(20):84-90 (in Russian). DOI:10.21518/ms2023-388
13. Ohar JA, Mahler DA, Davis GN, et al. Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow. Can Respir J. 2024;2024:8034923. DOI:10.1155/2024/8034923
14. Silva CPD, Cordeiro JSA, Britto MCA, et al. Peak inspiratory flow in children and adolescents with asthma using dry powder inhalers: a cross-sectional study. J Bras Pneumol. 2021;47(3):e20200473. DOI:10.36416/1806-3756/e20200473
15. Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142-52. DOI:10.1089/jamp.2015.1212
16. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1):2101499. DOI:10.1183/13993003.01499-2021
17. Meng W, Xiong R, Zhao Z, et al. Suboptimal peak inspiratory flow rate: a noticeable risk factor for inhaler concordance in patients with chronic airway diseases. BMJ Open Respir Res. 2024;11(1):e001981. DOI:10.1136/bmjresp-2023-001981
18. Pankovitch S, Frohlich M, AlOthman B, et al. Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study. Chest. 2024;167(3):736-45. DOI:10.1016/j.chest.2024.09.031
19. González-Montaos A, Pazos-Area L, Represas-Represas C, et al. Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors. J Aerosol Med Pulm Drug Deliv. 2024;37(5):225-31. DOI:10.1089/jamp.2024.0002
20. Trushenko NV, Lavginova BB, Chikina SY, et al. Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice. Tuberc Respir Dis (Seoul). 2025;88(3):516-25. DOI:10.4046/trd.2024.0154
21. Kuek SL, Wong NX, Dalziel S, et al. Dry-powder inhaler use in primary school-aged children with asthma: a systematic review. ERJ Open Res. 2024;10(6):455-2024. DOI:10.1183/23120541.00455-2024
22. Murugaiya S, Murugesan BSP. Prevalence and Factors Affecting the Optimal and Non-optimal Peak Inspiratory Flow Rate in Stable and Exacerbation Phases of Chronic Obstructive Pulmonary Disease and Bronchial Asthma in India. Cureus. 2024;16(4):e58670. DOI:10.7759/cureus.58670
23. Haughney J, Lee AJ, McKnight E, et al. Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma. J Allergy Clin Immunol Pract. 202;9(2):890-6. DOI:10.1016/j.jaip.2020.09.026
24. Mohd Rhazi NA, Muneswarao J, Abdul Aziz F, et al. Can patients achieve sufficient peak inspiratory flow rate (PIFR) with Turbuhaler® during acute exacerbation of asthma? J Asthma. 2023;60(8):1608-12. DOI:10.1080/02770903.2023.2169930
25. Kocks J, Wouters H, Bosnic-Anticevich S, et al. Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med. 2022;32(1):18. DOI:10.1038/s41533-022-00282-y
26. Azouz W, Chetcuti P, Hosker H, et al. Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study. BMC Pulm Med. 2015;15:47. DOI:10.1186/s12890-015-0043-x
27. Malmberg LP, Rytila P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257-62. DOI:10.2147/copd.s11474
28. Davidson HE, Radlowski P, Han L, et al. Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease. Sr Care Pharm. 2021;36:248-57. DOI:10.4140/TCP.n.2021.248
29. Sharma G, Mahler DA, Mayorga VM, et al. Prevalence of Low Peak Inspiratory Flow Rate at Discharge in Patients Hospitalized for COPD Exacerbation. Chronic Obstr Pulm Dis. 2017;4(3):217-24. DOI:10.15326/jcopdf.4.3.2017.0183
30. Ding N, Zhang W, Wang Z, et al. Prevalence and Associated Factors of Suboptimal Daily Peak Inspiratory Flow and Technique Misuse of Dry Powder Inhalers in Outpatients with Stable Chronic Airway Diseases. Int J Chron Obstruct Pulmon Dis. 2021;16:1913-24. DOI:10.2147/COPD.S311178
31. Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus® dry powder inhaler. J Aerosol Med Pulm Drug Deliv. 2013;26(3):174-9. DOI:10.1089/jamp.2012.0987
32. Harb HS, Laz NI, Rabea H, Abdelrahim MEA. Prevalence and predictors of suboptimal peak inspiratory flow rate in COPD patients. Eur J Pharm Sci. 2020;147:105298. DOI:10.1016/j.ejps.2020.105298
33. Loh CH, Peters SP, Lovings TM, Ohar JA. Suboptimal inspiratory flow rates are associated with chronic obstructive pulmonary disease and all-cause readmissions. Ann Am Thorac Soc. 2017;14(8):1305-11. DOI:10.1513/AnnalsATS.201611-903OC
34. Duarte AG, Tung L, Zhang W, et al. Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD. Chronic Obstr Pulm Dis. 2019;6(3):246-55. DOI:10.15326/jcopdf.6.3.2018.0163
35. Represas-Represas C, Aballe-Santos L, Fernández-García A, et al. Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD. J Clin Med. 2020;9(12):3949. DOI:10.3390/jcm9123949
2. Lannefors L. Inhalation therapy: practical considerations for nebulisation therapy. Physic TherRev. 2006;11:21-7. DOI:10.1179/108331906X98976
3. Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic Obstr Pulm Dis. 2019;6(3):267-80. DOI:10.15326/jcopdf.6.3.2018.0168.
4. Çakmaklı S, Özdemir A, Fırat H, Aypak C. An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease. J Taibah Univ Med Sci. 2023;18(4):860-7. DOI:10.1016/j.jtumed.2023.01.001
5. Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50(9):1209-27.
6. Mohan AR, Wang Q, Dhapare S, et al. Advancements in the Design and Development of Dry Powder Inhalers and Potential Implications for Generic Development. Pharmaceutics. 2022;14(11):2495. DOI:10.3390/pharmaceutics14112495
7. Mahler DA, Demirel S, Hollander R, et al. High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study. Chronic Obstr Pulm Dis. 2022;9(3):427-38. DOI:10.15326/jcopdf.2022.0291
8. Laube BL, Janssens HM, de Jongh FH, et al.; European Respiratory Society; International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308-31. DOI:10.1183/09031936.00166410
9. Clark AR, Hollingworth AM. The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers – implications for in vitro testing. J Aerosol Med. 1993;6(2):99-110. DOI:10.1089/jam.1993.6.99
10. Ganderton D. General factors influencing drug delivery to the lung. Respir Med. 1997;91(Suppl. A):13-6. DOI:10.1016/s0954-6111(97)90099-8
11. Sanders MJ. Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique. Pulm Med. 2017;1495867. DOI:10.1155/2017/1495867
12. Трушенко Н.В., Лавгинова Б.Б., Обухова Н.Е., и др. Роль пикового инспираторного потока в подборе ингаляционной терапии у пациентов с хронической обструктивной болезнью легких. Медицинский Совет. 2023;(20):84-90 [Trushenko NV, Lavginova BB, Obukhova NE, et al. The role of peak inspiratory flow in the selection of inhalation therapy in patients with chronic obstructive pulmonary disease. Meditsinskiy Sovet. 2023;17(20):84-90 (in Russian)]. DOI:10.21518/ms2023-388
13. Ohar JA, Mahler DA, Davis GN, et al. Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow. Can Respir J. 2024;2024:8034923. DOI:10.1155/2024/8034923
14. Silva CPD, Cordeiro JSA, Britto MCA, et al. Peak inspiratory flow in children and adolescents with asthma using dry powder inhalers: a cross-sectional study. J Bras Pneumol. 2021;47(3):e20200473. DOI:10.36416/1806-3756/e20200473
15. Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142-52. DOI:10.1089/jamp.2015.1212
16. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1):2101499. DOI:10.1183/13993003.01499-2021
17. Meng W, Xiong R, Zhao Z, et al. Suboptimal peak inspiratory flow rate: a noticeable risk factor for inhaler concordance in patients with chronic airway diseases. BMJ Open Respir Res. 2024;11(1):e001981. DOI:10.1136/bmjresp-2023-001981
18. Pankovitch S, Frohlich M, AlOthman B, et al. Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study. Chest. 2024;167(3):736-45. DOI:10.1016/j.chest.2024.09.031
19. González-Montaos A, Pazos-Area L, Represas-Represas C, et al. Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors. J Aerosol Med Pulm Drug Deliv. 2024;37(5):225-31. DOI:10.1089/jamp.2024.0002
20. Trushenko NV, Lavginova BB, Chikina SY, et al. Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice. Tuberc Respir Dis (Seoul). 2025;88(3):516-25. DOI:10.4046/trd.2024.0154
21. Kuek SL, Wong NX, Dalziel S, et al. Dry-powder inhaler use in primary school-aged children with asthma: a systematic review. ERJ Open Res. 2024;10(6):455-2024. DOI:10.1183/23120541.00455-2024
22. Murugaiya S, Murugesan BSP. Prevalence and Factors Affecting the Optimal and Non-optimal Peak Inspiratory Flow Rate in Stable and Exacerbation Phases of Chronic Obstructive Pulmonary Disease and Bronchial Asthma in India. Cureus. 2024;16(4):e58670. DOI:10.7759/cureus.58670
23. Haughney J, Lee AJ, McKnight E, et al. Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma. J Allergy Clin Immunol Pract. 202;9(2):890-6. DOI:10.1016/j.jaip.2020.09.026
24. Mohd Rhazi NA, Muneswarao J, Abdul Aziz F, et al. Can patients achieve sufficient peak inspiratory flow rate (PIFR) with Turbuhaler® during acute exacerbation of asthma? J Asthma. 2023;60(8):1608-12. DOI:10.1080/02770903.2023.2169930
25. Kocks J, Wouters H, Bosnic-Anticevich S, et al. Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med. 2022;32(1):18. DOI:10.1038/s41533-022-00282-y
26. Azouz W, Chetcuti P, Hosker H, et al. Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study. BMC Pulm Med. 2015;15:47. DOI:10.1186/s12890-015-0043-x
27. Malmberg LP, Rytila P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257-62. DOI:10.2147/copd.s11474
28. Davidson HE, Radlowski P, Han L, et al. Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease. Sr Care Pharm. 2021;36:248-57. DOI:10.4140/TCP.n.2021.248
29. Sharma G, Mahler DA, Mayorga VM, et al. Prevalence of Low Peak Inspiratory Flow Rate at Discharge in Patients Hospitalized for COPD Exacerbation. Chronic Obstr Pulm Dis. 2017;4(3):217-24. DOI:10.15326/jcopdf.4.3.2017.0183
30. Ding N, Zhang W, Wang Z, et al. Prevalence and Associated Factors of Suboptimal Daily Peak Inspiratory Flow and Technique Misuse of Dry Powder Inhalers in Outpatients with Stable Chronic Airway Diseases. Int J Chron Obstruct Pulmon Dis. 2021;16:1913-24. DOI:10.2147/COPD.S311178
31. Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus® dry powder inhaler. J Aerosol Med Pulm Drug Deliv. 2013;26(3):174-9. DOI:10.1089/jamp.2012.0987
32. Harb HS, Laz NI, Rabea H, Abdelrahim MEA. Prevalence and predictors of suboptimal peak inspiratory flow rate in COPD patients. Eur J Pharm Sci. 2020;147:105298. DOI:10.1016/j.ejps.2020.105298
33. Loh CH, Peters SP, Lovings TM, Ohar JA. Suboptimal inspiratory flow rates are associated with chronic obstructive pulmonary disease and all-cause readmissions. Ann Am Thorac Soc. 2017;14(8):1305-11. DOI:10.1513/AnnalsATS.201611-903OC
34. Duarte AG, Tung L, Zhang W, et al. Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD. Chronic Obstr Pulm Dis. 2019;6(3):246-55. DOI:10.15326/jcopdf.6.3.2018.0163
35. Represas-Represas C, Aballe-Santos L, Fernández-García A, et al. Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD. J Clin Med. 2020;9(12):3949. DOI:10.3390/jcm9123949
________________________________________________
2. Lannefors L. Inhalation therapy: practical considerations for nebulisation therapy. Physic TherRev. 2006;11:21-7. DOI:10.1179/108331906X98976
3. Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic Obstr Pulm Dis. 2019;6(3):267-80. DOI:10.15326/jcopdf.6.3.2018.0168.
4. Çakmaklı S, Özdemir A, Fırat H, Aypak C. An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease. J Taibah Univ Med Sci. 2023;18(4):860-7. DOI:10.1016/j.jtumed.2023.01.001
5. Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50(9):1209-27.
6. Mohan AR, Wang Q, Dhapare S, et al. Advancements in the Design and Development of Dry Powder Inhalers and Potential Implications for Generic Development. Pharmaceutics. 2022;14(11):2495. DOI:10.3390/pharmaceutics14112495
7. Mahler DA, Demirel S, Hollander R, et al. High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study. Chronic Obstr Pulm Dis. 2022;9(3):427-38. DOI:10.15326/jcopdf.2022.0291
8. Laube BL, Janssens HM, de Jongh FH, et al.; European Respiratory Society; International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308-31. DOI:10.1183/09031936.00166410
9. Clark AR, Hollingworth AM. The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers – implications for in vitro testing. J Aerosol Med. 1993;6(2):99-110. DOI:10.1089/jam.1993.6.99
10. Ganderton D. General factors influencing drug delivery to the lung. Respir Med. 1997;91(Suppl. A):13-6. DOI:10.1016/s0954-6111(97)90099-8
11. Sanders MJ. Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique. Pulm Med. 2017;1495867. DOI:10.1155/2017/1495867
12. Trushenko NV, Lavginova BB, Obukhova NE, et al. The role of peak inspiratory flow in the selection of inhalation therapy in patients with chronic obstructive pulmonary disease. Meditsinskiy Sovet. 2023;17(20):84-90 (in Russian). DOI:10.21518/ms2023-388
13. Ohar JA, Mahler DA, Davis GN, et al. Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow. Can Respir J. 2024;2024:8034923. DOI:10.1155/2024/8034923
14. Silva CPD, Cordeiro JSA, Britto MCA, et al. Peak inspiratory flow in children and adolescents with asthma using dry powder inhalers: a cross-sectional study. J Bras Pneumol. 2021;47(3):e20200473. DOI:10.36416/1806-3756/e20200473
15. Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142-52. DOI:10.1089/jamp.2015.1212
16. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1):2101499. DOI:10.1183/13993003.01499-2021
17. Meng W, Xiong R, Zhao Z, et al. Suboptimal peak inspiratory flow rate: a noticeable risk factor for inhaler concordance in patients with chronic airway diseases. BMJ Open Respir Res. 2024;11(1):e001981. DOI:10.1136/bmjresp-2023-001981
18. Pankovitch S, Frohlich M, AlOthman B, et al. Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study. Chest. 2024;167(3):736-45. DOI:10.1016/j.chest.2024.09.031
19. González-Montaos A, Pazos-Area L, Represas-Represas C, et al. Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors. J Aerosol Med Pulm Drug Deliv. 2024;37(5):225-31. DOI:10.1089/jamp.2024.0002
20. Trushenko NV, Lavginova BB, Chikina SY, et al. Predictors of suboptimal peak inspiratory flow in patients with acute exacerbation of chronic obstructive pulmonary disease in real clinical practice. Tuberc Respir Dis (Seoul). 2025;88(3):516-25. DOI:10.4046/trd.2024.0154
21. Kuek SL, Wong NX, Dalziel S, et al. Dry-powder inhaler use in primary school-aged children with asthma: a systematic review. ERJ Open Res. 2024;10(6):455-2024. DOI:10.1183/23120541.00455-2024
22. Murugaiya S, Murugesan BSP. Prevalence and Factors Affecting the Optimal and Non-optimal Peak Inspiratory Flow Rate in Stable and Exacerbation Phases of Chronic Obstructive Pulmonary Disease and Bronchial Asthma in India. Cureus. 2024;16(4):e58670. DOI:10.7759/cureus.58670
23. Haughney J, Lee AJ, McKnight E, et al. Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma. J Allergy Clin Immunol Pract. 202;9(2):890-6. DOI:10.1016/j.jaip.2020.09.026
24. Mohd Rhazi NA, Muneswarao J, Abdul Aziz F, et al. Can patients achieve sufficient peak inspiratory flow rate (PIFR) with Turbuhaler® during acute exacerbation of asthma? J Asthma. 2023;60(8):1608-12. DOI:10.1080/02770903.2023.2169930
25. Kocks J, Wouters H, Bosnic-Anticevich S, et al. Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med. 2022;32(1):18. DOI:10.1038/s41533-022-00282-y
26. Azouz W, Chetcuti P, Hosker H, et al. Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study. BMC Pulm Med. 2015;15:47. DOI:10.1186/s12890-015-0043-x
27. Malmberg LP, Rytila P, Happonen P, Haahtela T. Inspiratory flows through dry powder inhaler in chronic obstructive pulmonary disease: age and gender rather than severity matters. Int J Chron Obstruct Pulmon Dis. 2010;5:257-62. DOI:10.2147/copd.s11474
28. Davidson HE, Radlowski P, Han L, et al. Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease. Sr Care Pharm. 2021;36:248-57. DOI:10.4140/TCP.n.2021.248
29. Sharma G, Mahler DA, Mayorga VM, et al. Prevalence of Low Peak Inspiratory Flow Rate at Discharge in Patients Hospitalized for COPD Exacerbation. Chronic Obstr Pulm Dis. 2017;4(3):217-24. DOI:10.15326/jcopdf.4.3.2017.0183
30. Ding N, Zhang W, Wang Z, et al. Prevalence and Associated Factors of Suboptimal Daily Peak Inspiratory Flow and Technique Misuse of Dry Powder Inhalers in Outpatients with Stable Chronic Airway Diseases. Int J Chron Obstruct Pulmon Dis. 2021;16:1913-24. DOI:10.2147/COPD.S311178
31. Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus® dry powder inhaler. J Aerosol Med Pulm Drug Deliv. 2013;26(3):174-9. DOI:10.1089/jamp.2012.0987
32. Harb HS, Laz NI, Rabea H, Abdelrahim MEA. Prevalence and predictors of suboptimal peak inspiratory flow rate in COPD patients. Eur J Pharm Sci. 2020;147:105298. DOI:10.1016/j.ejps.2020.105298
33. Loh CH, Peters SP, Lovings TM, Ohar JA. Suboptimal inspiratory flow rates are associated with chronic obstructive pulmonary disease and all-cause readmissions. Ann Am Thorac Soc. 2017;14(8):1305-11. DOI:10.1513/AnnalsATS.201611-903OC
34. Duarte AG, Tung L, Zhang W, et al. Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD. Chronic Obstr Pulm Dis. 2019;6(3):246-55. DOI:10.15326/jcopdf.6.3.2018.0163
35. Represas-Represas C, Aballe-Santos L, Fernández-García A, et al. Evaluation of Suboptimal Peak Inspiratory Flow in Patients with Stable COPD. J Clin Med. 2020;9(12):3949. DOI:10.3390/jcm9123949
Авторы
Б.Б. Лавгинова1, Н.В. Трушенко*1,2, Г.В. Неклюдова1,2, О.С. Белкина1, С.Н. Авдеев1,2
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия
*trushenko.natalia@yandex.ru
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2Research Institute of Pulmonology, Moscow, Russia
*trushenko.natalia@yandex.ru
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия
*trushenko.natalia@yandex.ru
________________________________________________
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2Research Institute of Pulmonology, Moscow, Russia
*trushenko.natalia@yandex.ru
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