Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs.

Kirsten Schuttel, Janwillem H Kocks, Omar S Usmani, David B Price, Elisabeth Sophia Hartgers-Gubbels, Richard Dekhuijzen, Sinthia Z Bosnic-Anticevich, Job F M van Boven, Federico Lavorini, Marina Garcia Pardo, Jaime Correia de Sousa, Ioanna Tsiligianni, Nilouq Stoker, Marika T Leving, Miguel Roman-Rodriguez, Boyd Metz, Jiska Meijer, Tiago Maricoto, Ymke Janse, Iris van der Ham, Radosław Gawlik, Asparuh Gardev, Lars Dijk, Biljana Cvetkovski, Joyce van Cooten

Journal: International journal of chronic obstructive pulmonary disease 2022;17():2401-2415

PMID: 36185173

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Abstract

PURPOSE

To assess the relationship between suboptimal Peak Inspiratory Flow (sPIF), inhalation technique errors, and non-adherence, with Healthcare Resource Utilisation (HCRU) in Chronic Obstructive Pulmonary Disease (COPD) patients receiving maintenance therapy via a Dry Powder Inhaler (DPI).

PATIENTS AND METHODS

The cross-sectional, multi-country PIFotal study included 1434 COPD patients (≥40 years) using a DPI for maintenance therapy. PIF was measured with the In-Check DIAL G16, and sPIF was defined as a typical PIF lower than required for the device. Inhalation technique was assessed by standardised evaluation of video recordings and grouped into 10 steps. Patients completed the "Test of Adherence to Inhalers" questionnaire. HCRU was operationalised as COPD-related costs for primary healthcare, secondary healthcare, medication, and total COPD-related costs in a 1-year period.

RESULTS

Participants with sPIF had higher medication costs compared with those with optimal PIF (cost ratio [CR]: 1.07, 95% CI [1.01, 1.14]). Multiple inhalation technique errors were associated with increased HCRU. Specifically, "insufficient inspiratory effort" with higher secondary healthcare costs (CR: 2.20, 95% CI [1.37, 3.54]) and higher total COPD-related costs (CR: 1.16, 95% CI 1.03-1.31). "no breath-hold following the inhalation manoeuvre (<6 s)" with higher medication costs (CR: 1.08, 95% CI [1.02, 1.15]) and total COPD-related costs (CR 1.17, 95% CI [1.07, 1.28]), and "not breathing out calmly after inhalation" with higher medication costs (CR: 1.19, 95% CI [1.04, 1.37]). Non-adherence was not significantly associated with HCRU.

CONCLUSION

sPIF and inhalation technique errors were associated with higher COPD-related healthcare utilisation and costs in COPD patients on DPI maintenance therapy.

Address: General Practitioners Research Institute, Groningen, the Netherlands.; University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands.; University Medical Centre Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, the Netherlands.; Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, the Netherlands.; Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.; Sydney Local Health District, Sydney, Australia.; Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal.; Radboud University Medical Centre, Nijmegen, Netherlands.; Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma de Mallorca, Spain.; Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.; Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland.; Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.; Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.; Observational and Pragmatic Research Institute, Singapore.; Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece.; Airway Disease, National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK.; Department of Pulmonology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.

DOI: 10.2147/COPD.S380736

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MeSH Terms: Administration, Inhalation, Cross-Sectional Studies, Dry Powder Inhalers, Health Care Costs, Humans, Pulmonary Disease, Chronic Obstructive