吸气峰流速测定在慢性气道疾病中应用研究进展

doi:10.19983/j.issn.2096-8493.20230088

摘要/Abstract

摘要：

包括慢性阻塞性肺疾病(简称“慢阻肺”)、哮喘在内的慢性气道疾病,由于其逐年增加的患病率和病亡率,在严重威胁人类健康的同时,也给全球公共卫生健康系统带来了极大的负担。目前,吸入疗法是慢性气道疾病治疗的有效手段,且正确选择和正确使用吸入装置是慢性气道疾病管理中不可或缺的组成部分,而如何为患者选择合适的吸入装置一直是困扰临床医生的问题。吸气峰流速测定目前已被我国慢阻肺诊治指南推荐为个体化选择吸入装置过程中的重要环节。笔者总结了吸气峰流速测定在慢性气道疾病中的研究进展,并探讨了其在慢性气道疾病治疗过程中的指导意义。

关键词: 气管疾病, 肺疾病, 慢性阻塞性, 哮喘, 吸气峰流速

Abstract:

Chronic airway diseases, including chronic obstructive pulmonary disease (COPD) and asthma, pose a great burden to the global public health system due to their increasing morbidity and mortality. Inhaled therapy is an effective means for the treatment of chronic airway diseases, and the correct selection and use of inhalation devices is an indispensable part of the management of chronic airway diseases. However, how to choose suitable inhalation devices for patients has always been a problem for clinicians. Peak inspiratory flow rate (PIFR) has been recommended as an important step in the process of individualized inhalation device selection by Chinese Guidelines for the diagnosis and management of chronic obstructive pulmonary disease. Therefore, this review will summarize the current research progress of PIFR measurement in chronic airway diseases, and discuss its guiding significance in the treatment of chronic airway diseases.

Key words: Tracheal diseases, Pulmonary disease, chronic obstructive, Asthma, Peak inspiratory flow rate

中图分类号:

R563

孟玮玮, 曾慧卉, 陈燕. 吸气峰流速测定在慢性气道疾病中应用研究进展[J]. 结核与肺部疾病杂志, 2023, 4(5): 391-396. doi: 10.19983/j.issn.2096-8493.20230088

Meng Weiwei, Zeng Huihui, Chen Yan. Research progress in the application of peak inspiratory flow rate measurement in chronic airway diseases[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(5): 391-396. doi: 10.19983/j.issn.2096-8493.20230088

参考文献 51

[1]	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990—2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158. doi:10.1016/S0140-6736(19)30427-1.
[2]	Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717. doi:10.1016/S0140-6736(18)30841-9. pmid: 29650248
[3]	Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418. doi:10.1016/S0140-6736(19)31147-X. pmid: 31230828
[4]	Lareau SC, Fahy B, Meek P, et al. Chronic Obstructive Pulmonary Disease (COPD). Am J Respir Crit Care Med, 2019, 199(1): P1-P2. doi:10.1164/rccm.1991P1.
[5]	King-Biggs MB. Asthma. Ann Intern Med, 2019, 171(7): ITC49-ITC64. doi:10.7326/AITC201910010.
[6]	中国医学装备协会呼吸病学专委会吸入治疗与呼吸康复学组, 中国慢性阻塞性肺疾病联盟. 稳定期慢性气道疾病吸入装置规范应用中国专家共识. 中华结核和呼吸杂志, 2019, 42(4): 241-253. doi:10.3760/cma.j.issn.1001-0939.2019.04.001.
[7]	Rogliani P, Calzetta L, Coppola A, et al. Optimizing drug delivery in COPD: The role of inhaler devices. Respir Med, 2017, 124: 6-14. doi:10.1016/j.rmed.2017.01.006. pmid: 28284323
[8]	Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag, 2019, 15: 461-472. doi:10.2147/TCRM.S160365.
[9]	Harb HS, Ibrahim Laz N, Rabea H, et al. Real-life assessment of chronic obstructive pulmonary disease patient perfor-mance with different inhalers. Int J Clin Pract, 2021, 75(4): e13905. doi:10.1111/ijcp.13905.
[10]	Sanchis J, Gich I, Pedersen S. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest, 2016, 150(2): 394-406. doi:10.1016/j.chest.2016.03.041. pmid: 27060726
[11]	Chen SY, Huang CK, Peng HC, et al. Inappropriate Peak Inspiratory Flow Rate with Dry Powder Inhaler in Chronic Obstructive Pulmonary Disease. Sci Rep, 2020, 10(1): 7271. doi:10.1038/s41598-020-64235-6.
[12]	Bosnic-Anticevich SZ, Cvetkovski B, Azzi EA, et al. Identi-fying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management. Pulm Ther, 2018, 4(1): 1-12. doi:10.1007/s41030-018-0051-0. pmid: 32026244
[13]	Kawamatawong T, Khiawwan S, Pornsuriyasak P. Peak inspiratory flow rate measurement by using In-Check DIAL for the different inhaler devices in elderly with obstructive airway diseases. J Asthma Allergy, 2017, 10: 17-21. doi:10.2147/JAA.S127580. pmid: 28260934
[14]	Mahler DA. Peak Inspiratory Flow Rate: An Emerging Biomarker in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2019, 199(12): 1577-1579. doi:10.1164/rccm.201901-0005LE.
[15]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205. doi:10.3760/cma.j.cn112147-20210109-00031.
[16]	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): 246-255. doi:10.15326/jcopdf.6.3.2018.0163. pmid: 31189057
[17]	Sanders MJ. Guiding Inspiratory Flow: Development of the In-Check DIAL G16, a Tool for Improving Inhaler Technique. Pulm Med, 2017, 2017: 1495867. doi:10.1155/2017/1495867.
[18]	Broeders ME, Molema J, Vermue NA, et al. In Check Dial: accuracy for Diskus and Turbuhaler. Int J Pharm, 2003, 252(1-2): 275-280. doi:10.1016/s0378-5173(02)00650-6.
[19]	Ghosh S, Pleasants RA, Ohar JA, et al. Prevalence and factors associated with suboptimal peak inspiratory flow rates in COPD. Int J Chron Obstruct Pulmon Dis, 2019, 14: 585-595. doi:10.2147/COPD.S195438.
[20]	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): 174-179. doi:10.1089/jamp.2012.0987.
[21]	上海市医学会呼吸病学专科分会呼吸治疗与肺功能学组. 患者药物吸入能力评估上海专家共识. 上海医学, 2023, 46(1): 1-7. doi:10.19842/j.cnki.issn.0253-9934.2023.01.001.
[22]	Mahler DA, Halpin DMG. Peak Inspiratory Flow as a Predictive Therapeutic Biomarker in COPD. Chest, 2021, 160(2): 491-498. doi:10.1016/j.chest.2021.03.049. pmid: 33812852
[23]	Usmani OS, Biddiscombe MF, Barnes PJ. Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size. Am J Respir Crit Care Med, 2005, 172(12): 1497-1504. doi:10.1164/rccm.200410-1414OC.
[24]	Harb HS, Ibrahim Laz N, Rabea H, et al. Determinants of incorrect inhaler technique in chronic obstructive pulmonary disease patients. Int J Clin Pract, 2021, 75(6): e14073. doi:10.1111/ijcp.14073.
[25]	Hira D, Koide H, Nakamura S, et al. Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices. PLoS One, 2018, 13(2): e0193082. doi:10.1371/journal.pone.0193082.
[26]	Mahler DA. Peak Inspiratory Flow Rate as a Criterion for Dry Powder Inhaler Use in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc, 2017, 14(7): 1103-1107. doi:10.1513/AnnalsATS.201702-156PS. pmid: 28481631
[27]	何桦, 郑劲平, 赵子文, 等. 不同阻力状态下吸气峰流速分析. 国际呼吸杂志, 2009, 29(3): 146-149. doi:10.3760/cma.j.issn.1673-436x.2009.03.005.
[28]	Mahler DA. The role of inspiratory flow in selection and use of inhaled therapy for patients with chronic obstructive pulmonary disease. Respir Med, 2020, 161: 105857. doi:10.1016/j.rmed.2019.105857.
[29]	Al-Showair RA, Tarsin WY, Assi KH, et al. Can all patients with COPD use the correct inhalation flow with all inhalers and does training help? Respir Med, 2007, 101(11): 2395-2401. doi:10.1016/j.rmed.2007.06.008.
[30]	Hua JL, Ye XF, Du CL, et al. Optimizing inhalation therapy in the aspect of peak inhalation flow rate in patients with chronic obstructive pulmonary disease or asthma. BMC Pulm Med, 2021, 21(1): 302. doi:10.1186/s12890-021-01674-5.
[31]	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, 2021, 9(2): 890-896. doi:10.1016/j.jaip.2020.09.026. pmid: 33011302
[32]	van der Palen J. Peak inspiratory flow through diskus and turbuhaler, measured by means of a peak inspiratory flow meter (In-Check DIAL). Respir Med, 2003, 97(3): 285-289. doi:10.1053/rmed.2003.1289.
[33]	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): 217-224. doi:10.15326/jcopdf.4.3.2017.0183. pmid: 28848933
[34]	Harb HS, Laz NI, Rabea H, et al. 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.
[35]	Broeders ME, Molema J, Hop WC, et al. The course of inhalation profiles during an exacerbation of obstructive lung disease. Respir Med, 2004, 98(12): 1173-1179. doi:10.1016/j.rmed.2004.04.010.
[36]	Malmberg LP, Rytilä P, Happonen P, et al. 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: 257-262. doi:10.2147/copd.s11474.
[37]	Janssens W, VandenBrande P, Hardeman E, et al. Inspiratory flow rates at different levels of resistance in elderly COPD patients. Eur Respir J, 2008, 31(1): 78-83. doi:10.1183/09031936.00024807. pmid: 17898020
[38]	Chen HI, Kuo CS. Relationship between respiratory muscle function and age, sex, and other factors. J Appl Physiol (1985), 1989, 66(2): 943-948. doi:10.1152/jappl.1989.66.2.943.
[39]	Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet, 2019, 394(10206): 1376-1386. doi:10.1016/S0140-6736(19)31785-4. pmid: 31609229
[40]	Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet, 2019, 394(10206): 1365-1375. doi:10.1016/S0140-6736(19)31786-6. pmid: 31609228
[41]	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.
[42]	Cooper A, Parker J, Berry M, et al. Wixela Inhub: Dosing Performance In Vitro and Inhaled Flow Rates in Healthy Subjects and Patients Compared with Advair Diskus. J Aerosol Med Pulm Drug Deliv, 2020, 33(6): 323-341. doi:10.1089/jamp.2019.1584.
[43]	De Backer W, De Backer J, Vos W, et al. A randomized study using functional respiratory imaging to characterize bronchodilator effects of glycopyrrolate/formoterol fumarate delivered by a metered dose inhaler using co-suspension delivery technology in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2018, 13: 2673-2684. doi:10.2147/COPD.S171707.
[44]	Mahler DA, Waterman LA, Ward J, et al. Comparison of dry powder versus nebulized beta-agonist in patients with COPD who have suboptimal peak inspiratory flow rate. J Aerosol Med Pulm Drug Deliv, 2014, 27(2): 103-109. doi:10.1089/jamp.2013.1038.
[45]	Loh CH, Peters SP, Lovings TM, et al. Suboptimal Inspiratory Flow Rates Are Associated with Chronic Obstructive Pulmonary Disease and All-Cause Readmissions. Ann Am Thorac Soc, 2017, 14(8): 1305-1311. doi:10.1513/AnnalsATS.201611-903OC. pmid: 28406710
[46]	Mahler DA, Niu X, Deering KL, et al. Prospective Evaluation of Exacerbations Associated with Suboptimal Peak Inspiratory Flow Among Stable Outpatients with COPD. Int J Chron Obstruct Pulmon Dis, 2022, 17: 559-568. doi:10.2147/COPD.S353441.
[47]	Chen SY, Huang CK, Peng HC, et al. Peak-Inspiratory-Flow-Rate Guided Inhalation Therapy Reduce Severe Exacerbation of COPD. Front Pharmacol, 2021, 12: 704316. doi:10.3389/fphar.2021.704316.
[48]	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.
[49]	Brown PH, Ning AC, Greening AP, et al. Peak inspiratory flow through Turbuhaler in acute asthma. Eur Respir J, 1995, 8(11): 1940-1941. doi:10.1183/09031936.95.08111940. pmid: 8620966
[50]	Ghosh S, Ohar JA, Drummond MB. Peak Inspiratory Flow Rate in Chronic Obstructive Pulmonary Disease: Implications for Dry Powder Inhalers. J Aerosol Med Pulm Drug Deliv, 2017, 30(6): 381-387. doi:10.1089/jamp.2017.1416.
[51]	Gagnon P, Guenette JA, Langer D, et al. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2014, 9: 187-201. doi:10.2147/COPD.S38934.