Association between peak inspiratory flow rate and hand grip muscle strength in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease

• Type of Material: Article
• Authors: Arash Samarghandi, Emory University; Octavian Ioachimescu, Emory University; Rehan Qayyum, Virginia Commonwealth University
• Language: English
• Date: 2020-01-31
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Samarghandi et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0227737
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 15
• Issue: 1
• Start Page: e0227737
• End Page: e0227737
• Grant/Funding Information: This article published with support from Emory Libraries' Open Access Publishing Fund.; Research grant from VCU Johnson Center (VJC) for Critical Care and Pulmonary Research- non for profit source of funding provided by the department of pulmonary and critical care at VCU
• Keywords: RESISTANCE; PREVALENCE; DYSFUNCTION; ENDURANCE; Multidisciplinary Sciences; DEVICES; INHALER; COPD; Science & Technology; DELIVERY; DRY POWDER; Science & Technology - Other Topics; DISKUS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Rationale Ineffective peak inspiratory flow rate (PIFR) generation in patients using inhalers results in insufficient drug delivery to the lungs and poor clinical outcomes. Low inspiratory muscle strength is associated with suboptimal PIFR. Objective To examine in a prospective study the relationship between PIFR and skeletal muscle strength using hand grip strength (HGS) as a surrogate. Methods Adult patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled. PIFR was measured within 48 hours before discharge. PIFR below 60L/min was considered suboptimal. HGS was measured using a handheld dynamometer. Any readmissions and emergency department visit data were collected. The associations between PIFR, HGS, 30 and 90-day COPD and all-cause readmissions were examined, without and with adjustment for age, race and gender. Results Of the 75 enrolled patients, 56% had suboptimal PIFR; they were older (63.9±9.7 vs. 58.2 ±7.7 years) and had significantly lower HGS (24.2±11.1 vs. 30.9±10.9 Kg) compared to those with optimal PIFR. There were no significant differences between the two PIFR groups by gender, race, history of coronary artery disease, congestive heart failure, hypertension or functional scores. Each kilogram increase in HGS was associated with 0.50 (95% CI 0.18–0.89, p = 0.003) L/min increase in PIFR. We did not observe an association between PIFR and 30 or 90-day readmission rates. Conclusion We found a significant association between HGS and PIFR in hospitalized patients with acute exacerbations of COPD. Whether interventions aimed at increasing skeletal muscle strength also result in improvement in PIFR remains unclear and need further study.