Measuring Peak Inspiratory Flow in Patients with Chronic Obstructive Pulmonary Disease

Jill A. Ohar, Gary T. Ferguson, Donald A. Mahler, M. Bradley Drummond, Rajiv Dhand, Roy A. Pleasants, Antonio Anzueto, David Mg Halpin, David B. Price, Gail S. Drescher, Haley M. Hoy, John Haughney, Michael W. Hess, Omar S. Usmani

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Dry powder inhalers (DPIs) are breath actuated, and patients using DPIs need to generate an optimal inspiratory flow during the inhalation maneuver for effective drug delivery to the lungs. However, practical and standardized recommendations for measuring peak inspiratory flow (PIF)—a potential indicator for effective DPI use in chronic obstructive pulmonary disease (COPD)—are lacking. To evaluate recommended PIF assessment approaches, we reviewed the Instructions for Use of the In-Check™ DIAL and the prescribing information for eight DPIs approved for use in the treatment of COPD in the United States. To evaluate applied PIF assessment approaches, we conducted a PubMed search from inception to August 31, 2021, for reports of clinical and real-life studies where PIF was measured using the In-Check™ DIAL or through a DPI in patients with COPD. Evaluation of collective sources, including 47 applicable studies, showed that instructions related to the positioning of the patient with their DPI, instructions for exhalation before the inhalation maneuver, the inhalation maneuver itself, and post-inhalation breath-hold times varied, and in many instances, appeared vague and/or incomplete. We observed considerable variation in how PIF was measured in clinical and real-life studies, underscoring the need for a standardized method of PIF measurement. Standardization of technique will facilitate comparisons among studies. Based on these findings and our clinical and research experience, we propose specific recommendations for PIF measurement to standardize the process and better ensure accurate and reliable PIF values in clinical trials and in daily clinical practice.

Original languageEnglish (US)
Pages (from-to)79-92
Number of pages14
JournalInternational Journal of COPD
StatePublished - 2022


  • Chronic obstructive pulmonary disease
  • Dry powder inhalers
  • Peak inspiratory flow

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Pulmonary and Respiratory Medicine


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