Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD

Z Gerontol Geriatr. 2011 Aug;44(4):245-9. doi: 10.1007/s00391-011-0222-1.


Background: More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed.

Methods: In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer.

Results: A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively.

Conclusion: A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.

MeSH terms

  • Activities of Daily Living / classification
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Bronchodilator Agents / administration & dosage*
  • Comorbidity
  • Dry Powder Inhalers*
  • Female
  • Geriatric Assessment
  • Hand Strength*
  • Humans
  • Inspiratory Capacity
  • Male
  • Mental Status Schedule
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • ROC Curve
  • Treatment Outcome


  • Bronchodilator Agents