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

PLoS One. 2020 Jan 31;15(1):e0227737. doi: 10.1371/journal.pone.0227737. eCollection 2020.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Aged
  • Bronchodilator Agents / administration & dosage*
  • Dry Powder Inhalers
  • Female
  • Hand Strength / physiology*
  • Humans
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Muscle Strength Dynamometer
  • Oligopeptides
  • Patient Readmission / statistics & numerical data
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Ventilation / physiology*
  • Spirometry
  • Symptom Flare Up

Substances

  • Bronchodilator Agents
  • Oligopeptides
  • tyrosyl-glutamyl-tyrosyl-glutamic acid

Grants and funding

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