Abstract：
BACKGROUND: COPD primarily impairs expiratory flow due to progressive airflow obstruction and reduced lung elasticity. Increasing evidence underlines the importance of inspiratory flow as a biomarker for selecting inhaler devices and providing ancillary aerodynamic information.
OBJECTIVE: Does the longitudinal changes in maximum forced inspiratory flow (FIFmax) influence acute exacerbations and lung function decline in patients with COPD?
METHODS: This longitudinal study evaluated FIFmax in patients with COPD over a 7-year period from 2004 to 2020. Eligible patients were categorized into 2 groups based on FIFmax trajectory: the increased FIFmax group and the decreased FIFmax group. The study assessed the annual rate of acute exacerbations and the annual decline rate of FEV1. Subgroup analyses were conducted based on treatment status, with a focus on inhaled therapy and inhaler device usage.
RESULTS: Among the eligible 956 patients with COPD, 56.5% belonged to the increased FIFmax group. After propensity score matching, the increased FIFmax group experienced lower rates of severe exacerbations (0.16 per year vs 0.25 per year, P = .017) and a slower decline in FEV1 (0 [interquartile range, -51 to 71] mL/y vs -43 [interquartile range, -119 to 6] mL/y; P < .001) compared with the decreased FIFmax group. These associations were particularly prominent in patients using specific inhaler therapies such as dry powder inhalers.
CONCLUSIONS: This study showed that the longitudinal changes in FIFmax are associated with clinical outcomes in patients with COPD. Patients with increased FIFmax experienced a lower rate of severe exacerbations and a slower decline in lung function. These findings suggest the potential benefits of optimizing inspiratory flow in COPD management, although further studies are needed to confirm these observations due to potential confounding factors.
OBJECTIVE: Does the longitudinal changes in maximum forced inspiratory flow (FIFmax) influence acute exacerbations and lung function decline in patients with COPD?
METHODS: This longitudinal study evaluated FIFmax in patients with COPD over a 7-year period from 2004 to 2020. Eligible patients were categorized into 2 groups based on FIFmax trajectory: the increased FIFmax group and the decreased FIFmax group. The study assessed the annual rate of acute exacerbations and the annual decline rate of FEV1. Subgroup analyses were conducted based on treatment status, with a focus on inhaled therapy and inhaler device usage.
RESULTS: Among the eligible 956 patients with COPD, 56.5% belonged to the increased FIFmax group. After propensity score matching, the increased FIFmax group experienced lower rates of severe exacerbations (0.16 per year vs 0.25 per year, P = .017) and a slower decline in FEV1 (0 [interquartile range, -51 to 71] mL/y vs -43 [interquartile range, -119 to 6] mL/y; P < .001) compared with the decreased FIFmax group. These associations were particularly prominent in patients using specific inhaler therapies such as dry powder inhalers.
CONCLUSIONS: This study showed that the longitudinal changes in FIFmax are associated with clinical outcomes in patients with COPD. Patients with increased FIFmax experienced a lower rate of severe exacerbations and a slower decline in lung function. These findings suggest the potential benefits of optimizing inspiratory flow in COPD management, although further studies are needed to confirm these observations due to potential confounding factors.
摘要：
背景：慢性阻塞性肺疾病（COPD）主要由于进行性气流阻塞和肺弹性降低而损害呼气流量。越来越多的证据强调了吸气流量作为选择吸入器设备和提供辅助空气动力学信息的生物标志物的重要性。
目的：最大强制吸气流量（FIFmax）的纵向变化是否影响COPD患者的急性加重和肺功能下降？
方法：这项纵向研究观察了2004年至2020年7年间COPD患者的FIFmax。根据FIFmax轨迹将符合条件的患者分为两组：FIFmax增加组和FIFmax减少组。我们的研究评估了急性加重的年发生率和1秒用力呼气量的年下降率（FEV1）。根据治疗状态进行亚组分析，专注于吸入治疗和吸入器装置的使用。
结果：在符合条件的956例COPD患者中，56.5%属于增加的FIFmax组。在倾向得分匹配后，FIFmax增加组严重加重率较低(0.16/yrvs.0.25/yr,P值=0.017)和FEV1下降较慢(0[四分位数间距(IQR)，-51-71]vs.-43[IQR，-119-6]毫升/年，P值<0.001）与降低的FIFmax组相比。这些关联在使用特定吸入器疗法的患者中尤为突出。如DPI疗法。
结论：我们的研究表明，FIFmax的纵向变化与COPD患者的临床结局相关。FIFmax增加的患者经历了较低的严重恶化率和肺功能的较慢下降。这些研究结果表明，在COPD管理中优化吸气流量的潜在益处，尽管由于潜在的混杂因素，需要进一步的研究来证实这些观察结果。
目的：最大强制吸气流量（FIFmax）的纵向变化是否影响COPD患者的急性加重和肺功能下降？
方法：这项纵向研究观察了2004年至2020年7年间COPD患者的FIFmax。根据FIFmax轨迹将符合条件的患者分为两组：FIFmax增加组和FIFmax减少组。我们的研究评估了急性加重的年发生率和1秒用力呼气量的年下降率（FEV1）。根据治疗状态进行亚组分析，专注于吸入治疗和吸入器装置的使用。
结果：在符合条件的956例COPD患者中，56.5%属于增加的FIFmax组。在倾向得分匹配后，FIFmax增加组严重加重率较低(0.16/yrvs.0.25/yr,P值=0.017)和FEV1下降较慢(0[四分位数间距(IQR)，-51-71]vs.-43[IQR，-119-6]毫升/年，P值<0.001）与降低的FIFmax组相比。这些关联在使用特定吸入器疗法的患者中尤为突出。如DPI疗法。
结论：我们的研究表明，FIFmax的纵向变化与COPD患者的临床结局相关。FIFmax增加的患者经历了较低的严重恶化率和肺功能的较慢下降。这些研究结果表明，在COPD管理中优化吸气流量的潜在益处，尽管由于潜在的混杂因素，需要进一步的研究来证实这些观察结果。
