University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository




Dr. Elyse Watkins


Clinical Question: Determine if a suboptimal peak inspiratory flow rate (PIFR) /min will increase the likelihood of 30-day readmission among patients discharged for exacerbation of chronic obstructive pulmonary disease (COPD).

Objective: The purpose of this scoping review is to identify and map the available evidence regarding PIFR after hospitalization from an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). By this review, insights for conducting new research specific to PIFR in COPD readmissions will emerge.

Method: A comprehensive literature search of major medical databases was performed for using the following search terms: chronic obstructive pulmonary disease, COPD, exacerbation, peak inspiratory flow rate, PIFR, readmission, and discharge planning. References of identified articles were also reviewed. Peer-reviewed published studies investigating suboptimal peak inspiratory flow following hospitalization for COPD exacerbations were included. A total of two studies met inclusion criteria and are included in this review.

Results: There is limited research on this topic. A retrospective analysis identified PIFR of < 60 L/min as the only independent predictor of COPD readmission for exacerbation.1 However, this study is limited by its dataset, which comes from a single hospital system. A separate study with different parameters that prospectively evaluated COPD readmissions did not identify a difference in readmission rates between patients with suboptimal peak inspiratory flow and optimal peak inspiratory flow.2 Further study is needed to understand the relationship between suboptimal PIF and clinical outcomes.

Conclusion: There is considerable interest in identifying predictors of 30-day readmissions due to the significant financial incentives at stake. Suboptimal PIF is common following an acute exacerbation, but there is insufficient evidence to support measuring PIFR against resistance in patients with COPD at discharge. Additional studies are needed to determine the impact of suboptimal PIFR on outcomes following AECOPD hospitalization.

KEYWORDS: chronic obstructive pulmonary disease; exacerbation; peak inspiratory flow rate; readmission; inhaler


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